Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russia.
Int J Health Policy Manag. 2022 Sep 1;11(9):1863-1873. doi: 10.34172/ijhpm.2021.95. Epub 2021 Aug 25.
Policy is an important element of influencing individual health-related behaviours associated to major risk factors for non-communicable diseases (NCDs) such as smoking, alcohol consumption, unhealthy eating and physical inactivity. However, our understanding of the specific measures recommended in NCD prevention policy-making remains limited. This study analysed recent World Health Organization (WHO) documents to identify common policy instruments suggested for national NCD prevention policy and to assess similarities and differences between policies targeting different health-related behaviours.
Evert Vedung's typology of policy instruments, which differentiates between regulatory, economic/ fiscal and soft instruments, served as a basis for this analysis. A systematic search on WHO websites was conducted to identify documents relating to tobacco, alcohol, nutrition and physical activity. The staff of the respective units at the WHO Regional Office for Europe conducted an expert validation of these documents. The resulting documents were systematically searched for policy instruments. A word frequency analysis was conducted to estimate the use of individual instruments in the different policy fields, followed by an additional in-depth coding and content analysis by two independent reviewers.
Across all health-related behaviours, the following policy instruments were suggested most frequently in WHO guidance documents: laws, regulations, standards, taxes, prices, campaigns, recommendations, partnerships and coordination. The analysis showed that regulatory and economic/fiscal policy instruments are mainly applied in tobacco and alcohol policy, while soft instruments dominate in the fields of nutrition and especially physical activity.
The study confirms perceived differences regarding recommended policy instruments in the different policy fields and supports arguments that "harder" instruments still appear to be underutilized in nutrition and physical activity. However, more comprehensive research is needed, especially with respect to actual instrument use and effectiveness in national-level NCD prevention policy.
政策是影响与非传染性疾病（NCD）相关的主要风险因素（如吸烟、饮酒、不健康饮食和缺乏身体活动）的个人健康相关行为的重要因素。然而，我们对 NCD 预防政策制定中推荐的具体措施的理解仍然有限。本研究分析了最近的世界卫生组织（WHO）文件，以确定针对国家 NCD 预防政策的常见政策工具，并评估针对不同健康相关行为的政策之间的相似之处和差异。
埃弗特·文丁（Evert Vedung）的政策工具分类法将政策工具分为监管、经济/财政和软工具，为本分析提供了基础。在 WHO 网站上进行了系统搜索，以确定与烟草、酒精、营养和身体活动相关的文件。WHO 欧洲区域办事处的相关部门工作人员对这些文件进行了专家验证。对生成的文件进行了系统搜索，以查找政策工具。进行了词频分析，以估计在不同政策领域中使用单个工具的情况，然后由两名独立评审员进行额外的深入编码和内容分析。
在所有健康相关行为中，以下政策工具在 WHO 指导文件中被建议得最为频繁：法律、法规、标准、税收、价格、运动、建议、伙伴关系和协调。分析表明，监管和经济/财政政策工具主要应用于烟草和酒精政策，而软工具在营养领域，尤其是在身体活动领域占据主导地位。
该研究证实了在不同政策领域中推荐的政策工具存在差异，并支持了以下观点，即“更硬”的工具在营养和身体活动方面似乎仍未得到充分利用。然而，需要进行更全面的研究，特别是关于国家 NCD 预防政策中的实际工具使用和有效性。
