Hoe Connie, Rodriguez Daniela C, Üzümcüoğlu Yeşim, Hyder Adnan A
Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
Soc Sci Med. 2016 Sep;165:36-45. doi: 10.1016/j.socscimed.2016.07.027. Epub 2016 Jul 25.
In recent years, tobacco control emerged as a political priority in Turkey and today the country is widely regarded as one of the global leaders in tackling tobacco use. Although political priority is considered a facilitating factor to the success of addressing public health issues, there is a paucity of research to help us understand how it is developed in middle-income countries. The primary aim of this study is to understand the process and determinants of how tobacco control became a political priority in Turkey using the Multiple Streams Framework. A mixed-methods case study approach was used whereby data were gathered from three different sources: in-depth interviews (N = 19), document reviews (N = 216), and online self-administered surveys (N = 61). Qualitative data were collected for the purpose of understanding the processes and determinants that led to political prioritization of tobacco control and were analyzed using deductive and inductive coding. Quantitative data were collected to examine the actors and were analyzed using descriptive statistics and network nominations. Data were triangulated. Findings revealed that tobacco control achieved political priority in Turkey as a result of the development and convergence of multiple streams, including a fourth, separate global stream. Findings also shed light on the importance of Turkey's foreign policy in the transformation of the political stream. The country's desire for European Union accession and global visibility helped generate a political environment that was receptive to global norms for tobacco control. A diverse but cohesive network of actors joined forces with global allies to capitalize on this opportunity. Results suggest (1) the importance of global-agenda setting activities on political priority development, (2) the utility of aligning public health and foreign policy goals and (3) the need to build a strong global incentive structure to help entice governments to take action on public health issues.
近年来，烟草控制在土耳其成为一项政治优先事项，如今该国被广泛视为全球应对烟草使用的领导者之一。尽管政治优先事项被认为是解决公共卫生问题取得成功的一个促进因素，但缺乏相关研究来帮助我们了解它在中等收入国家是如何形成的。本研究的主要目的是运用多源流框架来理解烟草控制在土耳其成为政治优先事项的过程和决定因素。采用了混合方法案例研究方法，从三个不同来源收集数据：深度访谈（N = 19）、文件审查（N = 216）和在线自填式调查（N = 61）。收集定性数据是为了了解导致烟草控制政治优先化的过程和决定因素，并使用演绎和归纳编码进行分析。收集定量数据以考察行为主体，并使用描述性统计和网络提名进行分析。对数据进行了三角互证。研究结果表明，由于多股力量的发展和汇聚，包括第四条单独的全球力量，烟草控制在土耳其成为了政治优先事项。研究结果还揭示了土耳其外交政策在政治源流转变中的重要性。该国加入欧盟的愿望和全球知名度有助于营造一个接受全球烟草控制规范的政治环境。一个多元化但有凝聚力的行为主体网络与全球盟友携手利用了这一机会。结果表明：（1）全球议程设定活动对于政治优先事项发展的重要性；（2）使公共卫生和外交政策目标保持一致的效用；（3）需要建立一个强大的全球激励结构，以促使各国政府就公共卫生问题采取行动。
