Public Health is Politics

Abstract

‘Public health’ investigates the determinants of health, born during the Enlightenment in the seventeenth/eighteenth century. But ‘public health’ is also policies, aiming at the improvement of a population’s health. There is a mutual interchange between public health as science and as politics. A brief historical background is followed by an analysis of the impacts of political changes during the first two decades of the twenty first century in Sweden. In 2005, a policy document accepted by all political parties except for the Moderate Party highlighted socio-economic factors and structural reforms to decrease the health gaps in the population. The general election in September 2006 resulted in a new majority in the parliament and a center-right coalition government, including the Moderates and three parties that had approved of the 2005 document. In 2007 a “new public health policy” was introduced. Its priority lists stressed individual behavior and the new policy should be incentives to work instead of “allowances”. The Public Health Institute got instructions in accordance with the new policy. The ten years following this policy change has seen public health policies and attitudes to research shifting almost year by year. The new policy met a counter-stream from the very beginning. Influenced by Michael Marmot’s WHO Commission on health inequalities, regional commissions started in Sweden, Recommendations how to decrease social health gaps was adopted with almost no opposition by regional health boards in 2012–2013. But new problems were now occupying politicians and media—how to finance the growth of the old, multi-sick part of the population and increasing costs for new medical technologies and drugs. Public health as an academic discipline was in the middle of this fluctuating political landscape with direct effects on what has been considered worth listening to or support by public money.