Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Takemi Program in International Health, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA.
Glob Public Health. 2021 Aug-Sep;16(8-9):1187-1197. doi: 10.1080/17441692.2021.1925942. Epub 2021 May 27.
Drawing on Kingdon's Multiple Streams Framework as a heuristic, this article reviews the three streams - problems, policies, and politics - as applied to the adoption of economic policies in response to the socioeconomic impacts of COVID-19. In doing so, we argue that we are currently presented with a window of opportunity to better address the social determinants of health. First, through assessing the problem stream, an understanding of inequity as a problem gained wider recognition through the disproportionate impacts of COVID-19. Second, in the policy stream, we demonstrate that appropriate and unprecedented policies can be enacted even in the face of changing evidence or evidentiary uncertainty, which are needed to address upstream factors that influence health. Lastly, in the politics stream, we demonstrate that addressing a public health 'problem' can be well-received by the public, making it politically viable. However, it is important to ensure the 'problem' is clearly relayed to the public and that this information is not perceived to change, as this can undermine trust. The social, political, and behavioural lessons presented by the COVID-19 pandemic should be drawn on in this pivotal moment for global public health.
本文借鉴金登的多源流框架作为启发式方法,回顾了问题流、政策流和政治流这三个流,探讨了为应对 COVID-19 对社会经济的影响而采用经济政策的情况。通过这样做,我们认为当前有机会更好地解决健康的社会决定因素。首先,通过评估问题流,我们认识到不平等是一个问题,因为 COVID-19 的影响不成比例。其次,在政策流中,我们展示了即使在证据或证据不确定性发生变化的情况下,也可以制定适当和前所未有的政策,这些政策是解决影响健康的上游因素所必需的。最后,在政治流中,我们证明了解决公共卫生“问题”可以得到公众的欢迎,这在政治上是可行的。但是,必须确保向公众清楚地传达“问题”,并且该信息不会被认为发生变化,因为这会破坏信任。在全球公共卫生的关键时刻,应借鉴 COVID-19 大流行带来的社会、政治和行为经验教训。