How politics shapes public health systems around the world

Scott Greer

Q&A with University of Michigan researcher Scott Greer on democracy, trust and health policy

July 14, 2025

Scott Greer sees the world of health policy through a nuanced political lens. A political scientist at the University of Michigan School of Public Health, he explores how different countries navigate complex health challenges and political systems.

For Greer, comparing health systems across nations is more than academic research—it’s a way to understand how democracies respond to crises. By closely examining how countries like Spain, the United Kingdom and the United States handle public health challenges, he uncovers critical insights into political dynamics and health policy.

“Science is about understanding what’s actually happening, not just imagining possibilities,” said Greer, professor of Health Management and Policy and Global Public Health at Michigan Public Health. “By studying health systems in different countries, especially in Europe, I can provide fresh insights into American healthcare challenges. Instead of imagining theoretical solutions, I can point to real-world examples of how other countries have addressed similar problems.

“Recently, I’ve been working with my colleagues at Michigan Public Health to share lessons from the US experience with private equity in nursing homes, helping European countries prepare for similar changes in their healthcare systems.”

Whether he’s examining healthcare governance, COVID-19 responses or the intricate politics of public health, his research aims to provide real-world understanding of how political systems impact health.

One of Greer’s key research strengths is his ability to communicate across disciplines. In the Department of Health Management and Policy, he’s learned to understand how physical therapists, surgeons and public health doctors from different countries use evidence, communicate and make assumptions.

With a PhD in Political Science from Northwestern University and years of international research experience, Greer brings a deep and nuanced perspective to his work. As a senior expert advisor to the European Observatory on Health Systems and Policies, he translates complex political dynamics into insights that can help improve health systems.

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You’ve dedicated your career to studying the politics of health. What makes public health such a compelling field for political analysis?

Public health is an incredibly rich landscape for political analysis. It encompasses both big “P” Politics—with partisan conflicts, identity clashes and global issues—and small “p” politics that shape our daily lives.

At the national level, you see massive political dynamics: huge interest groups battling over policies, partisan debates that reveal deep societal divisions, and high-stakes global challenges. But equally fascinating are the smaller, more intimate political interactions that most people never see.

These “small p” politics play out everywhere: in medical professional hierarchies deciding who treats which patients, in rural communities determining healthcare access, and in individual decisions about when and how to seek medical care. What authorities do people trust? How do different communities make health decisions?

Health is an endlessly interesting field because it reveals that politics isn’t just about national parties or institutions. It’s also about what happens in states, cities, rural areas and even individual hospitals. For anyone truly interested in understanding how human societies function, public health offers an unparalleled window into those complex political interactions.

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In an era of widespread disinformation, how can we rebuild trust in democratic institutions?

We’re facing a serious crisis of trust. Almost no institutions have escaped a long-term decline in public confidence, and we don’t fully understand why. Part of the problem is that we don’t even measure trust effectively. When we ask people if they “trust the government,” we’re actually asking multiple complicated questions at once.

The research has revealed something fascinating: Declining health can actually reduce people’s political engagement. By investigating over 170 studies, we found that when people get sick, they experience institutional systems—healthcare, human resources, benefits—and often find these interactions impersonal and uncaring. This breeds distrust and can drive people toward populist political movements.

For anyone truly interested in understanding how human societies function, public health offers an unparalleled window into those complex political interactions.”

The solution isn’t just more transparency. We need to rebuild trust by:

  • Creating institutional systems that treat people with genuine respect
  • Strengthening political parties and community organizations that help people build collaborative skills
    Empowering individuals to feel they can actually make a difference
  • We’re essentially running a massive social experiment right now. We have an incredibly complex information environment where people are bombarded with convincing but incorrect narratives, while real-world experiences continue to shape people’s perspectives

Ultimately, I believe people fundamentally vote based on how their actual lives are going. But rebuilding trust requires us to design systems that recognize people’s dignity and agency.

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What’s one thing you wish everyone understood about public health?

I wish everyone would pause and marvel at vaccines as a remarkable human achievement. They represent the purest form of scientific triumph—we can literally teach our bodies how to defeat diseases without risking hospitalization or death. Take measles: Instead of treating a potentially devastating illness, we can simply prevent it with a small vaccine. It’s a Promethean control of technology that’s almost miraculous.

But beyond appreciating vaccines’ scientific brilliance, I want people to understand two key things. First, vaccines are incredibly safe. The very professionals who examine vaccines are rigorous precisely because they’re giving these shots to healthy people. Even the tiniest potential side effect matters to them.

Second, and most important, the narrative about vaccine resistance is incomplete. Despite loud anti-vaccine campaigns, about four-fifths of Americans still get vaccinated and support vaccination. The anti-vaccine movement is vocal and skilled at marketing misinformation, but they haven’t fundamentally changed most people’s behavior.

In fact, I believe we're on the cusp of a pro-public health backlash. With shifting federal policies and the potential for rapid disease spread, we might see a strong reaffirmation of vaccination’s importance very soon.

Vaccines aren't just a medical intervention—they’re a testament to human ingenuity and collective problem-solving. We should celebrate that.

Written by Bob Cunningham

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