Why Evidence Is Not Enough: Power, Politics, and a Strategy Shift for Public Health.

Policy Points Public health has lost political influence because of a mismatch between the forms of power primarily deployed in this field-knowledge and moral authority-and the forms of power that currently shape societal rules and health outcomes-economic, political, ideological, and physical. Rebuilding the influence of public health requires a strategy shift that returns the field to its roots: building people power through partnerships with labor and community organizing groups; strengthening ideological power through the development of narrative infrastructure; and in moments of institutional breakdown, deploying nonviolent disruptive power to protect population health. CONTEXT: Public health is inherently political, yet it has struggled in recent decades to influence the societal decisions that shape population health. Despite strong evidence supporting policies across domains such as environmental protection, infectious disease control, labor conditions, and reproductive health, the field has faced growing political backlash and policy retrenchment. This Perspective argues that these challenges reflect a mismatch between the forms of power public health primarily deploys and the forms of power that currently shape societal rules and health outcomes. ANALYTIC APPROACH: This Perspective draws on an established typology of power to conceptually analyze the forms of power available to public health practitioners and to actors advancing policies and institutional arrangements detrimental to public health.

findingsPublic health has relied primarily on knowledge and moral power, whereas actors advancing policies detrimental to health increasingly wield economic, political, ideological, and physical power within a neoliberal political economy. Under conditions of polarization, disinformation, and institutional capture, knowledge and moral power alone are structurally insufficient to shape the societal rules that determine health. The analysis identifies additional forms of power available to public health-including people, ideological, and nonviolent disruptive power-that could strengthen the field's political influence while remaining consistent with health equity values.

conclusionsThe analysis suggests a strategic shift for public health: rebuilding people power through partnerships with labor and community organizing groups, strengthening ideological power through sustained investment in narrative infrastructure, and, when democratic institutions fail to protect health, joining with others in the strategic use of nonviolent disruptive power. More broadly, advancing population health will require public health to engage more deliberately with power and politics rather than relying on evidence alone.