Cause Area Introduction - Health Policy
Introduction
We are all generally familiar with the actions we need to take to keep ourselves healthy and well. But how do we ensure our country or our society more broadly remains healthy and well? Ensuring the health of a country or society takes the coordinated action of health systems, governments, and policy makers. In this brief introduction to health policy, we explore why we think health policy is a high impact cause area that doctors are probably well placed to work on.
What is health policy?
Health policy describes the actions taken to achieve health goals at a local, national and international level. It is concerned with the function of health systems and how the policies that oversee these systems impact individual and public health.
Tobacco use and smoking are useful examples to appreciate how health policies influence individual and public health. From an individual and public health perspective, smoking is a significant determinant of poor health and preventable death, causing 8 million deaths per year (~15% of annual global deaths). Despite the individual difficulty patients can face in quitting smoking, rates of smoking and deaths attributable to smoking have actually significantly fallen over the past few decades (with the exception of low and middle income countries, where deaths from smoking are rising). Public health policies regarding the sale and advertisement for tobacco, affordability, and taxing of cigarettes and the development and promotion of smoking cessation interventions have all been instrumental in the falling rates of smoking and smoking attributable deaths. There are several other examples of how health policy impacts individual and public health - such as sanitation & hygiene policies and policies around air quality - but the influence of health policy on smoking is particularly interesting in highlighting how impactful health policy can be to national and societal health at large.
Is health policy a high impact cause area?
Health policy takes a broad approach to affecting individual and public health. Given its scale and scope, we think health policy is a high impact cause area to work on.
In considering the impact of health policy, it is useful to consider it through the lens of the scale, neglectedness, solvability framework. Regarding scale, health policy affects large numbers of people, whether that be a few hundred people in a particular region, a few hundred thousand in a country, or a few billion across the globe. In terms of tractability, there are several promising avenues for working on problems from a health policy angle (which we will expand on later in this article). Lastly, from a neglectedness point of view, relative to its scale, we think health policy remains relatively neglected as a cause area. With its broad scope, tractable solutions and relative neglectedness, we think health policy is therefore a high impact cause area.
Furthermore, health policy has knock on effects on various other high impact cause areas, such as pandemic preparedness and biosecurity, that both hinge significantly on strong health policies underlying interventions in this space. Similarly, global mental health and health systems are only as strong as the health policies governing these areas. As such, health policy is in and of itself a high impact cause area, but also foundational to the strength of interventions in several other cause areas.
How can we influence health policy?
Influencing health policy can be done in many ways, but mostly happens through advising, advocating or lobbying for policy development or reform at an organisational, national or international level.
If we consider health policy from an organisational perspective, there are several ways that we can begin to influence health policy (and in many ways, this can be the easiest way to start). Every organisation has a set of policies that oversee the practices and procedures in that workplace. By carefully understanding these policies and assessing their efficacy, we can begin to understand where or how new or altered policies might positively impact procedures. For example, the director of an anaesthetic department I previously worked with told me the department had recently changed its policy on propofol usage (changing its supplier and some departmental recommendations around its use) after a trainee led audit highlighted the extent of propofol wastage and the cost associated in that department. It was a small thing, but it was a change in local health policy nonetheless. If you are a medical student or doctor at any level, don’t underestimate the impact a judicious and thoughtful audit can have on local health policy!
From a regional or national level, affecting health policy by advising on, developing or reforming laws can be trickier and slower, but certainly impactful, given the leverage these laws then have on practice thereafter. Other issues that are global in nature can be influenced by advocating for health policy development or reform across several countries. An example of this is exposure to toxic substances such as lead, which causes a host of long-term health issues. Impressively, mean global lead levels have dropped dramatically since the late 70s (mean concentration of lead in children aged 1-5 years old was 15 µg/dL 1978; in 2016 the mean concentration for the same age group was 0.7 µg/dL) due to the phase out of leaded petrol (with Algeria being the final country to do so in 2021). Yet, national and regional variations still exist, largely due to ongoing exposure from leaded paints in households. As of 2022, only 83 countries have legally binding controls on lead concentrations in paint. By targeting this gap, NGOs like the Lead Exposure Elimination Project (LEEP) are working towards advocating for effective policy changes to reduced lead exposure through paint and have been successful in driving policy changes in Malawi, with engagement with several other governments in process.
There are also less direct but equally impactful ways to impact health policy. For example, using your expertise in a speciality to advise on related policies, conducting research in adjacent fields and even writing to members of parliament are all indirect but impactful ways of affecting policy development and reform. We will provide some further, specific examples of how to get involved in health policy later in this article.
Are doctors well placed to work on health policy?
We think doctors are well placed to work in the health policy space. As doctors, we are trained in promoting and influencing individual health and in how health systems and policies influence individual and public health. As such, doctors are credible experts in the field of health and have relevant knowledge and experience that can be beneficial in advising on strong health policies. Furthermore, our clinical experience and patient centred approach affords us insight into how individuals are impacted by policies and what sorts of policies will and won’t work. We are therefore well placed to advocate for policies that are impactful and practical at the individual and health system level.
Doctors in certain fields or specialities may have more relevant and helpful experience for particular types of health policy. For example, an infectious diseases specialist is probably better placed to advise on pandemic preparedness policy than a psychiatrist, whereas the psychiatrist is probably better placed to advise on mental health policy than the infectious diseases clinician. But from our universal training in health and health systems, we are all potentially well placed to work on health policy.
How to get involved in health policy
If you are interested in working on health policy, there are several avenues that you can follow to: a) get involved in health policy, and/or b) build career capital towards working in health policy.
If you're a medical student or junior doctor in particular, you could:
Canvas your interest in health policy to term supervisors and express your interest in being involved with any related projects
Conduct an audit at your medical school in your department on an issue that relates to health policy
Use your assignments in medical school to write about issues that relate to health policy
Contact doctors, researchers, lawyers or policy makers working in health policy who interest you and see whether they’d be open to advising you on how you can get into health policy
Consider using your elective term or a rotation to do something in public health, health policy or health administration
Get involved with local committees or working parties in your medical school, hospital, or health network
For medical students or doctors at any level:
Conduct your own research or audit on an issue affecting policy in your organisation, your country, or your field of expertise
Consider volunteering for an organisation in the health policy space, such as a committee, think tank or activist group
Consider taking a course in health policy (such as the NHS population health fellowship)
Several medical journals accept articles that have a reflection/ethics/education focus - consider writing an article related to an area of health policy that interests you and submit this to a medical journal
Consider writing an article on an area of health policy that interests you and pitch this to a non-medical publication
Consider specialising in public health, health administration or health economics
Write to a relevant member of parliament and bring your thoughts about a particular policy to their attention
Consider working for the government in a health policy related job (See a relevant 80K Hours write up on this here)
Found your own charity/NGO in the health policy space. You could do this on your own or via a formalised program like the incubation program run by Charity Entrepreneurship
Consider working for an international organisation that influences health policy, like the UN, World Bank or IMF
Consider working as a consultant at a for-profit organisation that advises government (doctors are particularly sought after in consultant roles that work on health issues)
Consider working for an elected official or government leader
Learn more about health policy
For more information about health policy:
Watch the Centre for Global Development Interview Series on different topics related to health policy, such as water, sanitation & hygiene, humanitarian reform and sustainable food systems
Read and listen to articles in the Health Policy and Planning journal / podcast series
Read the GiveWell priority list and rationale for public health regulation
Read about what a career in public health is like in the USA
Relevant organisations working on health policy to know about:
Acknowledgments
We would like to thank Akhil Basal, Abe Tolley and Erik Jentzen for their review of this document and their ongoing support, and especially Marie Firgau for coordinating and supporting us at any time and under all circumstances.
