Int J Health Serv. 2014;44(1):185-94. doi: 10.2190/HS.44.1.k.
Significant improvements in population health are likely to arise when the social determinants ofhealth are addressed. This creates a challenge for health systems, as the policy levers to influence the determinants largely lie outside of their direct control. Health agencies have been attempting to develop responses that affect these policy levers with mixed success. Success often requires particular conditions or "windows of opportunity" to be present before even small systemic change can be made. The government of South Australia has developed a practical, policy-oriented response to address the determinants of health--Health in All Policies--and has been successfully working across government for the past five years, using a policy learning process to implement this approach. This article will focus on how the South Australian Health in All Policies initiative started and the conditions that enabled South Australia to establish a centralized governance structure, harness a group of cross-sector policy entrepreneurs, and conduct health lens projects across a range of policy issues. The authors will comment on the nature of these conditions and their relevance for other governments struggling to reduce the burden of chronic disease and growing health budgets by addressing the social determinants of health.
当社会决定因素得到解决时，人口健康状况可能会得到显著改善。这给卫生系统带来了挑战，因为影响这些决定因素的政策杠杆在很大程度上不在其直接控制范围内。卫生机构一直在试图制定应对措施，以影响这些政策杠杆，但收效甚微。即使是进行微小的系统变革，也往往需要特定的条件或“机会之窗”才能实现。南澳大利亚州政府制定了一项实用的、面向政策的方案来解决健康决定因素问题——所有政策中的健康，并在过去五年中成功地在政府内部开展工作，利用政策学习过程来实施这一方法。本文将重点介绍南澳大利亚州所有政策中的健康倡议是如何启动的，以及南澳大利亚州是如何建立集中治理结构、利用一批跨部门政策企业家，并在一系列政策问题上开展健康视角项目的。作者将对这些条件的性质及其对其他政府的相关性进行评论，这些政府正在努力通过解决健康的社会决定因素来减轻慢性病负担和不断增长的卫生预算。
