Serban Stefan T, Perdomo Sandra, Borges-Yañez Aida, Allen Finbarr, Guarnizo-Herreño Carol, Navarro-Ramírez María Kamila, Hobbs Matt, Cohen Lois K, Tsakos Georgios, Baker Sarah R, Conway David I
School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK.
Genomic Epidemiology Branch, International Agency for Research on Cancer, World Health Organisation, Lyon, France.
Community Dent Oral Epidemiol. 2025 Jul 27. doi: 10.1111/cdoe.70005.
Oral diseases are the most prevalent diseases globally, affecting almost half of the world's population with a disproportionate burden on the most vulnerable groups. Despite growing attention on the social and commercial determinants of health, there is still a largely unexplored area in understanding the political determinants of health and oral health. The aim of this paper is to describe national policy development processes for policies impacting population oral health.
A multiple case study approach was used to analyse six case studies focused on national policy development processes targeting oral health. Kingdon's Multiple Streams Model was used to examine how problems, policy solutions, and political factors aligned to influence policymaking.
Some of the most common barriers to policy adoption and implementation were misinformation strategies, legal challenges, industry lobbying, ideological opposition to state intervention, and lack of transparency regarding conflicts of interest. Important common facilitators included robust scientific evidence presented in an accessible manner to the appropriate audiences, identification of key decision-makers, support from parties from across the political spectrum, intersectoral collaboration, and ongoing policy monitoring and evaluation.
This study provides novel insights into how political determinants influence social and commercial determinants of health, demonstrating how political contexts and power dynamics shape national public health policy development processes. Understanding these dynamics is essential for ensuring that evidence-based public health interventions are politically feasible and resilient to opposition from certain private industry and ideological interests. In a time of growing inequalities, neutrality in the face of structural injustice risks entrenching a status quo that favours those with the greatest influence. To address these problems sustainably, public health practitioners must recognise and engage with the political nature of policymaking.
口腔疾病是全球最普遍的疾病，影响着近一半的世界人口，且对最弱势群体造成了不成比例的负担。尽管人们越来越关注健康的社会和商业决定因素，但在理解健康和口腔健康的政治决定因素方面，仍有很大一部分领域未被探索。本文旨在描述影响人群口腔健康政策的国家政策制定过程。
采用多案例研究方法，分析了六个聚焦于国家口腔健康政策制定过程的案例研究。运用金登的多源流模型来考察问题、政策解决方案和政治因素如何相互协调以影响政策制定。
政策采纳和实施的一些最常见障碍包括错误信息策略、法律挑战、行业游说、对国家干预的意识形态反对以及利益冲突缺乏透明度。重要的共同促进因素包括以易于理解的方式向适当受众提供有力的科学证据、确定关键决策者、获得各政治派别的支持、跨部门合作以及持续的政策监测和评估。
本研究为政治决定因素如何影响健康的社会和商业决定因素提供了新的见解，展示了政治背景和权力动态如何塑造国家公共卫生政策制定过程。理解这些动态对于确保基于证据的公共卫生干预措施在政治上可行且能抵御某些私营行业和意识形态利益的反对至关重要。在不平等加剧的时代，面对结构性不公正保持中立有可能巩固有利于最具影响力者的现状。为了可持续地解决这些问题，公共卫生从业者必须认识到并参与政策制定的政治本质。
