Disease Prevention and Health Promotion Policies in OECD Countries. Explaining Differences in Policy Goals and Instruments

Medical science has made tremendous progress during the last century. Nevertheless, medical care has its limits. Nearly all of today’s dominant chronic diseases (e.g. diabetes) cannot be cured but require life-long (and costly) medical treatment. Yet, most diseases could be prevented. However, implementation of respective policies remains limited, albeit some countries increase their efforts to invest in prevention. What drives welfare states to expand disease prevention (DP) and health promotion (HP)? How do DP and HP policies of advanced welfare states differ in their goals, instruments and target population? And how can these differences be explained? Addressing these research questions, the paper wants to shed a first light on public health policies and politics from a political science perspective. Despite the increasing relevance of DP and HP, welfare state research has not paid much attention to this policy field yet. Therefore, the paper outlines and discusses implications of traditional welfare state theories for public health in a first step. In a second step, the theory section develops a taxonomy of DP and HP policies. In distinguishing between individual centered (medical and behavioral) and structural (health-directed and health-related) approaches, the taxonomy provides the framework for the empirical analysis. Based on these considerations, the empirical part describes variance in DP and HP policies and analyses the politics behind for four countries. The four countries comprise a high and a low spender on prevention from two welfare state regime type (social democratic: the Netherlands, Norway; conservative: Germany, Austria). With this case-study design, I am able to investigate the factors impacting on public health policy making that are not related to the particular welfare state model (e.g. power of doctors). At the same time, I can test my hypothesis that ideas about the causes of ill-health and goals pursued with public health interventions vary between welfare state regimes. The case studies are similarly structured and include information on political and public health institutions, relevant actors, and content and goals of DP and HP policies of the last 15 to 20 years. Following the country descriptions, the paper compares their findings and discusses the hypotheses developed in the first part. Finally, the conclusion considers the implications of results for practical health policy-making and underlines the necessity for further political science research on public health policies.