Public Health Policy Is Political

In his article,¹ Goldberg provides a very cohesive critique of why concern over politicization of public health policy as a justification for preferring a narrow to a broad model of public health is a nebulous argument.

To achieve its mission of assurance, public health is obligated to engage broadly with the spectrum of factors that impact health outcomes, most importantly the social and environmental determinants. Avoiding the political implications of these factors has never been possible. Even the “basic 6” services defined under the narrow model of public health² have never been free of politics. Several recent and ongoing controversies illustrate this point. Firstly, recent H5N1 research,^3,4 with clear implications for controlling communicable disease and epidemic preparedness, became controversial largely as a result of US national security concerns, a political matter. Secondly, the ongoing challenges regarding abortion rights in multiple state legislatures and the recent debate regarding coverage of contraception in the Affordable Care Act, both of which clearly fall within the purview of maternal health, remain a political quagmire. Lastly, sexual education, an important health education issue, has always been highly political. Thus, even issues within the “basic 6” have always been of a political nature. As a result, the “narrow model” not only fails to carry any less risk of politicization, it also fails to address some of the most critical public health issues.

The idea that any model of public health can avoid politics and political concerns, as Goldberg points out, is unfounded. In our view, the conversation needs to be about how the policymaking process can be more inclusive of the growing body of evidence showing the intimate relationship among population health and social and environmental factors and inequities. The challenge for public health professionals is to ensure that these discussions, however political, are informed with the best available science. In addition, we must develop the capacity of public health professionals to navigate the political landscape and advocate for the public’s health. Finally, we must engage across sectors and silos to ensure that assessments of the impact of policies on population health and health equity are integral components of all policy decisions. Then, and only then, will we truly be able to advance the nation’s health.