The Public Policy Approach: Governments, Institutions, Welfare States and Social Justice

Abstract

The twentieth century was, for many reasons, the age of successful public policy making. With the firm establishment of the nation-state in a colonialised context of the nineteenth century, the welfare state in its many guises emerged in the last century of the second millennium. The successes of the welfare state, and as a corollary the success of public policy in preventing disease and promoting health, has been undeniable.

But the world is changing and so is the notion of public policy. Similar to a debate in public health (is it “the public’s health” or “public sector health?”) public policy has faced a need to transcend the boundaries of the nation-state. This was already the case in the infectious disease era (and the networked nature of the smallpox eradication effort serves as a beautiful example) but is even more so the case in the twenty-first century where the growth and pathology of NCDs are much more complex and less amenable to direct clinical intervention.

The welfare state, as a major accomplishment of the age of modernity, is struggling to cope with a new world order though. Multinational corporations often manage financial turnovers many times the national accounts of nation-states, and seek to engage in global policy development, including (impacts on) global health. Similarly, a renewed global civil society is challenging both industry interests and the illusion of state prerogatives in health policy development.

The lessons are that governments need to engage in exercises mapping the social, cultural and organisational contexts in which NCDs emerge and result in substantial differences in health outcomes. That their role has shifted from direct control and ownership of public health to that of a coordinator and mediator of roles in a networked health society. Public policy is still important—but it has become “the public’s policy” and less “public sector policy.” The chapter concludes with arguments for health promoters and policy makers how to re-align and reconfigure their ambitions to promoting health and preventing (NC)Disease.