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新冠疫情后公共卫生政策制定的未来:对“健康融入所有政策”经验教训的定性系统综述

The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies.

作者信息

Cairney Paul, St Denny Emily, Mitchell Heather

机构信息

History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK.

Department of Political Science, University of Copenhagen, Copenhagen, DK-1353, Denmark.

出版信息

Open Res Eur. 2021 Jul 21;1:23. doi: 10.12688/openreseurope.13178.2. eCollection 2021.

Abstract

: 'Health in All Policies' (HiAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the 'social determinants' of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HiAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HiAP scholars and advocates.  Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HiAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HiAP narrative and explore how the relatively theory-informed articles enhance it. : Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HiAP expectations and policy outcomes. Theory-informed articles contribute to a HiAP playbook to close that gap or a programme theory to design and evaluate HiAP in new ways.   : Few HiAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HiAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.

摘要

“健康融入所有政策”(HiAP)描述了对健康公平的追求。它有五个主要要素:将健康视为人权;识别健康不平等“社会决定因素”的证据,认识到影响健康的大多数权力并非由卫生部门掌握,促进政府内外的跨部门政策制定与合作,以及产生政治意愿。研究描述了其潜力,但也哀叹存在重大的实施差距。一些HiAP学者从政策制定研究中学习如何理解这一差距,但政策理论的运用并不完善。在这种背景下,我们的指导性研究问题是:它使我们能够退后一步审视该领域,进而深入探究:政策变化的假定原因和实际原因,以及对HiAP学者和倡导者具有借鉴意义的经验教训。我们的定性系统综述(分两个阶段,2018年和2020年)共识别出4972篇HiAP文章。其中,113篇期刊文章(研究和评论)对政策制定有重要参考价值(至少提及一个政策制定概念)。我们利用这113篇文章构建了一个关于HiAP的总体叙述,并探讨了那些相对理论性较强的文章如何对其进行完善。:大多数文章关注政策分析(识别政策问题和解决方案)而非政策理论(解释政策制定动态)。它们报告了HiAP期望与政策结果之间令人失望的差距。有理论依据的文章有助于制定HiAP行动指南以弥合这一差距,或有助于形成以新方式设计和评估HiAP的项目理论。:很少有HiAP文章将政策理论用于其预期目的。政策理论提供的经验教训有助于对权力、政治困境和政策制定背景进行批判性反思。HiAP学者寻求更多实用性经验教训,这可能以有效宣传和研究为代价。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c76b/10446465/c9ab5e54d494/openreseurope-1-15055-g0000.jpg

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