Constance A. NATHANSON : Disease Prevention as Social Change : Toward a Theory of Public Health

A basic premise of the monumental World Bank study, Disease Control Priorities in Developing Countries (Jamison et al. 1993), is that public policies – « governmental instruments » in the authors’ language – are critical to the prevention and control of disease and the promotion of health in developing countries. The emphasis on public policies is attributable in part to the study’s anticipated audience of policymakers in governments and international agencies. This should not, however, obscure the fact of a fundamental shift – implicit if not explicit in the World Bank approach – from earlier, widely accepted frameworks for understanding the role of social factors in health and disease. The purposes of this article are, first, to make this shift explicit ; and, second, to move toward filling a major conceptual gap, not only in the World Bank analysis, but in the larger social science literature on disease prevention. Public health policies are not adopted and implemented in a socio-political vacuum. In order to achieve better health, it is not sufficient to know which health policies should be implemented ; we must also understand « how and why each country sets the priorities it does in health policy and between health and other areas of policy » (Fox 1992 : 95). In this article I propose a conceptual framework for analyzing social and political factors that facilitate or impede the adoption and implementation of public health policies.