Advocating for a single-payer healthcare system: What is the role of public health academics?

Abstract

Background: Historical accounts of healthcare movements have focused on grassroots organizations, as well as professional and labor-led organizations led by doctors and nurses; however, the role of public health professionals has been understudied. Given persisting uninsurance rates, public health academics are important stakeholders in achieving a single-payer system in the U.S. This study seeks to explore how public health academics perceive their role in influencing health policy and advocating for single-payer. Methods: Between April and June of 2020, 20 public health academics participated in in-depth, semi-structured qualitative interviews. A grounded theory approach guided the study, including the data collection and analytic processes. The Advocacy Coalition Framework shaped the development of our interview guide. Results: Public health academics hold varied perspectives regarding their role in influencing policy, including single-payer polices, with some more certain of their role than others. Participants suggested that providing evidence, crafting effective messages, utilizing diverse media sources, working with activists, and teaching healthcare payment models were all roles that public health academics could play in pursuit of single-payer. Participants noted that fear of engaging with politicized work, funding challenges and research gaps, and the perception that single-payer is unattainable in the U.S. undermined their willingness to engage in advocacy work toward that end. Finally, participants provided mixed opinions on the role of public health professional associations in supporting single-payer proposals. Conclusions: We recommend that academic institutions and funding mechanisms encourage engagement with single-payer research and advocacy work by altering incentives and providing space for political work and debate.