Exam 6: The Policy Basis of Public Health

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A specific event, such as those noted above, can open a "window of opportunity" for policy changes or the development of new policies. These policies may stimulate increased research funding and access to needed health care services and treatment. An idea that once was seen as "premature" or "unacceptable" can suddenly, through a series of coincidental events, result in political reform in the public health structure.

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Elites are business leaders, political operatives, professional spokespeople, prominent fundraisers, and others whose social, economic, or occupational positions provide them more "weight" in politics than a typical person. Policies and laws favoring industry over people or protecting some groups of people while not protecting others are the result of "normal" politics in which elites hold sway over the decision-making process. Also, many local public health decisions are a result of the elites discussing a problem among themselves and then working through the solutions without involving other citizens.

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Policy entrepreneurs are individuals and organizations that seek to promote their vision of change through formal policy making or in the political arena. Think tanks and advocacy groups are examples of policy entrepreneurs based on the role they play in the politics of health reform and in broader public health policy making. Most of the important leaders in public health can be viewed as policy entrepreneurs. A few examples are Luther Terry, Joseph Califano, and C. Everett Koop, who are regarded as influential individuals in the history of public health for their contributions to the political dialog and the policies that emerged while they served as surgeon general.