Int J Health Serv. 2012;42(1):77-94. doi: 10.2190/HS.42.1.h.
The role of political will in public health has been largely ignored. In Cuba, however, for the past 50 years, political will has been the ultimate, encompassing intersectoral action in public health. The excellent achievements in population health in Cuba during these 50 years have been widely recognized. Researchers have sought to explain this "Cuban paradox" by focusing on a large array of public health factors, including health promotion, primary care activities, and intersectoral action on health determinants. These factors constitute necessary but not sufficient conditions to achieve good health outcomes. This article defines political will and uses the experience of Cuba to illustrate the potential role of political will in public health. The authors suggest a framework for the evaluation of political will aimed at achieving good health, examining the "Five R's of political will," five observable features that may provide systematic information on the direction and realization of political will: (1) renewal of commitment, (2) reform of the system, (3) resource development, (4) review of performance, and (5) responsible management. These five features focus the spotlight on the consistency between health goals and public discourse and action.
政治意愿在公共卫生中的作用在很大程度上被忽视了。然而，在古巴，50 年来，政治意愿一直是公共卫生中最终的、包罗万象的跨部门行动。古巴在这 50 年里在人口健康方面取得的优异成绩得到了广泛认可。研究人员试图通过关注一系列广泛的公共卫生因素来解释这种“古巴悖论”，包括健康促进、初级保健活动以及对健康决定因素的跨部门行动。这些因素构成了实现良好健康结果的必要但非充分条件。本文定义了政治意愿，并利用古巴的经验来说明政治意愿在公共卫生中的潜在作用。作者提出了一个评估政治意愿以实现良好健康的框架，考察了政治意愿的“五个 R”，即五个可观察的特征，这些特征可能为政治意愿的方向和实现提供系统的信息：（1）承诺的更新，（2）制度的改革，（3）资源的开发，（4）绩效的审查，以及（5）负责任的管理。这五个特征将焦点集中在卫生目标与公共言论和行动之间的一致性上。
