Health, policy and geography: insights from a multi-level modelling approach.
Health, policy and geography: insights from a multi-level modelling approach.
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DOI：
10.1016/j.socscimed.2013.05.021
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发表时间：
2013-09
影响因子：
5.4
通讯作者：
Smith, Peter C.
中科院分区：
文献类型：
--
作者：
Castelli, Adriana;Jacobs, Rowena;Goddard, Maria;Smith, Peter C.
关键词：
改善公民的健康和福祉在大多数政府的议程上占有重要地位。增进健康和福祉的政策行动可以针对一系列地理层面，在英格兰，重点往往从国家一级转移到较小的地区，如社区和街区。我们的重点是确定在最适当的地理级别有针对性的政策干预的潜力，以提高健康和福祉。其理由是，在健康和福祉指标差异较大的地方，与在相对差异较小的地方采取针对政策的战略相比，针对该地域一级的政策干预对相关成果产生影响的可能性更大。我们使用一个多层次的回归方法，以确定存在于一组健康指标在每个级别的变化程度，考虑到公共部门组织的地理层次结构。我们发现，对于每个指标，总残差方差的比例是最大的较小的地理区域。我们还探讨了层次结构内的健康指标的变化，但在公共部门组织负责的地理区域。我们表明，它是可行的，以确定一个子集的组织，其中无法解释的变化，健康指标是显着更大的相对于他们的同行。我们表明，采用地理的角度来分析不同层次的健康指标的变化提供了一个潜在的强大的分析工具，以信号在公共部门组织，越来越多地面临着许多相互竞争的需求，应该针对他们的政策努力。这不仅适用于英语环境，也适用于将健康和福祉责任下放到地方和社区的其他国家。增进福祉的政策可能针对不同的层次，如个人、邻里或区域。负责执行这些政策的组织也在地理上界定的行政边界内运作。我们探讨了一系列与健康相关的指标在一些地理层次的变化。我们发现在同一层次结构内的组织之间的变化，也层次之间的证据。研究结果指导公共部门组织的决策者将政策努力瞄准可能产生最大影响的领域。
Improving the health and wellbeing of citizens ranks highly on the agenda of most governments. Policy action to enhance health and wellbeing can be targeted at a range of geographical levels and in England the focus has tended to shift away from the national level to smaller areas, such as communities and neighbourhoods. Our focus is to identify the potential for targeting policy interventions at the most appropriate geographical levels in order to enhance health and wellbeing. The rationale is that where variations in health and wellbeing indicators are larger, there may be greater potential for policy intervention targeted at that geographical level to have an impact on the outcomes of interest, compared with a strategy of targeting policy at those levels where relative variations are smaller. We use a multi-level regression approach to identify the degree of variation that exists in a set of health indicators at each level, taking account of the geographical hierarchical organisation of public sector organisations. We find that for each indicator, the proportion of total residual variance is greatest at smaller geographical areas. We also explore the variations in health indicators within a hierarchical level, but across the geographical areas for which public sector organisations are responsible. We show that it is feasible to identify a sub-set of organisations for which unexplained variation in health indicators is significantly greater relative to their counterparts. We demonstrate that adopting a geographical perspective to analyse the variation in indicators of health at different levels offers a potentially powerful analytical tool to signal where public sector organisations, faced increasingly with many competing demands, should target their policy efforts. This is relevant not only to the English context but also to other countries where responsibilities for health and wellbeing are being devolved to localities and communities. Policies to enhance wellbeing may be targeted at different hierarchical levels such as individual, neighbourhood or region. Organisations responsible for implementing such policies also operate in geographically defined administrative boundaries. We explore the variation in a range of health-related indicators at a number of geographical hierarchical levels. We find evidence of variation between organisations within the same hierarchy and also between hierarchical levels. The results direct policymakers in public sector organisations to target their policy efforts where impact may be greatest.