Thow Anne Marie, Harris Patrick, Lencucha Raphael
University of Sydney, Sydney School of Public Health, Menzies Centre for Health Policy and Economics, Level 5, Moore College, 1 King St, Newtown, NSW, 2042, Australia.
Centre for Health Equity Training, Research & Evaluation (CHETRE), University of New South Wales Research Centre for Primary Health Care & Equity, University of New South Wales, Level 3, AGSM Building, Sydney, NSW, 2052, Australia; Unit of Population Health, South Western Sydney Local Health District, NSW Health, Sydney, NSW, Australia.
Soc Sci Med. 2025 May;372:117939. doi: 10.1016/j.socscimed.2025.117939. Epub 2025 Mar 8.
Malnutrition in all its forms presents an urgent global health challenge and food systems transformation is a critical component of the necessary policy response. However, cross-sectoral policy engagement between nutrition policy makers and the policy sectors responsible for food systems change has proved challenging. This policy analysis focused on how policy makers act as agents within institutions to advance cross-sectoral policy making on food systems and nutrition, informed by theories of policy making and power. Forty-three interviews were conducted with policy actors working at global, regional and national level, in relevant sectors. The interview data were analysed iteratively, informed by theory, with a focus on actor roles, characteristics, skills and capacities and the dynamics between these dimensions. We found that successful cross-sectoral policy engagement for nutrition resulted from a dynamic interaction between agents and institutional structures, within which policy agents were able to exert 'power to' influence outcomes, and exert 'power with' multidisciplinary teams and cross-sectoral colleagues to effect change. These policy actors were able to shape ideas and create cultures and norms that supported cross-sectoral engagement, which led to effective engagement between policy sectors, characterised by constructive dialogue, shared decisions, trust, goodwill and balancing objectives across sectors. The result of this engagement was consideration of nutrition in policy making in sectors other than health, in ways that resulted in tangible policy outcomes. Success in cross-sectoral policy engagement was seen as strengthening both institutional support for cross-sectoral action on nutrition, and the ability of policy actors to overcome barriers.
各种形式的营养不良构成了紧迫的全球健康挑战，而转变粮食系统是必要政策应对措施的关键组成部分。然而，事实证明，营养政策制定者与负责粮食系统变革的政策部门之间的跨部门政策互动颇具挑战性。本政策分析聚焦于政策制定者如何在机构中充当推动者，以促进关于粮食系统和营养的跨部门政策制定，其依据是政策制定和权力理论。我们对全球、区域和国家层面相关部门的政策行动者进行了43次访谈。访谈数据在理论指导下进行了反复分析，重点关注行动者的角色、特征、技能和能力以及这些维度之间的动态关系。我们发现，成功的营养跨部门政策互动源于行动者与机构结构之间的动态互动，在这种互动中，政策行动者能够施加“影响力”以影响结果，并与多学科团队及跨部门同事施加“协同影响力”以实现变革。这些政策行动者能够塑造观念，营造支持跨部门互动的文化和规范，从而促成政策部门之间的有效互动，其特点是建设性对话、共同决策、信任、善意以及平衡各部门目标。这种互动的结果是，在卫生部门以外的其他部门的政策制定中考虑到了营养因素，并产生了切实的政策成果。跨部门政策互动的成功被视为既加强了对营养问题跨部门行动的机构支持，也增强了政策行动者克服障碍的能力。
