Changing National Subnational Relations In Health

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

A range of collaborative governance mechanisms has developed in many policy arenas in the past decade. The study on governance for health in the 21st century tracks governance innovations that have been introduced to address priority determinants of health and summarizes them as five strategic approaches to smart governance for health. The study relates the emergence of joint action of the health sector and non-health sectors, of public and private actors and of citizens to achieve seminal changes in 21st-century societies. They include a new understanding of health and well-being as key features of what constitutes a successful society and vibrant economy and the higher value placed on equity and participation. The study further describes the type of structures and mechanisms that enable collaboration and outlines the new role that health ministers and ministries and public health agencies need to adopt in such a challenging policy environment.

This book stems from Marmor's conviction that political science can provide answers to questions regarding the role of government in medical care.