Gage Ryan, Leung William, Gurtner Marcus, Reeder Anthony I, McNoe Bronwen M, Signal Louise
Department of Public Health, University of Otago, Wellington, New Zealand.
Social & Behavioural Research Unit, Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand.
Health Promot J Austr. 2022 Jul;33(3):740-750. doi: 10.1002/hpja.545. Epub 2021 Oct 17.
Skin cancer is highly prevalent but preventable, yet little research has been done on the challenges in generating political priority for skin cancer prevention. This qualitative study aimed to identify the political challenges to, facilitators of, and strategies to strengthen skin cancer prevention. The focus was on the case of Aotearoa New Zealand (NZ): a country with high skin cancer rates, but limited investment in primary prevention.
Data sources included 18 national key informant interviews and documentary analysis. Data were analysed inductively for emerging themes and framed using a conceptual framework of political priority.
Challenges to advocates for skin cancer primary prevention include limited resources and competing priorities. Political-level challenges include a lack of quick results compared with other initiatives vying for political attention, lack of negative externalities and, in NZ, misalignment with health system priorities. Challenges in the evidence base include the perceived conflict of sun protection with Vitamin D and physical activity, the lack of data on the financial burden of skin cancer and relatively low temperatures in NZ. Facilitators include strong policy community cohesion and issue framing, and weak opposition. Promising strategies to strengthen skin cancer prevention in NZ could include network building, using framing that resonates with policy makers and addressing key knowledge gaps in NZ, such as the financial burden of skin cancer.
Advocacy for skin cancer prevention faces challenges due to advocates' limited resources, political challenges such as lack of quick results and gaps in evidence. Nonetheless, the initiative encounters little opposition and can be framed in ways that resonate with policy makers. SO WHAT?: Skin cancer is highly preventable, but advocates for prevention initiatives have struggled to gain political traction. This study identifies several strategies that could help raise the political profile for skin cancer prevention.
皮肤癌非常普遍但可预防，然而在促使皮肤癌预防成为政治优先事项方面所面临的挑战，相关研究却很少。这项定性研究旨在确定加强皮肤癌预防的政治挑战、促进因素和策略。重点是新西兰的情况：该国皮肤癌发病率高，但在一级预防方面的投资有限。
数据来源包括18次全国关键信息人访谈和文献分析。对数据进行归纳分析以找出新出现的主题，并使用政治优先事项的概念框架进行构建。
皮肤癌一级预防倡导者面临的挑战包括资源有限和相互竞争的优先事项。政治层面的挑战包括与争夺政治关注的其他举措相比缺乏快速成果、缺乏负面外部效应，以及在新西兰与卫生系统优先事项不一致。证据基础方面的挑战包括防晒与维生素D及体育活动之间的认知冲突、缺乏皮肤癌经济负担的数据以及新西兰相对较低的气温。促进因素包括强大的政策社区凝聚力和议题构建，以及微弱的反对意见。在新西兰加强皮肤癌预防的有前景的策略可能包括建立网络、采用能引起政策制定者共鸣的框架以及解决新西兰的关键知识差距，如皮肤癌的经济负担。
由于倡导者资源有限、缺乏快速成果等政治挑战以及证据差距，皮肤癌预防倡导面临挑战。尽管如此，该倡议几乎没有遇到反对意见，并且可以采用能引起政策制定者共鸣的方式进行构建。那又如何？：皮肤癌是高度可预防的，但预防倡议的倡导者难以获得政治影响力。本研究确定了几种有助于提高皮肤癌预防政治形象的策略。
