Carey Gemma, Crammond Brad, Keast Robyn
National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
BMC Public Health. 2014 Oct 20;14:1087. doi: 10.1186/1471-2458-14-1087.
The evidence base for the impact of social determinants of health has been strengthened considerably in the last decade. Increasingly, the public health field is using this as a foundation for arguments and actions to change government policies. The Health in All Policies (HiAP) approach, alongside recommendations from the 2010 Marmot Review into health inequalities in the UK (which we refer to as the 'Fairness Agenda'), go beyond advocating for the redesign of individual policies, to shaping the government structures and processes that facilitate the implementation of these policies. In doing so, public health is drawing on recent trends in public policy towards 'joined up government', where greater integration is sought between government departments, agencies and actors outside of government.
In this paper we provide a meta-synthesis of the empirical public policy research into joined up government, drawing out characteristics associated with successful joined up initiatives.We use this thematic synthesis as a basis for comparing and contrasting emerging public health interventions concerned with joined-up action across government.
We find that HiAP and the Fairness Agenda exhibit some of the characteristics associated with successful joined up initiatives, however they also utilise 'change instruments' that have been found to be ineffective. Moreover, we find that - like many joined up initiatives - there is room for improvement in the alignment between the goals of the interventions and their design.
Drawing on public policy studies, we recommend a number of strategies to increase the efficacy of current interventions. More broadly, we argue that up-stream interventions need to be 'fit-for-purpose', and cannot be easily replicated from one context to the next.
在过去十年中，健康的社会决定因素影响的证据基础得到了显著加强。公共卫生领域越来越多地以此为基础来推动改变政府政策的论证和行动。“健康融入所有政策”（HiAP）方法，以及2010年英国 Marmot 健康不平等审查（我们称之为“公平议程”）的建议，不仅倡导重新设计个别政策，还致力于塑造有助于这些政策实施的政府结构和流程。在此过程中，公共卫生借鉴了公共政策中近期出现的“联合政府”趋势，即寻求政府部门、机构和政府外部行为体之间更大程度的整合。
在本文中，我们对关于联合政府的实证公共政策研究进行了元综合分析，提炼出与成功的联合举措相关的特征。我们将这种主题综合作为比较和对比新兴的、涉及政府间联合行动的公共卫生干预措施的基础。
我们发现，HiAP 和公平议程展现出一些与成功的联合举措相关的特征，但它们也使用了一些已被证明无效的“变革工具”。此外，我们发现——与许多联合举措一样——干预措施的目标与其设计之间的一致性还有提升空间。
借鉴公共政策研究，我们推荐了一些提高当前干预措施有效性的策略。更广泛地说，我们认为上游干预措施需要“有的放矢”，且不能轻易从一个背景复制到另一个背景。
