Why Public Health Is Political, and Always Has Been

Public health is often seen as a field dedicated solely to the well-being of populations, where the goal is to improve the health of individuals and communities without political bias or interference. However, the reality is far more complex. Public health is inextricably linked to politics, both in how policies are crafted and how they are implemented. From the allocation of resources to the framing of health crises, political forces shape the direction of public health initiatives, often determining who benefits and who does not. The intersection of public health and politics has existed for as long as organized health systems, and it continues to be a critical factor in the way we address health issues today. At its core, public health is about managing the collective health of a community. This often involves large-scale initiatives, such as vaccination programs, disease prevention campaigns, or public health laws that mandate actions like seatbelt use or smoking cessation. The decisions surrounding these initiatives are never purely scientific. They are influenced by a range of factors, from political ideologies to economic priorities, which complicate how health decisions are made.

One of the clearest examples of public health being inherently political is the way health policies are designed and enacted. Take, for example, the debate over healthcare access. The policy decisions around healthcare, whether it’s expanding access to insurance or determining which services will be funded, are directly shaped by political ideologies. In many countries, including the United States, health policies have been deeply tied to political party lines, with different political groups having different views on how to address health disparities, the role of government in healthcare, and the level of funding for public health programs. These political divisions often lead to vastly different outcomes for citizens, depending on their political leadership.

Health crises, too, are often political in nature. Consider the response to the COVID-19 pandemic. The global health emergency was met with varying political responses, from mask mandates and lockdowns to vaccine distribution strategies. Political leaders determined the prioritization of these actions, and their decisions, shaped by public opinion, economic considerations, and party agendas, affected how well the crisis was managed and how communities were protected. The pandemic illustrated how political affiliations could significantly influence public health responses, with some leaders pushing for swift action while others downplayed the severity or delayed implementing crucial measures.

https://www.phoenix.edu/blog/public-health-vs-community-health.html

Politics also play a significant role in the perpetuation of health inequities. Social determinants of health, such as access to clean water, nutritious food, safe housing, and quality healthcare, are often a direct result of political decisions. Communities that are politically marginalized, whether due to socioeconomic status, race, or geography, often face worse health outcomes because of a lack of access to these resources. Historically, marginalized communities have been left out of the policy-making process, or their needs have been deprioritized, leading to cycles of inequality that are difficult to break. For instance, consider the long-standing health disparities in the United States, where people of color, especially Black and Indigenous communities, have faced higher rates of chronic diseases, lower life expectancies, and worse health outcomes overall. These disparities are not random; they are a consequence of decades, if not centuries, of political decisions that have left these communities without access to the resources they need to thrive. The political structures that allowed segregation, redlining, and the denial of voting rights created an environment where these communities faced disproportionate health challenges. While these issues are now being addressed to some extent, they remain deeply entrenched, often requiring political solutions to dismantle.

Public health advocates play a critical role in pushing for the political changes needed to improve health outcomes. In many instances, public health professionals and organizations find themselves in a political struggle, advocating for policies that may be unpopular or opposed by powerful interest groups. For example, tobacco control efforts in the 20th century were met with fierce opposition from the tobacco industry, which used its political influence to delay or block policies aimed at reducing smoking rates. Similarly, campaigns for universal healthcare or for policies addressing environmental health hazards often encounter significant political resistance from groups with vested interests in maintaining the status quo. The success or failure of these advocacy efforts often depends on political will- the ability of politicians and decision-makers to act in the interest of public health despite opposition. When public health advocates can sway public opinion or build coalitions of support, they can push for policy changes that improve health outcomes. However, this is not always easy. Political polarization can make it difficult to find common ground on health issues, even when the evidence for action is clear. In these cases, public health can become a battleground, with competing interests influencing the direction of policy.

As global health challenges evolve, public health will remain at the heart of political debate. Issues like climate change, mental health, vaccination policies, and global pandemics will continue to spark political disagreements over how to approach them. In many cases, these debates will not just be about the science behind public health recommendations, they will also be about political ideologies, values, and priorities.

The future of public health will require political leaders who are willing to make evidence-based decisions, who understand the social and economic factors that influence health, and who are committed to addressing health disparities. At the same time, public health professionals must continue to advocate for policies that promote health equity, even when faced with political opposition. Public health has always been political, and it always will be. From policy decisions to health disparities, political factors shape the way we address health issues, often with significant implications for individuals and communities. Recognizing the political dimensions of public health can help us better understand the challenges we face and the solutions we need to implement. Public health is not just about health- it’s about politics, power, and the choices we make as a society.

Citations

"Global Health and the Politics of Governance." The Lancet, vol. 393, no. 10168, 2019, pp. 1736-1742. doi.org/10.1016/S0140-6736(19)31023-2.

Gostin, Lawrence O., et al. Global Health Law. Harvard University Press, 2014.

"Public Health and Politics." The American Journal of Public Health, vol. 108, no. 6, 2018, pp. 739-744. doi.org/10.2105/AJPH.2018.304444.

"COVID-19 and the Politics of Public Health." The New York Times, 15 Apr. 2020, www.nytimes.com/2020/04/15/opinion/coronavirus-politics-public-health.html.

"Health Inequality and Political Structures." The Lancet Public Health, vol. 5, no. 9, 2020, pp. e467-e468. doi.org/10.1016/S2468-2667(20)30143-1.