Why “Government, Politics, and Law”?

NEVER HAS IT BEEN MORE important for the public health community to understand the workings of government, politics, and law and—at the same time—for those who practice these often misunderstood disciplines to value public health. That is why the Journal has instituted the department “Government, Politics, and Law.”

The anthrax attacks in fall 2001 and the myriad hoaxes that followed have increased the awareness of the general public regarding health agencies and their officials to a level unsurpassed in 50 years. In January 2002, the Department of Health and Human Services began distributing $1.2 billion in planning grants for the current fiscal year for bioterrorism preparedness and improved public health infrastructure, with the prospect of more money in future years. At the same time, state and local officials are examining authorities, policies, and procedures for responding to public health emergencies that have the potential to become catastrophes. With renewed attention and money come increased expectations and—unavoidably—increased scrutiny.

Some readers of the Journal may wonder why we elected to devote already restricted space to government, politics, and law. I have known plenty of people in public health who want little to do with lawyers and even less to do with politicians, and who define bureaucrats as all government employees except themselves. Yet government, politics, and law are central to the practice of public health. It is impossible to consider the “public” portion of public health without involving government at some level—be it local, state, regional, or federal—and usually several levels at once.

Similarly, because politics may be usefully defined as “the way people decide who gets what, when, where, how, and why—without resorting to violence,”1 public health professionals must either know how to communicate in a way that is understood by decisionmakers or fail in their aim to protect the public’s health. Daniel Fox recently championed law and regulation as the delivery system by which science gets a chance to improve health, yet bemoaned their status as the neglected tools of public health practice.2 Without competent politics, moreover, there is no responsive law and hence no effective government.

I am not a lawyer, a politician, or an academic. Instead, I approach this department with the practical experience I’ve gained from 19 years in state government. I envision “Government, Politics, and Law” as a forum in which many voices—both new and familiar to readers of the Journal—will sound off on essential public health topics, with arguments grounded in critical analysis.

The response of public health to the threat of bioterrorism is a timely topic for this department. Articles are planned on the politics of the debate surrounding the expansion of emergency health powers, and ways in which the new federal grant dollars affect state allocation for spending on population health. Authors are encouraged to submit papers on this and other vital topics. The ultimate goal of “Government, Politics, and Law” is to engender greater communication and understanding between those who practice and study public health and those in and out of government who enact, interpret, and implement the laws and policies that govern it.

The following article by Wilfredo Lopez, general counsel to the New York City Department of Health, on the 1999–2001 outbreaks of West Nile virus in New York City moves us toward this ultimate goal. Lopez and his colleagues confronted challenges that other public health agencies might face in responding to public health emergencies, including how to coordinate government agencies that previously had limited contact and how to deal with direct and indirect opposition to instituted policies through both legal and political action. In the face of immense uncertainty, New York City health officials had to balance the risks and benefits of multiple alternatives. Equally important, they had also to successfully communicate these strategies to a concerned public. Dealing with complexity amidst uncertainty are certainly universal themes for our times, and worthy of an engaged public health discourse.