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从系统视角理解肥胖预防政策决策的动态:以维多利亚州健康共融为例。

Understanding the dynamics of obesity prevention policy decision-making using a systems perspective: A case study of Healthy Together Victoria.

机构信息

Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia.

School of Population Health, University of Auckland, Auckland, New Zealand.

出版信息

PLoS One. 2021 Jan 22;16(1):e0245535. doi: 10.1371/journal.pone.0245535. eCollection 2021.


DOI:10.1371/journal.pone.0245535
PMID:33481898
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7822316/
Abstract

INTRODUCTION: Despite global recommendations for governments to implement a comprehensive suite of policies to address obesity, policy adoption has been deficient globally. This paper utilised political science theory and systems thinking methods to examine the dynamics underlying decisions regarding obesity prevention policy adoption within the context of the Australian state government initiative, Healthy Together Victoria (HTV) (2011-2016). The aim was to understand key influences on policy processes, and to identify potential opportunities to increase the adoption of recommended policies. METHODS: Data describing government processes in relation to the adoption of six policy interventions considered as part of HTV were collected using interviews (n = 57), document analyses (n = 568) and field note observations. The data were analysed using multiple political science theories. A systematic method was then used to develop a Causal Loop Diagram (CLD) for each policy intervention. A simplified meta-CLD was generated from synthesis of common elements across each of the six policy interventions. RESULTS: The dynamics of policy change could be explained using a series of feedback loops. Five interconnected balancing loops served to reduce the propensity for policy change. These pertained to an organisational norm of risk aversion, and the complexity resulting from a whole-of-government policy approach and in-depth stakeholder consultation. However, seven virtuous reinforcing loops helped overcome policy resistance through policy actor capabilities that were improved over time as policy actors gained experience in advocating for change. CONCLUSION: Policy processes for obesity prevention are complex and resistant to change. In order to increase adoption of recommended policies, several capabilities of policy actors, including policy skills, political astuteness, negotiation skills and consensus building, should be fostered and strengthened. Strategies to facilitate effective and broad-based consultation, both across and external to government, need to be implemented in ways that do not result in substantial delays in the policy process.

摘要

简介:尽管全球建议各国政府实施一整套政策来解决肥胖问题,但全球范围内的政策采纳情况一直不足。本文利用政治学理论和系统思维方法,考察了澳大利亚州政府倡议“健康维多利亚”(HTV)(2011-2016 年)背景下,决策背后预防肥胖政策采纳的动态。目的是了解政策过程的主要影响因素,并确定增加推荐政策采纳的潜在机会。

方法:使用访谈(n=57)、文件分析(n=568)和现场观察收集了描述与 HTV 相关的六项政策干预措施采纳过程的政府流程数据。使用多种政治学理论对数据进行了分析。然后,使用一种系统的方法为每个政策干预措施生成了一个因果关系图(CLD)。从六个政策干预措施中的每一个的共同要素综合生成了一个简化的元 CLD。

结果:可以使用一系列反馈环来解释政策变化的动态。五个相互关联的平衡环有助于减少政策变化的倾向。这些与组织规避风险的规范、政府整体政策方法和深入的利益相关者咨询所带来的复杂性有关。然而,七个良性增强环通过政策行为者的能力帮助克服了政策阻力,这些能力随着政策行为者在倡导变革方面的经验增加而得到提高。

结论:肥胖预防政策的制定过程复杂,难以改变。为了增加推荐政策的采纳,应该培养和加强政策行为者的多项能力,包括政策技能、政治敏锐性、谈判技巧和共识建立。需要以不会导致政策过程实质性延迟的方式实施促进政府内外有效和广泛协商的策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb6f/7822316/6fc6430a0d89/pone.0245535.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb6f/7822316/7967b0c2e14b/pone.0245535.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb6f/7822316/6fc6430a0d89/pone.0245535.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb6f/7822316/7967b0c2e14b/pone.0245535.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb6f/7822316/6fc6430a0d89/pone.0245535.g002.jpg

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本文引用的文献

[1]
Applying influence for systems change in a large-scale community-based prevention intervention.

Public Health Res Pract. 2021-6-9

[2]
Understanding the LiveLighter® obesity prevention policy processes: An investigation using political science and systems thinking.

Soc Sci Med. 2020-2

[3]
Describing studies on childhood obesity determinants by Socio-Ecological Model level: a scoping review to identify gaps and provide guidance for future research.

Int J Obes (Lond). 2019-7-8

[4]
Generating political commitment for ending malnutrition in all its forms: A system dynamics approach for strengthening nutrition actor networks.

Obes Rev. 2019-6-27

[5]
Understanding Health Promotion Policy Processes: A Study of the Government Adoption of the Achievement Program in Victoria, Australia.

Int J Environ Res Public Health. 2018-10-29

[6]
Time to dismiss the idea of a structural fix within government? An analysis of intersectoral action for health in Danish municipalities.

Scand J Public Health. 2018-6

[7]
Understanding a successful obesity prevention initiative in children under 5 from a systems perspective.

PLoS One. 2018-3-29

[8]
What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition.

BMJ Glob Health. 2018-2-10

[9]
Australia's Health Star Rating policy process: Lessons for global policy-making in front-of-pack nutrition labelling.

Nutr Diet. 2017-11-12

[10]
Exploring the dynamics of food-related policymaking processes and evidence use in Fiji using systems thinking.

Health Res Policy Syst. 2017-8-29

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