Journal of Health Politics Policy and Law最新文献

Context: The COVID-19 pandemic highlighted the importance of public health programs in preventing diseases and providing health security for entire populations. Yet, governments invest very little in preventive health care. While it is generally assumed that this lack of public investment reflects individuals' lack of interest in public health, few studies have actually studied the public's preferences on this issue. Drawing on the literature on social investments, this article brings politics into the study of individuals' preferences for public health and curative care.

Methods: We rely on an original survey conducted in four OECD countries among 8,000 respondents to assess how citizens trade off preventive and curative care.

Findings: We show that higher trust and liberal social values are associated with support for preventive health care, as both variables correlate with support for policies whose benefits unfold in the long term. By contrast, individuals with poor self-rated health and low satisfaction with health care services prioritize expenditures in curative care that are beneficial to them in the short term.

Conclusions: These findings advance previous research by identifying the groups that demand additional investments in public health and those who prefer to allocate more resources towards curative care.

Context: Community Health Centers, a key part of the health safety net in the United States, have a long tradition of promoting political participation, but few studies have examined this influence. This paper fills the gap by examining how health centers influence election participation and outcomes.

Methods: This paper develops an innovative county-level dataset on health center coverage from 2006 to 2022 using ZIP code-level patient data and examines how health center coverage is associated with voter registration, turnout, and the Democratic presidential candidate's vote share. It also examines whether these associations are stronger in high-poverty counties, where voting is more challenging.

Findings: In most election years, health center coverage is positively associated with voter registration rates(except in 2018 and 2020) and turnout rates (after the ACA) in high-poverty counties, but not in other counties. There is no consistent evidence showing that higher health center coverage is associated with a higher Democratic vote share.

Conclusions: Health centers appear to play a more consistent role in facilitating election participation than in shaping electoral outcomes, with stronger effects concentrated in high-poverty counties. Health centers' influence may vary with the broader political environment, such as the passage of the ACA.

Context: Despite precision medicine's promise to revolutionize healthcare, access remains uneven, and disparities persist. This study examines how conflicts between the institutional logics of genetic science ("discovering") and market-based health insurance ("covering") impede precision-driven health equity.

Methods: We conducted 44 semi-structured, in-depth interviews with individuals at elevated risk for hereditary cancer. Data were analyzed using an abductive approach, combining thematic analysis with grounded theory tools.

Findings: Analysis reveals seven "zones of conflict" where precision medicine's aspirations clash with insurance practices, creating barriers to genetic testing and related services. These zones span initial access barriers (e.g., complex billing, inconsistent guideline uptake) and downstream care factors (e.g., financial concerns, lack of retesting guidelines). The interplay between expanding genomic knowledge and the fragmented American healthcare system particularly disadvantages underrepresented and minority populations.

Conclusions: Participant experiences reveal more unanticipated sources of inequity than precision medicine proponents anticipated. Incremental reforms targeting these conflict zones, such as guideline harmonization, expanding coverage mandates, and enhanced patient advocacy related to insurance coverage, could mitigate cascading disparities. This study highlights the importance of addressing institutional misalignments to realize the full equitable potential of precision medicine involving genetics.

Context: Attention to the potential impact of highly pathogenic avian influenza (H5N1, or "bird flu") on human health increased following documentation of mammalian transmission in Spring 2024, and the prevalence of H5N1 in the commercial dairy supply. We aim to quantify (a) the prevalence and (b) socio-political correlates of public concern about H5N1, as well as support for policy action aimed at reducing its potential health risks.

Methods: In a nationally representative survey of N = 831 US adults, we asked respondents to answer questions about their levels of concern about H5N1 transmission, beliefs about the safety of consuming unpasteurized milk products, and support for policy interventions.

Results: Few Americans express high levels of concern about the H5N1 health risks. People who express lower levels of concern about H5N1 and those who hold inaccurate or uncertain views toward raw milk safety are in turn less supportive of policies aimed at mitigating the spread of H5N1; as is both anti-intellectual attitude endorsement and partisan identification with the Republican Party.

Conclusions: Moderate levels of concern about H5N1 risks could undermine pandemic preparedness. Lacking strong signals from the public, policymakers may be reluctant to pursue policies that reduce avian influenza's pandemic potential.

Throughout the first months of his second term in office, the Trump administration has taken swift action to undermine the role that government health agencies play in the health policymaking process. This commentary makes the case that the Trump administration's efforts to undermine government health agencies' regulatory authority reflect a dislike and distrust of the people who serve in key civil service roles. It also provides evidence that efforts to roll back regulatory authority are part of a longstanding political strategy to cater to public dislike and distrust of scientific, medical, and academic experts. While the public could provide policymakers with an incentive to protect public health agencies, and the people who staff them, recent public opinion research shows that many Americans simply do not know or do not care enough about the Trump administration's actions to call for their elected officials to stop them. This commentary concludes by offering several health communication strategies and directions for future research (the "science of standing up for science") that might inspire public concern about efforts to roll back government health agencies' regulatory authority, and to show support for the civil servants who comprise those agencies.

A core mission of the US Food and Drug Administration is to advance public health through regulatory decision-making, demanding both scientific expertise and political judgment. Since its inception, FDA has undergone frequent reform intended to better position the agency to serve its mission, with attention to evidentiary standards, patient autonomy and protection, innovation and access, transparency, and independence. Situated within the executive branch, it is reasonable for FDA's priorities and approach to change from administration to administration. However, the scope, number, and magnitude of changes in the second Trump administration have been extraordinary, including tremendous loss of expert staff and leadership, proposals for rushed reviews and approvals based on little evidence, "expert panels" lacking public input and conflict of interest vetting, and political interference in lieu of established science and procedures. At stake are scientific rigor and public trust in FDA's decisions. Yet this crisis may offer an opportunity to rebuild and reenvision FDA for the future. We propose that developing a core set of principles and associated metrics can shape rebuilding and reform by providing a framework for guiding FDA policy choices, a shared evaluative structure for assessing agency actions, and parameters for differentiating reasonable from unreasonable policy changes.

This contribution to the special issue addresses the unprecedented politicization of science and health institutions, which threatens the functional integrity of democratic governance itself. Regulatory measures have weakened the infrastructure for evidence generation, constrained the autonomy of scientific actors, and subordinated public health priorities to cultural grievance and political loyalty. False and misleading information about core scientific knowledge is amplified not only in social media but by government itself. NIH disinvestment, advisory body sidelining, and public rhetoric casting science as elite overreach have together eroded the credibility of United States health leadership both domestically and abroad. The targeting of DEI policies in research portfolios, moreover, jeopardizes not only representational justice but the innovation capacity of American science at large. In this contribution, we trace the historical and political structure of science-politics confrontations and detail the damage to the public health and research ecosystem. We offer proposals to reconstruct the scientific enterprise in the next presidential administration.

Public health is under siege in the United States-particularly the parts of the field that focus on health equity. Though it may be tempting to abandon health equity efforts during this siege, in this commentary, I argue that would be a mistake for the field. Research on the history of public health found that health equity pursuits were essential for building the field, and contemporary research continues to find that health equity pursuits not only remain popular, they are also effective for mobilizing large and diverse segments of the population to engage in individual and collective actions that advance the field's goals. The pursuit of equitable and healthy futures may be one of the effective pathways for sustaining the field's future.

Since the election of President Donald J Trump, the US federal administration took considerable steps to weaken public health infrastructure and agencies; all of this is likely to have an impact on population health. Less discussed have been the health impacts of ostensibly "non-health" policies that are also being implemented by the current US federal administration. Drawing on the social determinants of health framework, we analyze how policies across domains-environmental regulation, food assistance, housing, immigration, and economic policy-fundamentally shape population health outcomes. The administration's sweeping deregulatory agenda, including rollbacks of environmental protections, cuts to nutrition assistance programs, and immigration enforcement policies, represents a systematic threat to the policy infrastructure that supports population health. These changes threaten to widen health gaps and undermine decades of progress in addressing the root causes of poor health. The analysis demonstrates that in evaluating contemporary threats to population health, we must look beyond traditional health sector policies to understand how the broader policy environment shapes the conditions in which people live, work, and thrive.

The withdrawal of the United States from the World Health Organization raises crucial questions about its future as the governing International Organization for health. The executive order on withdrawal was one of President Donald Trump's first acts in his second term. As WHO's biggest funder and most powerful state backer, withdrawal could indicate an existential threat. However, almost simultaneously member states passed a new international Pandemic Agreement expanding WHO's authority. How should these conflicting signals be understood? Analyzing WHO's decline in a context of broader US and geopolitical shifts, we find that withdrawal is the outcome of the end to broader political orders of neoliberal internationalism on which WHO depended for legitimacy, rather than idiosyncratic Trump politics. WHO's reliance on certain international norms and power structures leave it compromised. US normative and institutional shifts are far more difficult for WHO to navigate than in past political eras. International relations research suggests avoiding catastrophic impacts therefore depends on reform actions by WHO officials, other member states, and US actors. We find states and others in the US will face harm from WHO decline and suggest they have legal standing to challenge withdrawal. Complacency and inaction may be WHO's biggest risk.