The process of prioritization of non-communicable diseases in the global health policy arena
The process of prioritization of non-communicable diseases in the global health policy arena
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DOI：
10.1093/heapol/czz043
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发表时间：
2019-06-01
影响因子：
3.2
通讯作者：
Beran, David
中科院分区：
文献类型：
--
作者：
Heller, Olivia;Somerville, Claire;Beran, David
虽然非传染性疾病是全世界发病率和死亡率的主要原因，但全球对策与其健康、经济和社会负担不相称。这项研究审查了促进和阻碍将非传染性疾病列为联合国卫生议程优先事项的因素。Shiffman和Smith的《全球卫生倡议的政治优先事项的产生：孕产妇死亡率的框架和案例研究》。The Lancet 370：1370-9.）该政策优先框架作为分析审查世界卫生组织（世卫组织）《2013- 2020年非传染性疾病全球行动计划》确定的非传染性疾病政策文件的结构，并辅之以对来自不同部门的关键知情人进行的11次半结构化访谈。结果表明，存在一个有凝聚力的政策群体，领导人也在场，但行为者的权力并没有超出卫生部门，指导机构和民间社会的作用只是在最近才获得势头。将非传染性疾病界定为四种风险因素和四种疾病不一定能引起广大政策界专家的共鸣，但经济论点似乎使人们获得了一些吸引力。虽然出现了许多政策窗口，但其影响受到世卫组织体制限制的限制。可靠的指标和有效的干预措施是存在的，但其在全球范围内的适用性，特别是在低收入和中等收入国家的适用性值得怀疑。为了取得成效，非传染性疾病运动需要超越全球卫生专家的范围，培育民间社会并发展更广泛、更包容的全球治理结构。将Shiffman和Smith的非传染性疾病框架应用于非传染性疾病问题，可以使非传染性疾病如何能够列入联合国政策议程的不同因素得到解决。为确定挑战和解决办法做了大量工作，但执行进程及其适用性在全球范围内仍然具有挑战性。非传染性疾病的应对措施需要适应当地情况，充分重视疾病的预防和管理，并拥有更强有力的全球治理结构。
Although non-communicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, the global policy response has not been commensurate with their health, economic and social burden. This study examined factors facilitating and hampering the prioritization of NCDs on the United Nations (UN) health agenda. Shiffman and Smith's (Generation of political priority for global health initiatives: a framework and case study of maternal mortality. The Lancet 370: 1370-9.) political priority framework served as a structure for analysis of a review of NCD policy documents identified through the World Health Organization's (WHO) NCD Global Action Plan 2013-20, and complemented by 11 semi-structured interviews with key informants from different sectors. The results show that a cohesive policy community exists, and leaders are present, however, actor power does not extend beyond the health sector and the role of guiding institutions and civil society have only recently gained momentum. The framing of NCDs as four risk factors and four diseases does not necessarily resonate with experts from the larger policy community, but the economic argument seems to have enabled some traction to be gained. While many policy windows have occurred, their impact has been limited by the institutional constraints of the WHO. Credible indicators and effective interventions exist, but their applicability globally, especially in low- and middle-income countries, is questionable. To be effective, the NCD movement needs to expand beyond global health experts, foster civil society and develop a broader and more inclusive global governance structure. Applying the Shiffman and Smith framework for NCDs enabled different elements of how NCDs were able to get on the UN policy agenda to be disentangled. Much work has been done to frame the challenges and solutions, but implementation processes and their applicability remain challenging globally. NCD responses need to be adapted to local contexts, focus sufficiently on both prevention and management of disease, and have a stronger global governance structure.