How do political institutions shape the dynamics of policy change? This study traces the effects of Nazi Germany’s approach to public health on prospects for policy change in contemporary Germany. I argue that the promotion of public health policies by the Third Reich led to a backlash against government intervention on these issues after the collapse of the Nazi regime. As a result of this backlash, the post-war German government developed a decentralized and fragmented approach to public health that has slowed the pace of policy change in this domain into the contemporary period. A historical institutionalist lens and process tracing are utilized to support this argument. As evidence, it leverages more than 80 semi-structured elite interviews with public health professionals and political actors in Germany, original public opinion data, and analysis of the organizational structure of public health policymaking in all levels of government. In addition to evaluating these policies in general, the paper traces the progression of tobacco policy to demonstrate how backlash to Nazism and subsequent institutional structures slowed Germany’s ability to reduce tobacco consumption among the public. Comparisons with public health policymaking in the United States is used to strengthen the argument. The paper illustrates how critical junctures within a given policy domain can have lasting effects on the state’s ability to implement policy change effectively.