Katikireddi Srinivasa Vittal, Hilton Shona, Bonell Chris, Bond Lyndal
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom; Department of Public Health and Policy, NHS Lothian, Edinburgh, United Kingdom.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom.
PLoS One. 2014 Mar 26;9(3):e91185. doi: 10.1371/journal.pone.0091185. eCollection 2014.
Minimum unit pricing of alcohol is a novel public health policy with the potential to improve population health and reduce health inequalities. Theories of the policy process may help to understand the development of policy innovation and in turn identify lessons for future public health research and practice. This study aims to explain minimum unit pricing's development by taking a 'multiple-lenses' approach to understanding the policy process. In particular, we apply three perspectives of the policy process (Kingdon's multiple streams, Punctuated-Equilibrium Theory, Multi-Level Governance) to understand how and why minimum unit pricing has developed in Scotland and describe implications for efforts to develop evidence-informed policymaking.
Semi-structured interviews were conducted with policy actors (politicians, civil servants, academics, advocates, industry representatives) involved in the development of MUP (n = 36). Interviewees were asked about the policy process and the role of evidence in policy development. Data from two other sources (a review of policy documents and an analysis of evidence submission documents to the Scottish Parliament) were used for triangulation.
The three perspectives provide complementary understandings of the policy process. Evidence has played an important role in presenting the policy issue of alcohol as a problem requiring action. Scotland-specific data and a change in the policy 'image' to a population-based problem contributed to making alcohol-related harms a priority for action. The limited powers of Scottish Government help explain the type of price intervention pursued while distinct aspects of the Scottish political climate favoured the pursuit of price-based interventions.
Evidence has played a crucial but complex role in the development of an innovative policy. Utilising different political science theories helps explain different aspects of the policy process, with Multi-Level Governance particularly useful for highlighting important lessons for the future of public health policy.
酒精最低限价是一项新型公共卫生政策，有改善人群健康状况和减少健康不平等现象的潜力。政策过程理论可能有助于理解政策创新的发展，进而为未来的公共卫生研究与实践总结经验教训。本研究旨在通过采用“多视角”方法来理解政策过程，从而解释酒精最低限价政策的发展情况。具体而言，我们运用政策过程的三个视角（金登的多源流理论、间断均衡理论、多层治理理论）来理解酒精最低限价政策在苏格兰是如何以及为何得以发展，并描述其对制定循证决策的启示。
对参与酒精最低限价政策制定的政策行动者（政治家、公务员、学者、倡导者、行业代表）进行了半结构化访谈（n = 36）。受访者被问及政策过程以及证据在政策制定中的作用。另外两个来源的数据（政策文件综述以及提交给苏格兰议会的证据文件分析）用于三角互证。
这三个视角为政策过程提供了互补性理解。证据在将酒精政策问题呈现为需要采取行动的问题方面发挥了重要作用。苏格兰特有的数据以及政策“形象”向基于人群的问题的转变，促使与酒精相关的危害成为行动的优先事项。苏格兰政府权力有限有助于解释所采取的价格干预类型，而苏格兰政治氛围的不同方面则有利于推行基于价格的干预措施。
证据在一项创新政策的发展过程中发挥了关键但复杂的作用。运用不同的政治学理论有助于解释政策过程的不同方面，多层治理理论对于凸显公共卫生政策未来的重要经验教训尤其有用。
