Lee Yuri, Park Jiwon
Department of Health and Medical Information, Myongji College, Seoul, Republic of Korea.
Gyeonggi Public Health Policy Institute, Gyeonggi-do, Republic of Korea.
Front Public Health. 2025 Aug 18;13:1601467. doi: 10.3389/fpubh.2025.1601467. eCollection 2025.
Public health laws-whether focusing on taxation, bans, mandates, or licensing-are powerful tools for reducing risk behaviors and improving population health. However, identical legal interventions often produce starkly different outcomes across jurisdictions. Political and social contexts are increasingly recognized as key determinants of such variability.
This study aimed to examine how and why public health legal interventions succeed or fail under different political circumstances, drawing on a Realist Review approach. We synthesized the interplay between legal epidemiology and political determinants of health to develop a deeper understanding of the mechanisms driving health policy outcomes.
We followed RAMESES guidelines to identify and analyze 20 empirical studies, policy analyses, and global reports published from 2000 to 2023. We included sources that explicitly addressed both public health law or policy interventions and the political environment (e.g., trust in government, partisanship, lobbying, global donor influence). Using a Context-Mechanism-Outcome (CMO) framework, we coded and synthesized patterns to refine our initial program theory on how legal measures interact with political factors to shape health-related results.
Six recurring CMO patterns emerged. Laws are most effective when stable political leadership and public trust enable robust enforcement and funding. Conversely, fragmented governance or ideological polarization undermines or reverses legal interventions, especially those perceived as infringing personal freedoms (e.g., vaccine mandates, obesity restrictions). Industry lobbying frequently dilutes legislation, while external donor-driven policies can falter without sustained domestic support. Evolving moral and cultural attitudes likewise propel or hinder laws over time. We integrate these findings in a conceptual model demonstrating how political determinants modulate legal mechanisms, ultimately affecting population health outcomes.
This Realist Review underscores that legal interventions alone cannot guarantee public health improvements. Rather, their success relies on supportive political contexts, coherent enforcement strategies, and alignment with evolving social values. Policymakers and advocates should anticipate and address political barriers-from partisanship to lobbying to donor dependency-to design and implement resilient, evidence-based public health laws. Future research should refine these insights using mixed-methods case studies and longitudinal evaluations, ensuring policy adaptations that optimize health equity and policy sustainability.
公共卫生法律——无论是侧重于税收、禁令、强制规定还是许可——都是减少风险行为和改善人群健康的有力工具。然而，相同的法律干预措施在不同司法管辖区往往会产生截然不同的结果。政治和社会背景日益被视为这种差异的关键决定因素。
本研究旨在运用现实主义综述方法，探讨公共卫生法律干预措施在不同政治环境下成功或失败的方式及原因。我们综合了法律流行病学与健康的政治决定因素之间的相互作用，以更深入地理解推动卫生政策结果的机制。
我们遵循RAMESES指南，识别并分析了2000年至2023年发表的20项实证研究、政策分析和全球报告。我们纳入了明确涉及公共卫生法律或政策干预措施以及政治环境（如对政府的信任、党派性、游说、全球捐助者影响）的资料来源。使用背景-机制-结果（CMO）框架，我们对模式进行编码和综合，以完善我们最初关于法律措施如何与政治因素相互作用以塑造健康相关结果的项目理论。
出现了六种反复出现的CMO模式。当稳定的政治领导和公众信任能够实现有力的执行和资金投入时，法律最为有效。相反，治理碎片化或意识形态两极分化会破坏或逆转法律干预措施，尤其是那些被视为侵犯个人自由的措施（如疫苗强制令、肥胖限制）。行业游说常常削弱立法，而外部捐助者驱动的政策如果没有持续的国内支持则可能失败。随着时间的推移，不断演变的道德和文化态度同样会推动或阻碍法律。我们将这些发现整合到一个概念模型中，展示了政治决定因素如何调节法律机制，最终影响人群健康结果。
这项现实主义综述强调，仅靠法律干预措施无法保证公共卫生状况得到改善。相反，它们的成功依赖于支持性的政治环境、连贯的执行策略以及与不断演变的社会价值观保持一致。政策制定者和倡导者应预见并应对政治障碍——从党派性到游说再到捐助者依赖——以设计和实施有韧性的、基于证据的公共卫生法律。未来的研究应使用混合方法案例研究和纵向评估来完善这些见解，确保政策调整能够优化健康公平性和政策可持续性。
