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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.123117v1 98/4/644    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Béhague, D. P. Articles by Storeng, K. T. PubMed PubMed Citation Articles by Béhague, D. P. Articles by Storeng, K. T.

Dominique P. Béhague, PhD and Katerini T. Storeng, MSc

At the time of the study, Dominique P. Béhague and Katerini T. Storeng were with the Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, London, England.

Correspondence: Requests for reprints should be sent to Dominique P. Béhague, Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom (email: dominique.behague{at}lshtm.ac.uk).

Using the international maternal health field as a case study, we draw on ethnographic research to investigate how public health researchers and policy experts are responding to tensions between vertical and horizontal approaches to health improvement. Despite nominal support for an integrative health system approach, we found that competition for funds and international recognition pushes professionals toward vertical initiatives. We also highlight how research practices contribute to the dominance of vertical strategies and limit the success of evidence-based policymaking for strengthening health systems. Rather than support disease-and subfield-specific advocacy, the public health community urgently needs to engage in open dialogue regarding the international, academic, and donor-driven forces that drive professionals toward an exclusive interest in vertical programs.