14.8: Health Policy and the Future of Healthcare
Policymaking is an important part of public health. Typically we think of policies as laws, regulations, or funding requirements created and enforced by governments. In the U.S., public health is governed at the local, state, and national levels. The interplay between different bureaucracies - at times cooperative and at others in opposition with each other - can actually have just as much of an impact on health policies as the politicians (and interest groups) who propose them (Shi & Singh, 2017).
A prime example of health policies are those associated with smoking. At the national level, the sale of tobacco products to anyone under 21 years of age is prohibited, and the products must all carry a warning label from the Surgeon General. Additionally, the Food and Drug Administration (FDA) has authority to regulate tobacco products (Office on Smoking and Health, CDC, 2023). At the state level, California was one of the first states to ban smoking in indoor public spaces and workplaces in 1995. Smoking had been previously banned in public schools and daycare centers, and taxes are levied on cigarette purchases to fund tobacco-prevention programs through the CA Department of Public Health. In the 2000’s, additional state legislation made smoking illegal on all government property - including state universities and community colleges - and it is also illegal to smoke in a car with a minor present (California Air Resources Board, n.d.). Cities can also enact local smoking bans to protect its residents from environmental tobacco smoke (secondhand smoke), as the city of Burbank in California has done. In Burbank, smoking is prohibited in or around any city facility or park, on any public transit or at any station, on sidewalks in the downtown area, outdoor cafes and event venues, as well as service areas (such as a delivery dock for a restaurant, or a ticket line for a concert) (Burbank Municipal Code, 2024).
Health policies also include the appropriation of tax revenue to fund specific government agencies. The Department of Health and Human Services (HHS) budget for 2024 was $2.37 trillion, which includes funding for Medicare/Medicaid, the Centers for Disease Control and Prevention (CDC), National Institute of Health (NIH), Food and Drug Administration (FDA), Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Administration (SAMHSA), and Indian Health Service (IHS) as well as other agencies (USAspending.gov, 2024).