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Perspectives |
PERSPECTIVE
One Academic’s Perspective On The Role Of Health Affairs
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Over the past twenty-five years, Health Affairs has become a visibly important source of information for policymakers. In addition, academic readers of Health Affairs have learned that the real world of policy making is complex; rarely involves decisions based on the thinking of a single discipline; and includes political, historical, and administrative factors in its outcome. Health Affairs has also made members of the academic community more appreciative of interdisciplinary work and more aware of other factors, such as health politics, that need to be addressed if their research is to be meaningful to decision-makers.
THIS ISSUE MARKS the twenty-fifth anniversary of the creation of an extraordinarily important institution— Health Affairs. Originally modeled in its purpose on the highly influential journal Foreign Affairs, Health Affairs has had a markedly different mission from those of other important scientific journals in health, medicine, and the social sciences. From the outset, it has had as its principal publication focus the critical information needs of major health policy decisionmakers at all levels of government and the private sector. Its mission has always been to bring them—in a timely and understandable fashion—relevant research, analysis, and organized intellectual thinking related to the complicated health policy issues that were likely to become important subjects of governmental decision making. Twenty-five years later, its success in accomplishing its original mission is measured by independent survey results showing that Health Affairs is the journal that health care policymakers turn to most frequently when seeking information on health policy issues.1 It is read by more than half (55 percent) of the staff of the U.S. Senate and House committees with jurisdiction in this field, which greatly outpaces other health-related journals.2
From breadth to depth. In its early years, Health Affairs, like Foreign Affairs (then and now), emphasized broader policy perspectives in its articles. Over the years, however, Health Affairs has moved away from that model to include an increasing amount of data and statistical analysis, reflecting the importance that these elements have come to have in health policy decision making.
Impact on the research community. In addition to the journal’s visible importance to policymakers, Health Affairs has had a major impact on the academic health policy and health services research community. Many academics in public policy fields are drawn to their areas of interest because of a deep desire to have their work influence future policy decision making. However, they face a continuing quandary. The scholarly journals in their field, although scientifically rigorous and often academically prestigious, are not generally read by policy decisionmakers, or even by scholars in other policy-related disciplines.
For those researchers, Health Affairs offers a mutually beneficial bargain. If academic researchers produce timely and understandable papers that are relevant to decisionmakers, the journal offers them access to the widest readership among senior decisionmakers. It also grants researchers access to a readership of other policy-oriented academics from a wide range of disciplines outside their own scholarly fields.
Joining the disciplines. I believe that this bargain has led to a narrowing of the gap between what is known by academic researchers and the knowledge base of policy decision-makers. But it also has had a reciprocal effect. Over the years, academic readers of Health Affairs have learned that the real world of policy making is complex; rarely involves decisions based on the thinking of a single discipline; and includes political, historical, and administrative factors in its outcome. This higher level of understanding of the policy decision-making process has made the academic community in this field more appreciative of interdisciplinary work and more aware of the other factors that need to be addressed if their research work is to be meaningful to policy decisionmakers.
Bringing health politics into the equation. Health Affairs also has been a source of critical information in another key area: politics. Over the years, the journal has routinely integrated timely articles on the important influence of public opinion, national election outcomes, and powerful interest groups on the direction of major policy debates. For example, insights from these articles have helped explain to readers why, even though many health policy experts have for years seen the need for major health care reform, it has been so difficult to achieve in this country. One of the reasons has been the role of public opinion. Papers that we and other researchers have published in Health Affairs have shown that although the American public has supported the principles of major health care reform, health care generally has not been at the top of the public’s agenda for government action.3 Public opinion is important because changing the health care system would involve substantial conflicts with various powerful interests. For politicians to take on these groups, they need the sense that health care reform is a very high priority for the public. During the period in which Health Affairs has been publishing, the only time that health care was such a high priority was during the early stages of debate about the Clinton health reform plan.
In addition, although a majority of Americans over the past twenty-five years have been dissatisfied with the U.S. health care system, most people with health insurance are satisfied with their own day-to-day health care arrangements and distrustful of government. As a result, a majority has never favored completely rebuilding the system (Exhibit 1
).4
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THE NEXT TWENTY-FIVE YEARS of Health Affairs have started at a fortuitous moment, because health care is likely to be an important issue in the 2008 presidential election. We are likely to see leaders from both parties bringing forth a broad array of health care proposals in a way that has not been seen since the early 1990s. No other journal is better situated than Health Affairs, in its second generation, to offer a non-partisan forum for discussing these proposals and to provide the background data and analysis to evaluate them.
| Editor's Notes |
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Bob Blendon (rblendon{at}hsph.harvard.edu) is a professor of health policy and political analysis at the Harvard School of Public Health in Boston, Massachussets, and the John F. Kennedy School of Government in Cambridge, Massachusetts.
| NOTES |
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 Top NOTES |
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- Sutton Social Marketing, An In-Depth Interview Study of Health Care Policy Professionals and Their Research Needs (Washington: Sutton Social Marketing, 2000).
- Center for Studying Health System Change, Breaking Through: Using Research to Inform National Health Policy (Washington: HSC, 2003).
- R.J. Blendon et al., "Understanding the American Public’s Health Priorities: A 2006 Perspective," Health Affairs 25 (2006): w508–w515 (published online 17 October 2006; 10.1377/hlthaff.25.w508).
[Abstract/Free Full Text] - R.J. Blendon and J.M. Benson, "Americans’ Views on Health Policy: A Fifty-Year Historical Perspective," Health Affairs 20, no. 2 (2001): 33–46
[Abstract/Free Full Text] ; Harris Interactive, "Attitudes toward the United States’ Health Care System: Long-Term Trends," Health Care News, 21 August 2002, http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2002Vol2_Iss17.pdf (accessed 27 July 2007); R.J. Blendon et al., "Americans’ Views about Health Care Costs, Access, and Quality," Milbank Quarterly 84, no. 4 (2006): 623–657[CrossRef][ISI][Medline]; and Harris Interactive poll (New York: Harris Interactive, June 2007).
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