AMERICAN JOURNAL OF PUBLIC HEALTH EDITOR-IN-CHIEF ASSISTANT EDITOR DEPUTY EDITOR FEATURE EDITOR IMAGE EDITOR ASSOCIATE EDITORS
EDITOR’S CHOICE Bringing Public Health Back Into Public Health Policy Debates Harry: This says Congress is moving ahead on health care reform. Louise: If they can just cover everyone. Harry: But they’re talking price controls. Louise: Right. Government spending limits. . . .Rationing, the way I read it. You know, long waits for health care and some services not even available. Harry: Government-controlled health care. Huh. Congress can do better than that.
The soap-opera style Harry and Louise ad campaign against Clinton Administration health reform broadcast during 1993---1994 was financed by the Health Insurance Association of America, an industry group concerned that health reform would reduce their revenues. In one episode, Louise informed a coworker that health reform would result in new taxes and loss of “the quality we like, the doctors we want, plans like ours.” The combination of simple, clear messaging and absence of a Clinton Administration response contributed to health reform’s demise. In one series of polls, public opposition nearly doubled. There was a shift in public sentiment from concern about the uninsured to self-interest predicated on the notion that gains by others necessitate losses for oneself: less choice, fewer services, higher cost, and more government control. These themes were exploited beginning with the August 2009 Town Hall meetings that galvanized opposition to Obama Administration health reform, again with no response. Market-based insurance exchanges were misrepresented as a “government takeover,” because people are “deathly afraid” this would worsen health care quality. A new potential loss was introduced: death panels were invented as part of health reform. People became concerned that “government bureaucrats” would decide who gets care and who is left to die. Belief in death panels was so well established that years after some who promoted the idea admitted it was false, polling showed 27% of head-and-neck surgeons (including 40% who self-identified as Republicans) thought death panels were included in the legislation. Public support remains lower for the law than for its provisions. Public health experts were marginalized in these highly charged partisan debates of vital public health issues. In a New York Times op-ed column, Nicholas Kristoff wrote that America’s best-informed thinkers “just don’t matter” in policy
772 | Editor's Choice
debates. One of the worst dismissals of an argument is “it’s academic.” Scholars publish in “obscure journals.” They are too often ideological liberals (exception, economists). Doctoral programs “glorify arcane unintelligibility.” Social media platforms such as Twitter and Facebook are inadequately utilized. Online response was swift. Corey Robin countered that there are plenty of academicians who write clearly, but not enough places to publish. American Journal of Public Health, a major source of health policy papers for decades, is an ideal venue to bring public health professionals back into public health policy controversies. Under the leadership of outgoing Department Editor Les Beitsch, the Journal’s Department of Government, Law, and Public Health Practice has become a major source for papers on health policy and translation of scientific findings to public health practitioners. It will continue to welcome contributions of analytic essays of up to 3500 words that contribute to our understanding of the ongoing profound transformations in the public health field. The Department has added a new article type designed to facilitate timely engagement by the public health community in policy debates: Public Health Policy Briefs. This format allows up to 1500 words with 15 citations. It encourages public health professionals to respond to misinformation and directly state their policy positions, with supportive evidence. Our goal is to bring Public Health Policy Briefs, if accepted, to online publication within three months of submission. We will depend on reviewers who are comfortable with policy writing and committed to completing reviews quickly to help make this happen. The Journal is also continuing to explore additional ways to use social media to further involve the public health community in policy debates. We value your participation as authors and reviewers! I can be reached at roygrant.roy@ gmail.com and look forward to hearing from you. A list of sources for this column is available on request. j
Roy Grant Department Editor AJPH
Mary E. Northridge, PhD, MPH Cynthia Golembeski, MPH Farzana Kapadia, PhD Gabriel N. Stover, MPA Aleisha Kropf Hortensia Amaro, PhD Mary T. Bassett, MD, MPH Michael R. Greenberg, PhD Sofia Gruskin, JD, MIA Said Ibrahim, MD, MPH Robert J. Kim-Farley, MD, MPH Stewart J. Landers, JD, MCP Stella M. Yu, ScD, MPH ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION Roger Vaughan, DrPH, MS INTERNATIONAL ASSOCIATE EDITORS Kenneth Rochel de Camargo Jr, MD, PhD (Rio de Janeiro, Brazil) Daniel Tarantola, MD (Ferney-Voltaire, France) DEPARTMENT EDITORS Roy Grant, MA Government, Law, and Public Health Practice Public Health Policy Briefs Elizabeth Fee, PhD, and Theodore M. Brown, PhD Images of Health Public Health Then and Now Voices From the Past Mark A. Rothstein, JD Public Health Ethics Kenneth R. McLeroy, PhD, and Deborah Holtzman, PhD, MSW Framing Health Matters EDITORIAL BOARD Jeffrey R. Wilson, PhD, MS (2015), Chair Chinua Akukwe, MPH (2015) Caroline Bergeron, MSc (2016) Eric R. Buhi, PhD (2016) Keith Elder, PhD, MPH (2016) Thomas Greenfield, PhD (2015) Jeffrey Hallam, PhD (2014) Dio Kavalieratos, PhD (2016) Maureen Lichtveld, MD, MPH (2015) Justin B. Moore, PhD (2016) Samuel L. Posner, PhD (2015) Joan Reede, MD, MPH (2014) Helena Temkin-Greener, PhD, MPH (2014) David H. Wegman, MD, MSc (2014) Ruth Zambrana, PhD (2016) STAFF Georges C. Benjamin, MD Executive Director/Publisher Ashell Alston, Interim Publications Director Brian Selzer, Interim Deputy Publications Director Jamie Smith, Production Coordinator Michael Henry, Associate Production Editor (Sr) Aisha Jamil, Associate Production Editor (Jr) Mazin Abdelgader, Graphic Designer Vivian Tinsley, Subscriptions Manager FREELANCE STAFF Kelly Burch, Greg Edmondson, John Lane, Gary Norton, Michelle Quirk, Alisa Riccardi, Trish Weisman, Eileen Wolfberg, Copyeditors Sarah Cook, Marci McGrath, Chris Smith, Proofreaders Vanessa Sifford, Graphic Designer
doi:10.2105/AJPH.2014.301965
American Journal of Public Health | May 2014, Vol 104, No. 5
EDITOR’S CHOICE Bringing Public Health Back Into Public Health Policy Debates Harry: This says Congress is moving ahead on health care reform. Louise: If they can just cover everyone. Harry: But they’re talking price controls. Louise: Right. Government spending limits. . . .Rationing, the way I read it. You know, long waits for health care and some services not even available. Harry: Government-controlled health care. Huh. Congress can do better than that.
The soap-opera style Harry and Louise ad campaign against Clinton Administration health reform broadcast during 1993---1994 was financed by the Health Insurance Association of America, an industry group concerned that health reform would reduce their revenues. In one episode, Louise informed a coworker that health reform would result in new taxes and loss of “the quality we like, the doctors we want, plans like ours.” The combination of simple, clear messaging and absence of a Clinton Administration response contributed to health reform’s demise. In one series of polls, public opposition nearly doubled. There was a shift in public sentiment from concern about the uninsured to self-interest predicated on the notion that gains by others necessitate losses for oneself: less choice, fewer services, higher cost, and more government control. These themes were exploited beginning with the August 2009 Town Hall meetings that galvanized opposition to Obama Administration health reform, again with no response. Market-based insurance exchanges were misrepresented as a “government takeover,” because people are “deathly afraid” this would worsen health care quality. A new potential loss was introduced: death panels were invented as part of health reform. People became concerned that “government bureaucrats” would decide who gets care and who is left to die. Belief in death panels was so well established that years after some who promoted the idea admitted it was false, polling showed 27% of head-and-neck surgeons (including 40% who self-identified as Republicans) thought death panels were included in the legislation. Public support remains lower for the law than for its provisions. Public health experts were marginalized in these highly charged partisan debates of vital public health issues. In a New York Times op-ed column, Nicholas Kristoff wrote that America’s best-informed thinkers “just don’t matter” in policy
772 | Editor's Choice
debates. One of the worst dismissals of an argument is “it’s academic.” Scholars publish in “obscure journals.” They are too often ideological liberals (exception, economists). Doctoral programs “glorify arcane unintelligibility.” Social media platforms such as Twitter and Facebook are inadequately utilized. Online response was swift. Corey Robin countered that there are plenty of academicians who write clearly, but not enough places to publish. American Journal of Public Health, a major source of health policy papers for decades, is an ideal venue to bring public health professionals back into public health policy controversies. Under the leadership of outgoing Department Editor Les Beitsch, the Journal’s Department of Government, Law, and Public Health Practice has become a major source for papers on health policy and translation of scientific findings to public health practitioners. It will continue to welcome contributions of analytic essays of up to 3500 words that contribute to our understanding of the ongoing profound transformations in the public health field. The Department has added a new article type designed to facilitate timely engagement by the public health community in policy debates: Public Health Policy Briefs. This format allows up to 1500 words with 15 citations. It encourages public health professionals to respond to misinformation and directly state their policy positions, with supportive evidence. Our goal is to bring Public Health Policy Briefs, if accepted, to online publication within three months of submission. We will depend on reviewers who are comfortable with policy writing and committed to completing reviews quickly to help make this happen. The Journal is also continuing to explore additional ways to use social media to further involve the public health community in policy debates. We value your participation as authors and reviewers! I can be reached at roygrant.roy@ gmail.com and look forward to hearing from you. A list of sources for this column is available on request. j
Roy Grant Department Editor AJPH
Mary E. Northridge, PhD, MPH Cynthia Golembeski, MPH Farzana Kapadia, PhD Gabriel N. Stover, MPA Aleisha Kropf Hortensia Amaro, PhD Mary T. Bassett, MD, MPH Michael R. Greenberg, PhD Sofia Gruskin, JD, MIA Said Ibrahim, MD, MPH Robert J. Kim-Farley, MD, MPH Stewart J. Landers, JD, MCP Stella M. Yu, ScD, MPH ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION Roger Vaughan, DrPH, MS INTERNATIONAL ASSOCIATE EDITORS Kenneth Rochel de Camargo Jr, MD, PhD (Rio de Janeiro, Brazil) Daniel Tarantola, MD (Ferney-Voltaire, France) DEPARTMENT EDITORS Roy Grant, MA Government, Law, and Public Health Practice Public Health Policy Briefs Elizabeth Fee, PhD, and Theodore M. Brown, PhD Images of Health Public Health Then and Now Voices From the Past Mark A. Rothstein, JD Public Health Ethics Kenneth R. McLeroy, PhD, and Deborah Holtzman, PhD, MSW Framing Health Matters EDITORIAL BOARD Jeffrey R. Wilson, PhD, MS (2015), Chair Chinua Akukwe, MPH (2015) Caroline Bergeron, MSc (2016) Eric R. Buhi, PhD (2016) Keith Elder, PhD, MPH (2016) Thomas Greenfield, PhD (2015) Jeffrey Hallam, PhD (2014) Dio Kavalieratos, PhD (2016) Maureen Lichtveld, MD, MPH (2015) Justin B. Moore, PhD (2016) Samuel L. Posner, PhD (2015) Joan Reede, MD, MPH (2014) Helena Temkin-Greener, PhD, MPH (2014) David H. Wegman, MD, MSc (2014) Ruth Zambrana, PhD (2016) STAFF Georges C. Benjamin, MD Executive Director/Publisher Ashell Alston, Interim Publications Director Brian Selzer, Interim Deputy Publications Director Jamie Smith, Production Coordinator Michael Henry, Associate Production Editor (Sr) Aisha Jamil, Associate Production Editor (Jr) Mazin Abdelgader, Graphic Designer Vivian Tinsley, Subscriptions Manager FREELANCE STAFF Kelly Burch, Greg Edmondson, John Lane, Gary Norton, Michelle Quirk, Alisa Riccardi, Trish Weisman, Eileen Wolfberg, Copyeditors Sarah Cook, Marci McGrath, Chris Smith, Proofreaders Vanessa Sifford, Graphic Designer
doi:10.2105/AJPH.2014.301965
American Journal of Public Health | May 2014, Vol 104, No. 5
