Murphy Madhuvanti M, Unwin Nigel, Samuels T Alafia, Hassel Trevor A, Bishop Lisa, Guell Cornelia
Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, Barbados.
Medical Research Council Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom.
Rev Panam Salud Publica. 2018 Dec 17;42:e174. doi: 10.26633/RPSP.2018.174. eCollection 2018.
To identify, assess, and compare existing policies on noncommunicable diseases (NCDs) in the Caribbean, gaps in policy responses, and the factors influencing successful policy development and implementation following the Port of Spain Declaration of 2007. Specifically, to examine policies that target the upstream determinants of two NCD risk factors-unhealthy diets and physical inactivity.
A total of 76 semi-structured interviews with 80 relevant stakeholders in government, the private sector, and civil society were complemented by policy document analysis. Interviews were analyzed pragmatically, framed by the CARICOM government commitments, the WHO NCD Action Plan, a Multiple Streams framework approach, and realist evaluation ideas.
The most widely-reported policy successes involved health promotion activities (e.g., school meal programs) that leveraged multisectoral collaboration among government ministries, such as Health, Education, and Agriculture. Large policy gaps still exist around creating legislative, physical, and social environments to support healthy eating and physical activity at the population level. Multisectoral NCD commissions successfully reached across sectors, but had limited influence on policy development. Different policy levels emerged with national-level policies considered a lengthy process, while "On-the-ground" programming was considered faster to implement than national policies. External barriers included a reliance on food imports enabled by international trade agreements limited availability, quality, and affordability of healthy foods. International pushback limited legislation to reduce food imports and the absence of an international/regional framework, similar to the Framework Convention on Tobacco Control, further impedes efforts.
Regional collaboration and political support across sectors are essential to accelerating the pace of action to support healthy eating and active living environments. Policy "blueprints" could accelerate the process of development. Regional "NCD champions" could spearhead such responses and approaches.
识别、评估和比较加勒比地区关于非传染性疾病（NCDs）的现有政策、政策应对方面的差距，以及自2007年《西班牙港宣言》发布后影响政策成功制定和实施的因素。具体而言，研究针对两种非传染性疾病风险因素（不健康饮食和身体活动不足）的上游决定因素的政策。
对政府、私营部门和民间社会的80名相关利益攸关方进行了76次半结构化访谈，并辅以政策文件分析。访谈采用务实的方式进行分析，以加共体政府承诺、世卫组织非传染性疾病行动计划、多源流框架方法和现实主义评价理念为框架。
最广泛报道的政策成功案例涉及健康促进活动（如学校膳食计划），这些活动利用了卫生部、教育部和农业部等政府部门之间的多部门合作。在营造支持人群层面健康饮食和身体活动的立法、物质和社会环境方面，仍然存在很大的政策差距。多部门非传染性疾病委员会成功地跨部门开展工作，但对政策制定的影响有限。出现了不同的政策层面，国家层面的政策被认为是一个漫长的过程，而“实地”项目的实施被认为比国家政策更快。外部障碍包括依赖国际贸易协定促成的食品进口，这限制了健康食品的供应、质量和可承受性。国际上的反对限制了减少食品进口的立法，而且缺乏类似于《烟草控制框架公约》的国际/区域框架，这进一步阻碍了相关努力。
跨部门的区域合作和政治支持对于加快支持健康饮食和积极生活环境的行动步伐至关重要。政策“蓝图”可以加快制定进程。区域“非传染性疾病倡导者”可以带头采取此类应对措施和方法。
