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高影响力政策中的公平性如何?评“一项关于共同目标、领导力和敬业员工如何促进芬兰库奥皮奥市实施所有政策中健康的现实解释性案例研究”。

Where Is Equity in HiAP? Comment on "A Realist Explanatory Case Study Investigating How Common Goals, Leadership, and Committed Staff Facilitate Health in All Policies Implementation in the Municipality of Kuopio, Finland".

机构信息

Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway.

出版信息

Int J Health Policy Manag. 2023;12:7611. doi: 10.34172/ijhpm.2023.7611. Epub 2023 Apr 10.

Abstract

Health equity is no longer a central feature of Health in All Policies (HiAP) approaches despite its presence in select definitions of HiAP. In other words, HiAP is not just about considering health, but also health equity. But as HiAP has become more mainstream, its success around health equity has been muted and largely non-existent. Given the normative underpinning and centrality of equity in HiAP, equity should be better considered in HiAP and particularly when considering what 'successful' implementation may look like. Raising health on the radar of policy-makers is not mutually exclusive from considering equity. Taking an incremental approach to considering equity in HiAP can yield positive results. This article discusses these ideas and presents potential actions to restore HiAP's once central equity objectives, which include: seeking synergies focused on health equity with those who hold different convictions, both in terms of goals and measures of success; considering the conditions that allow HiAP to be fostered, such as good governance; and drawing on research on HiAP and other multisectoral approaches.

摘要

健康公平不再是“所有政策中的健康”(Health in All Policies,HiAP)方法的核心特征,尽管在 HiAP 的某些定义中仍存在健康公平。换句话说,HiAP 不仅要考虑健康,还要考虑健康公平。但随着 HiAP 变得更加主流,它在健康公平方面的成功却被淡化了,而且在很大程度上是不存在的。鉴于 HiAP 具有规范性基础和公平性的核心地位,在 HiAP 中应该更好地考虑公平性,特别是在考虑“成功”实施可能是什么样子的时候。在决策者的雷达上提高健康水平并不与考虑公平性相排斥。在 HiAP 中采取渐进的方法来考虑公平性可以带来积极的结果。本文讨论了这些想法,并提出了恢复 HiAP 曾经的核心公平目标的潜在行动,包括:寻求与那些在目标和成功衡量标准上有不同信念的人在关注健康公平方面的协同作用;考虑允许 HiAP 得到培养的条件,例如良好的治理;并借鉴关于 HiAP 和其他多部门方法的研究。

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