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瑞典跨部门卫生政策的机遇之窗——开放、半开放还是半关闭?

Window of opportunity for intersectoral health policy in Sweden--open, half-open or half-shut?

作者信息

Mannheimer Louise Nilunger, Lehto Juhani, Ostlin Piroska

机构信息

School of Public Health, University of Tampere, Tampere, Finland.

出版信息

Health Promot Int. 2007 Dec;22(4):307-15. doi: 10.1093/heapro/dam028. Epub 2007 Oct 18.

Abstract

'Health in All Policies' (HiAP) is defined as a 'horizontal, complementary policy-related strategy with a high potential for contributing to population health'. To ensure that health impacts are highlighted across sectors, the support of actors in different sectors, not just the health sector, is needed. Public health, here defined as a universally important but a low prioritized politics area, needs to involve high politics areas to fulfil the HiAP strategy. This study aimed to analyse the agenda setting, formulation, initiation and implementation of the intersectoral public health policy and one tool of HiAP, health impact assessment (HIA), at the national and local level (exemplified by Stockholm County) in Sweden. A literature search was carried out of scientific and grey literature on intersectoral health policy and HIA in Sweden. The study was a policy analysis, using a content analysis method, and the theoretical framework of Kingdon where the results were examined through problem identification (why a window of opportunity opens for an intersectoral health policy and HIA), the factors and impact of politics (support for the formulation and implementation of policy) and policy (how best to solve the problem). The results showed that actors perceived the problems (the rationale) differently depending on their agenda and interest. Politicians and experts had a high impact on the formulation of the policy, agreeing on the policy goals. However, there was little focus on implementation plans implying that the political actors were not in agreement, and the experts sometimes showing conflicting evidence-based opinions on how to best ensure the policy. Without this in place, it is difficult to involve high politics areas, and vice versa, without the involvement of high politics, it is difficult to achieve the policy. However, this is a long-term process, where small steps need to be taken, leaving the policy window half-shut.

摘要

“健康融入所有政策”(HiAP)被定义为“一项具有极大潜力促进人群健康的横向、互补性政策相关战略”。为确保各部门都能凸显健康影响,不仅需要卫生部门,还需要不同部门行为主体的支持。公共卫生在此被定义为一个普遍重要但优先级较低的政治领域,需要涉及高级政治领域才能实现HiAP战略。本研究旨在分析瑞典国家和地方层面(以斯德哥尔摩郡为例)跨部门公共卫生政策以及HiAP的一项工具——健康影响评估(HIA)的议程设定、制定、启动和实施情况。对瑞典跨部门卫生政策和HIA的科学文献及灰色文献进行了检索。该研究是一项政策分析,采用内容分析法,并运用金登的理论框架,通过问题识别(跨部门卫生政策和HIA的机会之窗为何打开)、政治因素及影响(对政策制定和实施的支持)和政策(如何最好地解决问题)来审视研究结果。结果表明,行为主体根据其议程和利益对问题(基本原理)的认知各不相同。政治家和专家对政策制定有很大影响,在政策目标上达成一致。然而,对实施计划关注甚少,这意味着政治行为主体意见不一致,而且专家有时在如何最好地确保政策实施方面给出相互矛盾的基于证据的意见。没有这些,就难以涉及高级政治领域,反之亦然,没有高级政治领域的参与,就难以实现政策目标。然而,这是一个长期过程,需要逐步推进,使得政策之窗半掩。

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