School of Public Administration, Central China Normal University, Wuhan 430079, China.
School of Public Affairs, Pennsylvania State University, Middletown, PA 17057, USA.
Int J Environ Res Public Health. 2022 Feb 17;19(4):2289. doi: 10.3390/ijerph19042289.
Health policies are regarded as a governance mechanism crucial for reducing health inequity and improving overall health outcomes. Policies that address chronic conditions or health inequity suggest a governance shift toward active health over past decades. However, the current literature in health policy largely focused on some specific health policy changes and their tangible outcomes, or on specific inequality of health policies in gender, age, racial, or economic status, short of comprehensively responding to and addressing the shift. This is exacerbated further by a common confusion that equates health policy with health care policy, which has been burdened by increased population ageing, growing inequalities, rising expenditures, and growing social expectations. This study conducted a narrative literature review to comprehensively and critically analyze the most current knowledge on health policy in order to help us establish a theoretical framework on active health governance. The comprehensive framework proposed in this paper identifies the main elements of a well-defined active health governance and the interactions between these elements. The proposed framework is composed of four elements (governance for health, social determinants of health, lifestyle determinants of health, and health system) and three approaches (whole-of-government approach, whole-of-society approach, and lifespan/life-course approach) that are dynamically interacted to achieve two active health outcomes (health equity and health improvement). The framework provides a conceptual solution to the issues of current literature on health policy and practically serves as a new guide for health policymaking.
健康政策被视为减少健康不平等和改善整体健康结果的关键治理机制。过去几十年，针对慢性病或健康不平等的政策表明，治理方向已经转向积极的健康。然而，目前健康政策领域的文献主要集中在一些具体的健康政策变化及其可衡量的结果上，或者集中在性别、年龄、种族或经济地位方面的具体健康政策不平等上，而未能全面应对和解决这种转变。由于人们普遍混淆了健康政策和医疗保健政策，这进一步加剧了这种情况，因为医疗保健政策因人口老龄化加剧、不平等加剧、支出增加和社会期望不断提高而负担沉重。本研究进行了叙述性文献综述，以全面和批判性地分析健康政策的最新知识，帮助我们建立积极健康治理的理论框架。本文提出的综合框架确定了明确的积极健康治理的主要要素以及这些要素之间的相互作用。该框架由四个要素（卫生治理、健康的社会决定因素、健康的生活方式决定因素和卫生系统）和三个方法（全政府方法、全社会方法和全生命周期/生命过程方法）组成，这些要素和方法相互动态作用，以实现两个积极的健康结果（健康公平和健康改善）。该框架为健康政策文献中的问题提供了一个概念性的解决方案，并为健康政策制定提供了一个实用的新指南。
