Public policy determines health and well-being

If you have read my previous commentaries, you may have found yourself wondering why a medical doctor would write about public policy.

In the first twenty years of my career, I worked in clinics, emergency rooms and intensive care units.  Sometimes, it seemed that no matter how hard I worked or how much I cared for my patients, I was spinning my wheels.  Some problems my patients faced were simply not resolvable with the tools and knowledge I had as a medical doctor.

This is not surprising because only twenty-five percent of health outcomes are determined by the health care system consisting of hospitals, clinics, doctors and nurses.  The remainder is shaped by public policies adopted by the society in which we live – policies related to employment, housing, education, etc.  Collectively known as the social determinants of health, the conditions in which people live, work and play influence health to a far greater degree than diagnosis and treatment by a health care professional.

An eighteenth-century physician by the name of Rudolf Virchow said, “Medicine is a social science, and politics nothing but medicine at a larger scale.”  He believed that physicians were obligated to expose social problems and contribute to solving them by entering political life.  Virchow acted on his belief by becoming a member of the Municipal Council of Berlin.  He was instrumental in bringing about water and sanitation improvements in the city along with other civic reforms.

Governments at all levels are unduly influenced by business interests at the expense of public health and well-being.

In more recent times, the Ottawa Charter for Health Promotion underscores the importance of healthy public policy in achieving health for all.  It calls on public health professionals to make elected officials aware of their responsibility in creating and maintaining health and the consequences of their decisions on the health of their electorate.  

Policy is often made on the basis of political ideology or under the influence of powerful business lobbies that represent major corporations.  In Canada, like in the United States, we place the marketplace as the primary institution of society; governments at all levels are unduly influenced by business interests at the expense of public health and well-being.  

But there is a better way to create public policy.  Social scientists and researchers analyze and identify policies that are effective in achieving public goods such as health, equality and security.  Governments at all levels can improve the use of data and research findings to inform their policy decisions in the same way as doctors use evidence from clinical trials to prescribe effective treatments. 

Politicians need to fulfill their responsibility to the people they serve by intentional selection of policies that work together to promote health.  They need to choose policies that have proportionately more benefits for those with greater needs.  Creating healthy public policy is at heart a non-partisan activity, based on evidence, a sense of fairness and a long-term view.

Community members support healthy public policies when they inform themselves about important issues in their community and about policy options that are known to favour health and well-being.  They need to engage in conversations with fellow citizens and elected officials about local problems and solutions that promote public over corporate interests.  

When it comes down to it, politicians and community members have far more control over the health of populations than do health care professionals.  This is worth remembering next time you find yourself at the ballot box.

Vamini Selvanandan© 2020. This work is licensed under a Creative Commons CC BY 4.0 license. This article was originally published in the Rocky Mountain Outlook on July 16, 2020. Photo credit: Deepak Digwal on

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