Langeveld Kirsten, Stronks Karien, Harting Janneke
Department of Public Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, Amsterdam, 1100 DE, The Netherlands.
BMC Public Health. 2016 Mar 15;16:271. doi: 10.1186/s12889-016-2832-4.
Public health is to a large extent determined by non-health-sector policies. One approach to address this apparent paradox is to establish healthy public policies. This requires policy makers in non-health sectors to become more aware of the health impacts of their policies, and more willing to adopt evidence-informed policy measures to improve health. We employed a knowledge broker to set the agenda for health and to specify health-promoting policy alternatives. This study aimed at gaining in-depth understanding of how this knowledge broker approach works.
In the context of a long-term partnership between the two universities in Amsterdam and the municipal public health service, we employed a knowledge broker who worked part-time at a university and part-time for an Amsterdam city district. When setting an agenda and specifying evidence-informed policy alternatives, we considered three individual policy portfolios as well as the policy organization of the city district. We evaluated and developed the knowledge broker approach through action research using participant observation.
Our knowledge brokering strategy led to the adoption of several policy alternatives in individual policy portfolios, and was especially successful in agenda-setting for health. More specifically, health became an issue on the formal policy agenda as evidenced by its uptake in the city district's mid-term review and the appointment of a policy analyst for health. Our study corroborated the importance of process factors such as building trust, clearly distinguishing the knowledge broker role, and adequate management support. We also saw the benefits of multilevel agenda-setting and specifying policy alternatives at appropriate policy levels. Sector-specific responsibilities hampered the adoption of cross-sectoral policy alternatives, while thematically designed policy documents offered opportunities for including them. Further interpretation revealed three additional themes in knowledge brokering: boundary spanning, a ripple effect, and participant observation.
The employment of a knowledge broker who works simultaneously on both agenda-setting for health as well as the specification of health-promoting policy alternatives seems to be a promising first step in establishing local healthy public policies. Future studies are needed to explore the usefulness of our approach in further policy development and policy implementation.
公共卫生在很大程度上由非卫生部门的政策决定。解决这一明显矛盾的一种方法是制定健康的公共政策。这要求非卫生部门的政策制定者更加意识到其政策对健康的影响，并更愿意采取基于证据的政策措施来改善健康状况。我们聘请了一名知识经纪人来设定健康议程，并明确促进健康的政策选择。本研究旨在深入了解这种知识经纪人方法的运作方式。
在阿姆斯特丹的两所大学与市公共卫生服务机构的长期合作背景下，我们聘请了一名知识经纪人，他在一所大学兼职，同时也为阿姆斯特丹的一个城区工作。在设定议程和明确基于证据的政策选择时，我们考虑了三个单独的政策组合以及城区的政策组织。我们通过参与观察的行动研究对知识经纪人方法进行了评估和完善。
我们的知识经纪策略导致在各个政策组合中采用了多项政策选择，并且在健康议程设定方面特别成功。更具体地说，健康成为正式政策议程上的一个议题，城区的中期审查中对健康议题的采纳以及任命一名健康政策分析师就是证明。我们的研究证实了过程因素的重要性，如建立信任、明确区分知识经纪人的角色以及获得足够的管理支持。我们还看到了多层次议程设定以及在适当政策层面明确政策选择的好处。部门特定职责阻碍了跨部门政策选择的采用，而主题设计的政策文件为纳入这些选择提供了机会。进一步的解读揭示了知识经纪中的另外三个主题：跨越边界、涟漪效应和参与观察。
聘请一名同时致力于健康议程设定和促进健康政策选择明确的知识经纪人，似乎是建立地方健康公共政策的有前景的第一步。未来需要开展研究来探索我们的方法在进一步的政策制定和政策实施中的实用性。
