ACT Health, Canberra, ACT, Australia; Australian National University Medical School, Canberra, ACT, Australia.
ACT Health , Canberra, ACT , Australia.
Front Public Health. 2016 Mar 30;4:60. doi: 10.3389/fpubh.2016.00060. eCollection 2016.
To illuminate the key components of multi-sector reform to address the obesogenic environment in New York City during the administration of Mayor Michael Bloomberg from 2002 to 2013, we conducted a case study consisting of interviews with and a critical analysis of the experiences of leading decision makers and implementers.
Key informant interviews (N = 41) conducted in 2014 were recorded, transcribed, coded, and thematically analyzed. Participants included officials from the Health Department and other New York City Government agencies, academics, civil society members, and private sector executives.
Participants described Mayor Bloomberg as a data-driven politician who wanted to improve the lives of New Yorkers. He appointed talented Commissioners and encouraged them and their staff to be bold, innovative, and collaborative. Multiple programs spanning multiple sectors, with varied approaches and targets, were supported. This study found that much of the work relied on loose coalitions across City Government, with single agencies responsible for their own agendas, some with health co-benefits. Many policies were implemented through non-legislative mechanisms such as executive orders and the Health Code. Despite support from academic and some civil society groups, strong lobbying from industry and an unfavorable media led to some reforms being modified, legally challenged or blocked completely, particularly food environment modifiers. In contrast, reforms of the physical environment were described as highly consultative across and outside government and resulted in slower but more sustained reform.
The Bloomberg administration was a "window of opportunity" with the imprimatur of the executive to progress a long-term, multi-faceted obesity prevention strategy, which has successfully reversed childhood trends. Through the involvement of external researchers and the extensive use of empirical data from a wide range of participants, this study offers a unique insight into the ways in which this was achieved. While some of the aspects of the reforms in New York City are unique to that setting at that time, there are important lessons that are transferable to other urban settings. These include: strong and consistent leadership; a commitment to innovative approaches and cross-sectoral collaboration; and a context to support and encourage this approach.
通过对迈克尔·布隆伯格（Michael Bloomberg）市长于 2002 年至 2013 年在任期间纽约市多部门改革的关键内容进行案例研究，阐明解决肥胖环境的主要组成部分。我们对主要决策者和执行者的经验进行了访谈和批判性分析。
2014 年进行了关键知情者访谈（N=41），对访谈进行了记录、转录、编码和主题分析。参与者包括卫生署和其他纽约市政府机构的官员、学者、民间社会成员和私营部门高管。
参与者将布隆伯格市长描述为一位注重数据的政治家，他希望改善纽约人的生活。他任命了有才华的专员，并鼓励他们及其工作人员大胆、创新和协作。多个跨越多个部门的项目，采用不同的方法和目标，都得到了支持。本研究发现，大部分工作依赖于市政府内部松散的联盟，单一机构负责自己的议程，其中一些具有健康的共同效益。许多政策是通过行政命令和卫生法规等非立法机制实施的。尽管得到了学术界和一些民间社会团体的支持，但来自行业的强大游说以及不利的媒体报道导致一些改革被修改、法律质疑或完全阻止，特别是食品环境调节剂。相比之下，物理环境的改革被描述为在政府内外进行了广泛的协商，导致改革进展缓慢但更持续。
布隆伯格政府是一个“机会之窗”，具有行政长官的认可，可以推进一项长期的、多方面的肥胖预防战略，该战略已成功扭转了儿童时期的趋势。通过外部研究人员的参与以及广泛利用来自广泛参与者的经验数据，本研究提供了一个独特的视角，了解了这一目标是如何实现的。虽然纽约市的一些改革方面在当时的背景下是独特的，但有一些重要的经验教训可以转移到其他城市环境中。这些经验包括：强有力和一致的领导；对创新方法和跨部门合作的承诺；以及支持和鼓励这种方法的背景。
