Are public health ideas spreading across government? The case of ‘prevention' policy in the UK and US

Background: The optimal approach to addressing non-communicable diseases (NCDs), including cancer is prevention policies to modify behaviors/lifestyles. With NCDs being the major preventable cause of morbidity and mortality worldwide, we aim to conceptualize and theorize prevention policy through a comparison between the United Kingdom (UK) and United States (US) to facilitate lesson drawing and health promotion.

Methods:  We triangulate interviews and archival documents to identify the extent that prevention policies have diffused more widely into government policymaking in the UK and US. We focus on broad terms ‘prevention’ and ‘early intervention’ to describe a broad philosophy about addressing problems before they become acute and relatively expensive, by shifting resources to early years interventions.

Results: In the UK, tobacco control is relatively ‘comprehensive’ and its experience is becoming a model for alcohol and obesity. In devolved areas, such as Scotland, there is a much wider shift to prevention and early intervention as a way to reduce inequality. This idea has emerged on the US agenda through policies such as the Family Smoking Prevention and the Tobacco Control Act and the Affordable Care Act, which has made resources available for preventive programs and access to preventive services, although major states such as California and Massachusetts have adopted such approach for decades.

Conclusion: The thinking about prevention policies has a long history to address health inequalities, but we examine the extent to which relatively recent public health success in areas such as tobacco control has helped push them further up government agendas.