Gneiting Uwe, Schmitz Hans Peter
Private Sector Department, Oxfam America, Washington, DC 20005 and.
Department of Leadership Studies, University of San Diego, San Diego, CA 92110-2492, USA
Health Policy Plan. 2016 Apr;31 Suppl 1(Suppl 1):i98-109. doi: 10.1093/heapol/czv125. Epub 2016 Jan 4.
Smoking and drinking constitute two risk factors contributing to the rising burden of non-communicable diseases in low- and middle-income countries. Both issues have gained increased international attention, but tobacco control has made more sustained progress in terms of international and domestic policy commitments, resources dedicated to reducing harm, and reduction of tobacco use in many high-income countries. The research presented here offers insights into why risk factors with comparable levels of harm experience different trajectories of global attention. The analysis focuses particular attention on the role of dedicated global health networks composed of individuals and organizations producing research and engaging in advocacy on a given health problem. Variation in issue characteristics and the policy environment shape the opportunities and challenges of global health networks focused on reducing the burden of disease. What sets the tobacco case apart was the ability of tobacco control advocates to create and maintain a consensus on policy solutions, expand their reach in low- and middle-income countries and combine evidence-based research with advocacy reaching beyond the public health-centered focus of the core network. In contrast, a similar network in the alcohol case struggled with expanding its reach and has yet to overcome divisions based on competing problem definitions and solutions to alcohol harm. The tobacco control network evolved from a group of dedicated individuals to a global coalition of membership-based organizations, whereas the alcohol control network remains at the stage of a collection of dedicated and like-minded individuals.
吸烟和饮酒是导致低收入和中等收入国家非传染性疾病负担不断上升的两个风险因素。这两个问题都已受到越来越多的国际关注，但在国际和国内政策承诺、用于减少危害的资源以及许多高收入国家吸烟率的降低方面，烟草控制取得了更持续的进展。本文所呈现的研究深入探讨了为何危害程度相当的风险因素在全球受到的关注轨迹不同。该分析特别关注由致力于针对特定健康问题开展研究和倡导活动的个人及组织所组成的专门全球卫生网络的作用。问题特征和政策环境的差异塑造了旨在减轻疾病负担的全球卫生网络所面临的机遇和挑战。烟草案例的独特之处在于，烟草控制倡导者能够就政策解决方案达成并维持共识，在低收入和中等收入国家扩大影响力，并将基于证据的研究与超越核心网络以公共卫生为中心重点的倡导活动相结合。相比之下，酒精案例中的类似网络在扩大影响力方面面临困难，并且尚未克服基于对酒精危害的竞争性问题定义和解决方案所产生的分歧。烟草控制网络从一群专注的个人发展成为一个基于会员制组织的全球联盟，而酒精控制网络仍处于一群专注且志同道合的个人集合的阶段。
