Majoritarian and entrepreneurial politics, which brought public health and sanitation, are efforts which the public can not long sustain. Thus it was natural that, after significant victories, proponents fell to implementation, leaving little energy to wage continuing public contest. Perhaps their time and past victories were best protected by avoiding the political fray. Additional progress came when technology and public education enabled it, but attention stayed upon established programs. It also is natural that physicians and nurses play relatively limited roles in health promotion and disease prevention, given that reimbursement systems discourage spending time on patient education and that providers' training focuses on diagnosis and treatment of established disease.
Providers can keep busy doing that for which they are most appreciated and best paid.
Thus half a century of relative stagnation in health promotion and disease prevention might be explained as the natural result of the incentives and circumstances of public health officials and health care providers. The shift in smoking policy showed leadership could use scientifically derived information to capitalize upon luck and thus to shape its own opportunities. Attention to health promotion and disease prevention has mushroomed over the last two decades. While the framework and much of the general description are Wilson's, the above speculations about the four politics are drawn from several sources and this author's own experience, and are not necessarily consistent with those of Wilson.