Why Evidence Is Not Enough: Power, Politics, and a Strategy Shift for Public Health

Area of Science:

• Political Science and Public Health
• Power Dynamics in Health Policy
• Social Determinants of Health

Background:

• Public health's political influence has declined due to a power mismatch.
• The field relies on knowledge and moral authority, insufficient against economic and political power.
• Challenges include political backlash and policy retrenchment despite strong evidence.

Purpose of the Study:

• To analyze the forms of power available to public health practitioners.
• To understand how to counter detrimental policies and institutional arrangements.
• To propose strategies for rebuilding public health's political influence.

Main Methods:

• Conceptual analysis using an established typology of power.
• Examination of power forms wielded by public health and opposing actors.
• Application of power dynamics theory to public health challenges.

Main Results:

• Public health's reliance on knowledge and moral power is insufficient against economic, political, ideological, and physical power.
• Neoliberal political economy favors actors with economic and political power.
• People power, ideological power, and nonviolent disruptive power are identified as crucial for public health influence.

Conclusions:

• A strategic shift is necessary: build people power via partnerships, strengthen ideological power through narrative infrastructure, and use nonviolent disruptive power when needed.
• Public health must engage more deliberately with power and politics, not just evidence.
• Rebuilding influence requires a multifaceted approach beyond traditional methods.