Department of Public Health & Policy, Institute of Psychology, Health & Society, Whelan Building, Quadrangle, University of Liverpool, Liverpool, UK.
J Public Health (Oxf). 2018 Jun 1;40(2):350-358. doi: 10.1093/pubmed/fdx055.
Non-communicable disease prevention strategies usually target the four major risk factors of poor diet, tobacco, alcohol and physical inactivity. Yet, the most effective approaches remain disputed. However, increasing evidence supports the concept of an effectiveness hierarchy. Thus, 'downstream' preventive activities targeting individuals (such as 1:1 personal advice, health education, 'nudge' or primary prevention medications) consistently achieve a smaller population health impact than interventions aimed further 'upstream' (for instance, smoke-free legislation, alcohol minimum pricing or regulations eliminating dietary transfats). These comprehensive, policy-based interventions reach all parts of the population and do not depend on a sustained 'agentic' individual response. They thus tend to be more effective, more rapid, more equitable and also cost-saving. This effectiveness hierarchy is self-evident to many professionals working in public health. Previously neglected in the wider world, this effectiveness hierarchy now needs to be acknowledged by policy makers.
非传染性疾病预防策略通常针对不良饮食、烟草、酒精和缺乏身体活动这四个主要危险因素。然而，最有效的方法仍存在争议。但是，越来越多的证据支持有效性层次的概念。因此，针对个人的“下游”预防活动（如一对一的个人建议、健康教育、“推动”或初级预防药物）对人群健康的影响始终小于针对更上游的干预措施（例如，无烟立法、酒精最低定价或消除饮食反式脂肪的规定）。这些全面的、基于政策的干预措施涵盖了人口的各个方面，不依赖于持续的“能动”个体反应。因此，它们往往更有效、更迅速、更公平，也更具成本效益。这一有效性层次对许多从事公共卫生工作的专业人员来说是不言而喻的。这一有效性层次以前在更广泛的领域被忽视，现在需要得到政策制定者的承认。
