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Public health policy in developed countries 

Public health policy in developed countries
Chapter:
Public health policy in developed countries
Author(s):

John Powles

DOI:
10.1093/med/9780199218707.003.0016
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date: 06 December 2019

In the developed market economy (OECD) countries, adult mortality risks halved in the second half of the twentieth century. Trends were less favourable in Eastern Europe and were actually adverse in the Slavic and Baltic republics of the former Soviet Union.

These variable health gains cannot easily be related to explicit health policies or to organizational forms within health ministries. An alternative approach is to explore ways in which knowledge has been developed and used in response to leading adult health risks. In the last half century, there were historically unprecedented levels of investment in medical research, especially in the Scandinavian and English-speaking countries.

New knowledge has been used to protect and enhance health in a variety of ways according to the nature of the health risks being addressed. In general, knowing what to do has been powerfully permissive of it (ultimately) being done.

Linkages between the development and successful use of knowledge have not, however, been tight—in part, because openly published science is a global public good. The United States, in particular, has been more successful as a generator than as a successful user of knowledge, suggesting that health protection and enhancement are being impeded by distinctive features of its political economy.

The diverse ways in which knowledge has been used extend well beyond processes appropriately described as ‘interventions’. Decentralized, informal, and ‘spontaneous’ uses have also played important roles.

Investments in medical research by government, civil, and commercial organizations should be sustained at high levels in expectation of continuing favourable returns to human well-being. Difficult unsolved problems—such as those related to excess adiposity and ecological disruption—are likely to require a wide repertoire of inventive responses, suggesting a need to leave space for decentralized activity and institutional creativity.

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