Mitchell Institute for Education and Health Policy, Victoria University, Melbourne, Australia.
Family Medicine and Public Health, University of California, San Diego, USA.
Health Res Policy Syst. 2021 Jan 18;19(1):6. doi: 10.1186/s12961-020-00672-z.
Globally, insufficient physical activity (PA) is one of the main risk factors for premature mortality. Although insufficient PA is prevalent in nearly every demographic, people with socio-economic disadvantage participate in lower levels of PA than those who are more affluent, and this contributes to widening health inequities. PA promotion interventions in primary healthcare are effective and cost effective, however they are not widely implemented in practice. Further, current approaches that adopt a 'universal' approach to PA promotion do not consider or address the additional barriers experienced by people who experience socioeconomic disadvantages. To address the research to policy and practice gap, and taking Australia as a case study, this commentary proposes a novel model which blends an implementation science framework with the principles of proportionate universalism. Proportionate universalism is a principle suggesting that health interventions and policies need to be universal, not targeted, but with intensity and scale proportionate to the level of social need and/or disadvantage. Within this model, we propose interrelated and multi-level evidence-based policies and strategies to support PA promotion in primary healthcare while addressing health inequities. The principles outlined in the new model which blends proportionate (Pro) universalism principles and Practical, Robust Implementation and Sustainability Model (PRISM), 'ProPRISM' can be applied to the implementation of PA promotion interventions in health care settings in other high-income countries. Future studies should test the model and provide evidence of its effectiveness in improving implementation and patient health outcomes and cost-effectiveness. There is potential to expand the proposed model to other health sectors (e.g., secondary and tertiary care) and to address other chronic disease risk factors such as unhealthy diet, smoking, and alcohol consumption. Therefore, this approach has the potential to transform the delivery of health care to a prevention-focused health service model, which could reduce the prevalence and burden of chronic disease and health care costs in high-income countries.
全球范围内，体力活动不足是导致过早死亡的主要危险因素之一。尽管几乎每个年龄段的人群都存在体力活动不足的问题，但社会经济地位较低的人群参与体力活动的程度低于较富裕的人群，这导致了健康不平等的加剧。初级医疗保健中的体力活动促进干预措施是有效且具有成本效益的，但在实践中并未广泛实施。此外，目前采用“普遍”方法促进体力活动的方法并没有考虑或解决那些经历社会经济劣势的人所面临的额外障碍。为了解决研究与政策和实践之间的差距，并以澳大利亚为例，本评论提出了一种新的模型，该模型将实施科学框架与相称普遍性原则相结合。相称普遍性原则是指健康干预措施和政策需要具有普遍性，而不是针对性，但需要根据社会需求和/或劣势的程度来调整强度和规模。在这个模型中，我们提出了一系列相互关联的、多层次的循证政策和策略，以支持初级医疗保健中的体力活动促进，同时解决健康不平等问题。该模型结合了相称（Pro）普遍性原则和实用、稳健实施和可持续性模型（PRISM），提出了“ProPRISM”原则，可将其应用于高收入国家医疗保健环境中促进体力活动的干预措施的实施。未来的研究应测试该模型，并提供其在改善实施和患者健康结果以及成本效益方面的有效性的证据。该模型具有推广到其他卫生部门（例如二级和三级保健）的潜力，并可用于解决其他慢性病危险因素，如不健康饮食、吸烟和饮酒。因此，这种方法有可能将医疗保健服务转变为以预防为重点的服务模式，从而降低高收入国家慢性病的流行率和负担以及医疗保健成本。
