Health Policy Research Consortium, CTIS Inc., Greenbelt, MD, USA.
J Racial Ethn Health Disparities. 2018 Apr;5(2):366-374. doi: 10.1007/s40615-017-0379-4. Epub 2017 May 27.
Effective, timely, and intentional policy efforts can significantly impact and improve the public's health and reduce racial and ethnic health disparities across the nation. Creating and implementing responsive policies at the state and county level is essential to supporting community efforts to improve health behaviors and health outcomes, particularly for communities of color who bear the brunt of disease risk and negative health outcomes. Using policy examples from the State of Maryland and Prince George's County, the largest and wealthiest predominately African-American county in the USA, this case study highlights the importance of state and county policy action when presented with opportunities to affect long-lasting, positive change. We examine each jurisdiction's policy response through the lens of timeliness, intentionality, and effectiveness. At first glance, it would appear that Maryland responded effectively to the rise in tobacco use. Similarly, at face value, it appears that Prince George's County's unchecked rise in obesity rates among African-Americans is an example of nonresponsiveness among local policymakers in the face of an obesity epidemic. However-guided by a more nuanced understanding of "policy responsiveness"-this analysis uncovers a more revealing picture, with important strengths and limitations seen in both policy situations. This analysis raises critical questions about the determinants of jurisdictions' health policy capacity and how policymakers might best be supported in their efforts to build an arsenal of health policies that are timely, effective, and intentional in meeting the needs of vulnerable communities.
有效的、及时的和有针对性的政策努力可以显著影响和改善公众的健康,并减少全国范围内的种族和族裔健康差距。在州和县级创建和实施响应性政策对于支持社区改善健康行为和健康结果的努力至关重要,特别是对于那些承担疾病风险和负面健康结果主要负担的有色人种社区。本案例研究以美国最大和最富裕的主要是非裔美国人的县——马里兰州和乔治王子县为例,强调了在有机会产生持久积极变化时,州和县级政策行动的重要性。我们通过及时性、针对性和有效性的视角来审视每个管辖区的政策反应。乍一看,马里兰州似乎对烟草使用的增加做出了有效的反应。同样,从表面上看,乔治王子县非洲裔美国人肥胖率的失控上升似乎是地方政策制定者在面对肥胖流行时反应迟钝的一个例子。然而,在对“政策响应性”有更细微理解的指导下,这种分析揭示了一个更具启示性的画面,这两种政策情况都有重要的优势和局限性。这种分析提出了关于司法管辖区健康政策能力的决定因素的关键问题,以及如何最好地支持政策制定者努力建立一个及时、有效和有针对性的健康政策武器库,以满足弱势社区的需求。