Holly Jarman

Tobacco control policies are complex with the potential for significant health effects. The public health actors and regulators who design, influence, and implement these policies place a high value on the evidence base that underpins them, engaging in scientific and applied debates about how to evaluate the success of existing policies and justify new actions. To investigate the construction of this evidence base, we conducted interviews with 40 individuals involved in formulating, advising, and implementing flavour restrictions for tobacco products. Our interviews inform case studies of six jurisdictions in three US states, Canada, the UK, and the Netherlands. We find that tobacco policy stakeholders, which include regulators and public health personnel, play a vital role as data integrators in the construction of this evidence base: they bring together disparate types and sources of information to create synthetic evaluations of tobacco control policies that incorporate the complexity of the policy environment and differential impacts on population subgroups. Significantly, data integration is not easy to replicate or automate; should these positions be lost due to funding cuts as political priorities shift in the US and globally, the capacity they add to our policymaking and research systems will be difficult to restore.

In 2025, the Trump Administration imposed significant tariffs on imports to the US as part of aggressive trade negotiations with other countries. Tariffs have important impacts on health that include increases in the prices that consumers and businesses pay for goods and potential damage to global supply chains. The Administration also pushed foreign governments to change their domestic policies on issues such as pharmaceutical pricing, claiming that other countries' policies are responsible for high US drug prices. Some US politicians celebrated new tariff revenues, suggesting that they could be used to support key health programs and welfare payments to individuals and farmers. We argue that funding health programs through tariffs has negative consequences for health and for democracy. US tariffs are likely to have harmful effects on the global economy and America's relationship with other countries. Tariff decisions are being determined via a process that is not fully democratic: the US Executive cannot redirect tariff revenue to fix policy problems at will without Congressional authorization, and absent Congressional scrutiny, this process is not transparent or accountable. And tariffs are a regressive tax, hurting people on the lowest incomes the most through increased prices. Even at 2025 levels, tariff revenues are unlikely to ever be a substantial, sustainable source of funding for key health programs and are instead likely to be targeted at core Trump supporters only.

Public health capacity can be placed in local public health departments or alternative bureaucracies. Provision of local services through special district (SD) governments has been widely studied in local politics. What have not been examined are the implications of SD governance for the provision of public health services. Public health services are often categorically different from other types of local government services because they address problems affecting the entire local population. Siloing public health governance may influence not only agency capacity to carry out tasks, but the effectiveness and equity of public health solutions. We examine SD governance of local mosquito control in Florida, to analyze differences in policy-design and implementation between SDs and non-SDs across counties. SDs are primarily located in wealthy districts, have substantially greater resources, and provided over limited, sub-county, service-areas. Jurisdictions outside of SD service-provision often have no local mosquito control governance, relying on intergovernmental services.

Compound threats—two or more relatively rare and high-consequence events that co-occur in time and space, amplifying their effects—present difficult-to-predict events that can impose potentially grave consequences. While there has been increasing attention placed on modeling the probabilities and outcomes of compounding threats, there are no proposed governance models for compound threats, limiting the ability of policymakers and decisionmakers to manage such crises in the future. We visualize resilience for compound threats to understand how critical functioning and system utility to contain hazards, to absorb losses, and to recover from stressors shifts over time. Using North Carolina as a case study, we conduct a compound threats assessment for disaster risk to showcase its effectiveness in more accurately predicting disaster risk areas, as well highlight the limitations of existing risk models used by policymakers. We propose a resilience-augmented conceptual framework to rethink risk governance for compound threats that allows for speed (specifically flexibility and adaptability) in situations of high uncertainty while working within the rigid, slow-moving boundaries of government and bureaucracy. Finally, we discuss strategies for key actors to apply a resilience-augmented governance approach to compound threats into operational decision-making during crisis situations.

Politicians often claim to be “following science” but their claims are, reasonably, disputed. To claim to be following the science can mean tha

Healthcare systems frequently find themselves ill-equipped to handle unexpected shocks, underscoring the importance of evaluating and enhancing their resilience. This chapter explores policy responses to the COVID-19 pandemic, seeking to shed light on practices that enhanced the resilience of the health systems. It acknowledges challenges in defining and measuring resilience, considering various factors beyond the scope and depth of the health system like political leadership and the broader governance factors, the resilience of the health workforce, and the importance of trust. The chapter’s main focus is on the shock management phase and on distilling the key adaptive, absorptive, and transformative strategies that contributed to resilient health system responses. However, it also goes beyond the shock management phase, acknowledging the importance of investing in health system preparedness, particularly in adequate and well-supported health workforce but also in effective governance and generalist state capacity, and in post-shock learning.

Equitable allocation and distribution of the COVID-19 vaccine have proven to be a major policy challenge exacerbated by incomplete pandemic risk data. To rectify this shortcoming, a three-step data visualization methodology was developed to assess COVID-19 vaccination equity in the United States using state health department, U.S. Census, and CDC data. Part one establishes an equitable pathway deviation index to identify populations with limited vaccination. Part two measures perceived access and public intentions to vaccinate over time. Part three synthesizes these data with the social vulnerability index to identify areas and communities at particular risk. Results demonstrate significant equity differences at a census-tract level, and across demographic and socioeconomic population characteristics. Results were used by various federal agencies to improve coordinated pandemic risk response and implement a commitment to equity as defined by the Executive Order regarding COVID-19 vaccination and booster policy. This methodology can be utilized in other fields where addressing the difficulties of promoting health equity in public policy is essential.