Lost in translation: Ideas of population health determinants in the American policy arena

Maria Gilson Sistrom, RN MSN PhD

Background: Public health research reveals the determinants of population health to be social, political and economic, yet health policy in the US remains individualistic. Concurrently, population health measures in the United States are worsening in comparison to other developed countries. Public health researchers subscribe to a view of policy that is evidence-based, yet policy may be informed by research only insofar as it conforms to existing political and cultural ideas. Policymakers' decisions may be influenced as much by institutional pathways and the constraints of culture and ideology as they are by compelling research. Policies do change, however, although policy researchers contend that they can change only if associated ideas can be readily found in the policy arena. In this conception, it is ideas and their timely marketing, not credible research, that are key to changing policy. In order to understand the translation of population health research into policy and ultimately improve population health, the objective of this study is to understand and explain the presence, nature and character of population health ideas, and influences upon them, in the American policy arena.

Methods: Fourteen federal and state level policymakers and policy experts were interviewed using a modified semi-structured survey developed for a previous study of policymaking and health inequality in Britain. Grounded Theory methods were used to develop themes in population health ideas in the policy arena, the role of research in policymaking, and the policymaking process in general.

Results: Substantive theory in the American policy context and an extension of a theory of health policy previously developed in Britain are developed. Explanations are developed regarding the role of research, idea entrepreneurship, institutional pathways, and the political and ideological environment of policymaking in the US.

Conclusions: Preliminary conclusions reveal a policymaking context much dependent on institutional pathways and the political environment in Congress, very similar to the British study on which this study is based. Contrary to expectations, American cultural individualism plays an ambivalent role in health policymaking in the US. Final analyses and conclusions will be presented.