Soraya P. A. Verstraeten is with the Institute for Public Health (Volksgezondheid Instituut Curaçao), Ministry of Health, Environment and Nature, Willemstad, Curaçao. Hans A. M. van Oers is with the National Institute for Public Health and the Environment, Bilthoven, the Netherlands, and with the Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, the Netherlands. Johan P. Mackenbach is with the Department of Public Health, Erasmus MC, Rotterdam, the Netherlands.
Am J Public Health. 2019 Apr;109(4):626-632. doi: 10.2105/AJPH.2018.304733. Epub 2019 Feb 21.
To determine whether Caribbean states vary in health policy performance in 11 different areas; to explore the association with sociodemographic, economical, and governance determinants; and to estimate the potential health gains of "best-practice" health policies.
We selected 50 indicators that included data on mortality (latest available, 2010-2015), intermediate outcomes, and policy implementation to calculate a state's health policy performance score. We related this score to country characteristics and calculated the potential number of avoidable deaths if the age-specific mortality rates of best-performer Martinique applied in all states.
We found large differences in health policy performance among Caribbean states. Martinique, Cuba, and Guadeloupe had the highest performance scores, and Guyana, Belize, and Suriname the lowest. Political affiliation, religious fractionalization, corruption, national income, and population density were associated with health policy performance. If the mortality rates of Martinique applied to all Caribbean states, an overall mortality reduction of 12% would be achieved.
Differences in health outcomes between Caribbean states are partly attributable to variations in health policy implementation. Our results suggest that many deaths can be prevented if Caribbean governments adopt best-practice policies.
确定加勒比国家在 11 个不同领域的卫生政策绩效是否存在差异；探讨与社会人口统计学、经济和治理决定因素的关联；并估计“最佳实践”卫生政策的潜在健康收益。
我们选择了 50 个指标，包括死亡率（最新数据为 2010-2015 年）、中间结果和政策实施情况，以计算各国的卫生政策绩效得分。我们将这一得分与国家特征相关联，并计算了如果将最佳表现者马提尼克的特定年龄死亡率应用于所有国家，可避免多少死亡人数。
我们发现加勒比国家的卫生政策绩效存在很大差异。马提尼克、古巴和瓜德罗普得分最高，而圭亚那、伯利兹和苏里南得分最低。政治派别、宗教分裂、腐败、国民收入和人口密度与卫生政策绩效相关。如果将马提尼克的死亡率应用于所有加勒比国家，总体死亡率将降低 12%。
加勒比国家之间的健康结果差异部分归因于卫生政策实施的差异。我们的结果表明，如果加勒比国家政府采用最佳实践政策，许多死亡是可以预防的。
