Implications of social class and race for urban public health policy making: a case study of HIV/AIDS and TB policy in Washington, DC

This paper explores how social class and race affect the public health policy-making process in an urban area. Ethnographic methods were used to collect and analyze information about HIV/AIDS and tuberculosis policymaking by the Washington, DC Commission of Public Health. Kingdon's conceptual model of policy making was used to analyze and understand the process. The problems of HIV/AIDS and tuberculosis in the district have important social class dimensions that were not always made explicit, but were instead defined in terms of 'race' and 'place'. Social class considerations and racial politics shaped what policies were developed or not developed and implemented successfully or failed. This study, which has national and international implications, concludes that there is a need to improve our understanding of the complex social dimensions of public health problems, there needs to be more consideration of the politics of strategy formulation and how issues of social class and race affect this process; and public health needs to strengthen its constituency in order to build support for the successful development and implementation of policy. (C) 1999 Elsevier Science Ltd. All rights reserved.