How to Inform Citizens Who Do Not Listen- The Failures of Public Health Policy in the United States and Denmark.

Three decades ago, most Western nations experienced a shift in health policy. While downplaying their belief in treatment technology, the potentials of preventive public health were suddenly viewed upon with unbridled optimism. As a Canadian report argued in 1974, this potential required governments to 'get into the business of modifying behavior', i.e. to counter lifestyle diseases by getting citizens to exercise more, but eat, drink, and smoke less than they used to.Despite the clear and early identification of goals and target groups, the experience of public health policy has been less than successful. Many citizens in the developed world already know what they are supposed to do and yet they almost never conform with the goals of policy makers in the field. What accounts for this gap? Is it because citizens never listen, or is the goal setting of public health policy to blame? This paper seeks to advance our understanding of policy failures in public health and other forms of preemptive action. The paper is motivated by the view that the interaction of knowledge and politics is currently an underdeveloped topic in the public policy literature, partly because knowledge is often reduced to a somewhat technical input factor. Undertheorized in public policy is both what knowledge is and what it does for the evaluation of policy success or failure. As the public health case illustrates, there is no linear relation between knowledge, governmental action, and successful changes to individual behavior.In order to improve policy theory on the topic of knowledge, this paper combines a more traditional style of public policy case comparison with ideas drawn from a Foucauldian perspective on knowledge, power and subjectivity. Clearly associated with discourse analysis, this latter perspective focuses on how various knowledge forms structure our conception of healthy citizens and the prospects of governmental action.Based on a larger study of public health documents in the United States and Denmark between 1975 and 2005, this paper demonstrates that two highly different systems of health care and welfare provision has experienced similar difficulties in putting knowledge into action. This similarity supports the claim that there is a proprietary logic of policy failure within this area, part of which has to do with governing through knowledge, and part of which is due to the preventive character of this policy area.The experience of policy failure generates new health promoting instruments, and in particular both countries have shifted its efforts from reporting statistical knowledge to focus much more on strategically designed forms of health communication. This result leaves public health policy in a normative dilemma, however, because while policy makers generally seek to give individuals more responsibility for their own health status, their communication is predesigned on the premise that people do not listen and are not able to meet the responsibility handed to them. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]