The George Institute for Global Health, University of New South Wales, Level 5/ 1 King St, Newtown, NSW, 2042, Australia; Australian Human Rights Institute, University of New South Wales, Sydney, NSW, 2052, Australia.
The George Institute for Global Health, University of New South Wales, Level 5/ 1 King St, Newtown, NSW, 2042, Australia.
Soc Sci Med. 2023 Sep;333:116149. doi: 10.1016/j.socscimed.2023.116149. Epub 2023 Aug 6.
There are a range of priority setting methods for non-communicable disease (NCDs) prevention. However, existing methods are often designed without detailed consideration of local context and political economy- critical success factors for implementation. In Australia, codes of practice under state government Public Health Acts could be used for NCD prevention. To inform the potential development of codes of practice under Public Health Acts, this study aimed to co-create a priority setting framework that accounts for local context and the prevailing regulatory agenda. A priority setting framework was co-produced by a multidisciplinary technical advisory group consisting of government representatives, public health lawyers and academic experts. It incorporated general prioritisation criteria (evidence, cost-effectiveness, equity, burden of disease) and local contextual criteria (legal compatibility, unmet-needs, political acceptability, structural and technical feasibility, community support). The framework was then applied in practice through surveys and policy dialogue workshops to discuss political economy factors. Policies were limited to nutrition, alcohol and physical activity risk factors. Through the prioritisation process, the most impactful, feasible and acceptable policies for NCD prevention via state government codes of practice were: restrictions on in-store placement of unhealthy products, enhancing data systems and capabilities for health surveillance and implementation monitoring, removal of unhealthy foods and drinks sold and supplied in public institutions, prohibition of marketing of unhealthy foods and drinks on assets controlled by government, and implementation of subsidies or grants to increase fruit and vegetable intake. The process illustrated that explicit consideration of local context, legal compatibility and the political economy had a substantial influence on the prioritised list of actions. The proposed priority setting framework is designed to be flexible and adaptable to varying contexts, can be embedded in government processes or utilised by researchers and practitioners to co-produce a regulatory agenda that is locally relevant.
有一系列用于预防非传染性疾病（NCD）的优先排序方法。然而，现有的方法往往在没有详细考虑当地背景和政治经济因素的情况下设计，而这些因素是实施的关键成功因素。在澳大利亚，州政府《公共卫生法》下的业务守则可用于 NCD 预防。为了为《公共卫生法》下的业务守则的潜在制定提供信息，本研究旨在共同制定一个考虑当地背景和当前监管议程的优先排序框架。一个多学科技术咨询小组共同制定了优先排序框架，该小组由政府代表、公共卫生律师和学术专家组成。它纳入了一般优先排序标准（证据、成本效益、公平、疾病负担）和当地背景标准（法律兼容性、未满足的需求、政治可接受性、结构和技术可行性、社区支持）。然后，通过调查和政策对话研讨会将该框架应用于实践，以讨论政治经济因素。政策仅限于营养、酒精和身体活动风险因素。通过优先排序过程，通过州政府业务守则预防 NCD 的最具影响力、最可行和最可接受的政策是：限制不健康产品在店内的摆放位置、增强健康监测和实施监测的数据系统和能力、去除公共机构销售和供应的不健康食品和饮料、禁止在政府控制的资产上对不健康食品和饮料进行营销，以及实施补贴或赠款以增加水果和蔬菜的摄入量。该过程表明，对当地背景、法律兼容性和政治经济的明确考虑对优先排序的行动清单有重大影响。拟议的优先排序框架旨在具有灵活性和适应性，可以嵌入政府流程中，也可以由研究人员和从业者共同使用，以制定与当地相关的监管议程。
