Abstract
Look around EUPHA, or any other public health conference. Public health is difficult to define, in theory and in practice. Its boundaries are all blurred, whether with medicine, schools, environmental protection or workplace safety inspectorates. Too often, we overstate the similarities between public health systems among countries. Efforts to promote networks, good practice, and even basic coordination have been undermined for decades by misunderstandings born of different educational, organizational, financial and political systems. The lack of comparison, and comparative political analysis in particular, also means that countries can have very similar debates about the proper nature and scope of public health, an about who is to blame for deficiencies, without awareness of when they are distinctive and when they are actually part of larger trends.
This project aims to identify and explain variation in the scope and organization of public health systems in selected high-income countries. Based on a formalized comparative historical analysis of Austria, France, Germany, Poland, the United Kingdom and the United States, researchers in the study first mapped the various axes of divergence: workforce composition, organization, levels of government, relationship to medicine, and the extent to which public health encompassed adjacent areas such as environmental health and occupational health and safety. For each country we then followed both case studies (communicable disease control including vaccines, HIV/AIDS, tobacco control, diet and nutrition, occupational health and safety) as well as the legislative history of the public health field in order to identify its changing organization and scope. It then identifies the relative role of historical legacies, changing science, burden of disease and politics in explaining patterns of both divergence and convergence.
This workshop presents four country specific case studies (France, Germany, United Kingdom and the United States) that identify the most important forms of variation and the political, scientific and professional drivers of convergence and divergence.
Key messages
Political organization and scope as images of public health are grossly under-researched and nonexistent in a comparative nature. Understanding the scope and organization of public health in different countries will permit better lesson-drawing and identification of relevant and effective levers of change.
Recent Advances in Public Health Systems Research in the United States