Stretton Health Equity, University of Adelaide, Adelaide, SA 5005, Australia.
Research Unit, Médecine pour le Peuple, Rue du Comte de Flandre 25, Brussels 1080, Belgium.
Health Policy Plan. 2024 Nov 18;39(Supplement_2):i75-i92. doi: 10.1093/heapol/czae047.
Our paper examines the political considerations in the intersectoral action that was evident during the SAR-COV-2 virus (COVID-19) pandemic through case studies of political and institutional responses in 16 nations (Australia, Belgium, Brazil, Ethiopia, India, New Zealand, Nigeria, Peru, South Africa, South Korea, Spain, Taiwan, Thailand, Vietnam, UK, and USA). Our qualitative case study approach involved an iterative process of data gathering and interpretation through the three Is (institutions, ideas and interests) lens, which we used to shape our understanding of political and intersectoral factors affecting pandemic responses. The institutional factors examined were: national economic and political context; influence of the global economic order; structural inequities; and public health structures and legislation, including intersectoral action. The ideas explored were: orientation of governments; political actors' views on science; willingness to challenge neoliberal policies; previous pandemic experiences. We examined the interests of political leaders and civil society and the extent of public trust. We derived five elements that predict effective and equity-sensitive political responses to a pandemic. Firstly, effective responses have to be intersectoral and led from the head of government with technical support from health agencies. Secondly, we found that political leaders' willingness to accept science, communicate empathetically and avoid 'othering' population groups was vital. The lack of political will was found in those countries stressing individualistic values. Thirdly, a supportive civil society which questions governments about excessive infringement of human rights without adopting populist anti-science views, and is free to express opposition to the government encourages effective political action in the interests of the population. Fourthly, citizen trust is vital in times of uncertainty and fear. Fifthly, evidence of consideration is needed regarding when people's health must be prioritized over the needs of the economy. All these factors are unlikely to be present in any one country. Recognizing the political aspects of pandemic preparedness is vital for effective responses to future pandemics and while intersectoral action is vital, it is not enough in isolation to improve pandemic outcomes.
我们的论文通过对 16 个国家（澳大利亚、比利时、巴西、埃塞俄比亚、印度、新西兰、尼日利亚、秘鲁、南非、韩国、西班牙、中国台湾、泰国、越南、英国和美国）在 SARS-CoV-2 病毒（COVID-19）大流行期间的跨部门行动中的政治考虑因素进行案例研究，考察了这一点。我们的定性案例研究方法涉及通过三 I（机构、理念和利益）视角进行数据收集和解释的迭代过程，我们利用这一视角来理解影响大流行应对的政治和跨部门因素。所审查的机构因素包括：国家经济和政治背景；全球经济秩序的影响；结构性不平等；以及公共卫生结构和立法，包括跨部门行动。探讨的理念包括：政府的定位；政治行为者对科学的看法；挑战新自由主义政策的意愿；以往的大流行经验。我们研究了政治领导人与民间社会的利益以及公众信任的程度。我们得出了五个预测对大流行做出有效和公平反应的要素。首先，有效的应对措施必须是跨部门的，由政府首脑领导，并由卫生机构提供技术支持。其次，我们发现，政治领导人愿意接受科学、富有同情心的沟通和避免将人群“他者化”至关重要。那些强调个人主义价值观的国家缺乏政治意愿。第三，一个支持性的民间社会，如果对政府过度侵犯人权提出质疑，但不采取民粹主义反科学观点，并自由表达对政府的反对，就会鼓励为了民众的利益而采取有效的政治行动。第四，在不确定和恐惧时期，公民信任至关重要。第五，当人民的健康必须优先于经济需求时，需要有考虑的证据。所有这些因素都不太可能在任何一个国家存在。认识到大流行准备的政治方面对于未来大流行的有效应对至关重要，虽然跨部门行动至关重要，但孤立地采取行动不足以改善大流行的结果。
