UK Centre for Ecology & Hydrology, Maclean Building, Wallingford, United Kingdom.
One Health Trust, Obeya Pulse, Bengaluru, Karnataka, India.
Front Public Health. 2023 Aug 22;11:1228950. doi: 10.3389/fpubh.2023.1228950. eCollection 2023.
Why do some zoonotic diseases receive priority from health policy decision-makers and planners whereas others receive little attention? By leveraging Shiffman and Smith's political prioritisation framework, our paper advances a political economy of disease prioritisation focusing on four key components: the strength of the actors involved in the prioritisation, the power of the ideas they use to portray the issue, the political contexts in which they operate, and the characteristics of the issue itself (e.g., overall burdens, severity, cost-effective interventions). These components afford a nuanced characterisation of how zoonotic diseases are prioritised for intervention and highlight the associated knowledge gaps affecting prioritisation outcomes. We apply this framework to the case of zoonoses management in India, specifically to identify the factors that shape disease prioritisation decision-making and outcomes.
We conducted 26 semi-structured interviews with national, state and district level health policymakers, disease managers and technical experts involved in disease surveillance and control in India.
Our results show pluralistic interpretation of risks, exemplified by a disconnect between state and district level actors on priority diseases. The main factors identified as shaping prioritisation outcomes were related to the nature of the zoonoses problem (the complexity of the zoonotic disease, insufficient awareness and lack of evidence on disease burdens and impacts) as well as political, social, cultural and institutional environments (isolated departmental priorities, limited institutional authority, opaque funding mechanisms), and challenges in organisation leadership for cross-sectoral engagement.
The findings highlight a compartmentalised regulatory system for zoonoses where political, social, cultural, and media factors can influence disease management and prioritisation. A major policy window is the institutionalisation of One Health to increase the political priority for strengthening cross-sectoral engagement to address several challenges, including the creation of effective institutions to reconcile stakeholder priorities and prioritisation processes.
为什么有些人畜共患病会受到卫生政策决策者和规划者的优先关注，而其他一些则很少受到关注？利用 Shiffman 和 Smith 的政治优先排序框架，我们的论文提出了一种关注四个关键组成部分的疾病优先排序政治经济学：参与优先排序的行为者的实力、他们用来描绘问题的观点的力量、他们运作的政治背景以及问题本身的特征（例如，总体负担、严重程度、具有成本效益的干预措施）。这些组成部分细致地描述了人畜共患病如何被优先考虑进行干预，并强调了影响优先排序结果的相关知识差距。我们将该框架应用于印度人畜共患病管理案例，以确定影响疾病优先排序决策和结果的因素。
我们对参与印度疾病监测和控制的国家、邦和地区级卫生政策制定者、疾病管理者和技术专家进行了 26 次半结构化访谈。
我们的研究结果表明，对风险的解释存在多元化，州和地区层面的行为者对优先疾病的看法存在脱节。确定为影响优先排序结果的主要因素与人畜共患病问题的性质有关（人畜共患疾病的复杂性、对疾病负担和影响的认识不足以及缺乏证据）以及政治、社会、文化和制度环境（孤立的部门优先事项、有限的机构权力、不透明的供资机制），以及跨部门参与的组织领导方面的挑战。
研究结果强调了人畜共患病的分割监管系统，其中政治、社会、文化和媒体因素会影响疾病管理和优先排序。一个主要的政策窗口是将“One Health”体制化，以增加加强跨部门参与以应对包括建立有效机构以调和利益相关者的优先事项和优先排序过程在内的多个挑战的政治优先地位。
