Healthcare is a giant sector; within it, policymakers specialize in child health, regulation, hospital-building, medicines, workforce issues, and plenty of other areas. A major challenge, not new to healthcare, is how to get all these areas to not just simply exist together but also work in tandem. Healthcare critics talk about transitioning towards ‘integration. Moving from ambitious buzzwords to reality is hard, but sick or Healthy? the novel book from Philipp Trein which examines how the coevolution of policies to prevent diseases are related to policies targeted to cure illnesses might help shed light on how to co-evolve two giant policy sectors & make sure that the systems in which they exist are ready for 21st-century challenges.
The central thesis this book is that cohesive or integrated healthcare & public health policymaking in Western countries originates from 2 factors: 1) a mixture of a strong national government that has a vast range of control over subnational levels of government.2) whether professional organizations perceive non-medical and preventative health policy as vital and campaign for it actively. Trein employs 5 case studies: the United States, The United Kingdom, Germany, Australia & Switzerland. These case studies are assessed over a longer time period i.e. from 1880 to 2010. Whereas this extensive scope of 130 years of policy history across 5 countries is commendable, it means that a study is a high-level approach and at times does not drill down into the basic practical details of the policy workings to completely comprehend the reasoning behind policy directions amongst the countries.
Instead of using the terms integration or cohesion, Trein employs the term ‘coupling’ of policy sectors. Where 2 policy sectors are firmly coupled, they are not unique i.e. they share common structures & are institutionally unified. Also, they have high responsiveness. Professionals from both sectors work together.