onse to modern environments, and one therefore amenable to improvement through public policy measures (Milio, 1991, p. 9).
Contemporary public health policies are determined, at least in part, in the context of costs and accountability. These concepts were in place in ancient Rome, where physicians were held accountable for the effects of their "ignorance . . . recklessness . . . (and) bumbling" (Illich, 1976, p. 21).
In the United States in the late twentieth century, public health is a responsibility of all three levels of government, with the federal level exercising a major policy making role, and local governments involved primarily in the implementation of action programs, while state governments are active in each of these aspects of public health services delivery.
Public health policy in the United Kingdom is almost an exclusive responsibility of the national government (Heidenheimer, Heclo, and Adams, 1990, p. 59). Through the National Health Service, the national government in the United Kingdom also exercises primary responsibilities for the implementation of action programs for the delivery of health care services.
The development of health care policy in the United States is a cumbersome an ineffective process. A political structure at the national level that divides governing powers between the executive and legislative branches and which permits these branches to be controlled at any given time by opposing political factions all but assures that all policy development will be held hostage by the demands of a political minority. The contemporary morass of health care reform is an example of this dreadful phenomenon.
The political structure of the United Kingdom enables a sitting government to develop and implement a cohesive health care policy in an efficient manner. A majority government, therefore, could conceivably implement a health care policy of its own choosing. The practical realities of the s...