Fighting tuberculosis in the 1990s: how effective is planning in policy making?

Planning is a common tool for addressing important health issues, especially urgent ones, and has been reintroduced recently in several federal, state, and local public health programs. This article presents a case study of planning and policy making concerning the reemergence of tuberculosis in urban areas, using Washington, D.C. and New York City as examples. Planning was unsuccessful in D.C. because it failed to acknowledge the important political and bureaucratic aspects of policy making. In New York City, on the other hand, planning played a central role in policy-making efforts, and the health department took a leadership role in building a consensus on the problem, formulating strategies, and overcoming implementation obstacles. This article concludes with several key considerations for making planning more effective in health policy-making.