Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Can J Public Health. 2023 Jun;114(3):331-345. doi: 10.17269/s41997-023-00752-x. Epub 2023 Mar 21.
Our aim was to synthesize published scholarship that applies policy diffusion-a theory of the policy process that considers the interdependence of government-level public health policy choices. We paid particular attention to the role of scientific evidence in the diffusion process, and to identifying challenges and gaps towards strengthening the intersection of public health, public policy, and political science.
We systematically searched 17 electronic academic databases. We included English-language, peer-reviewed articles published between 2000 and 2021. For each article, we extracted the following information: public health policy domain, geographic setting, diffusion directions and mechanisms, the role of scientific evidence in the diffusion process, and author research discipline.
We identified 39 peer-reviewed, primary research articles. Anti-smoking and tobacco control policies in the United States (n = 9/39) were the most common policy domain and geographic context examined; comparatively fewer studies examined policy diffusion in the Canadian context (n = 4/39). In terms of how policies diffuse, we found evidence of five diffusion mechanisms (learning, emulation, competition, coercion, and social contagion), which could moreover be conditional on internal government characteristics. The role of scientific evidence in the diffusion process was unclear, as only five articles discussed this. Policy diffusion theory was primarily used by public policy and political science scholars (n = 19/39), with comparatively fewer interdisciplinary authorship teams (n = 6/39).
Policy diffusion theory provides important insights into the intergovernmental factors that influence public health policy decisions, thus helping to expand our conceptualization of evidence-informed public health. Despite this, policy diffusion research in the Canadian public health context is limited.
本研究旨在综合已发表的学术文献，应用政策扩散理论——一种考虑政府层面公共卫生政策选择相互依存关系的政策过程理论。我们特别关注科学证据在扩散过程中的作用，并确定加强公共卫生、公共政策和政治学交叉点的挑战和差距。
我们系统地检索了 17 个电子学术数据库。我们纳入了 2000 年至 2021 年间发表的英文同行评议文章。对于每篇文章，我们提取了以下信息：公共卫生政策领域、地理背景、扩散方向和机制、科学证据在扩散过程中的作用以及作者的研究学科。
我们确定了 39 篇同行评议的原始研究文章。美国的反吸烟和烟草控制政策（n=9/39）是最常见的政策领域和地理背景；相比之下，较少的研究考察了加拿大的政策扩散（n=4/39）。就政策如何扩散而言，我们发现了五种扩散机制（学习、效仿、竞争、强制和社会传染）的证据，这些机制还可以根据政府内部特征而变化。科学证据在扩散过程中的作用尚不清楚，只有五篇文章讨论了这一点。政策扩散理论主要由公共政策和政治学学者使用（n=19/39），相比之下，跨学科作者团队较少（n=6/39）。
政策扩散理论为理解影响公共卫生政策决策的政府间因素提供了重要的见解，从而有助于扩展我们对循证公共卫生的概念化。尽管如此，加拿大公共卫生领域的政策扩散研究仍然有限。
