Public policy frameworks for improving population health
Public policy frameworks for improving population health
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DOI：
10.1111/j.1749-6632.1999.tb08123.x
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发表时间：
1999-01-01
期刊：
影响因子：
--
通讯作者：
Tarlov, AR
中科院分区：
文献类型：
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作者：
Tarlov, AR
四个概念框架为构建全面的公共政策战略提供了基础，以改善富裕国家（经合组织）的人口健康。(1)人口健康的决定因素。有五大类：基因和生物学，医疗保健，健康行为，所有生物的生态学，以及社会/社会特征。(2)复杂系统：线性效应模型和多重独立效应模型不能产生令人满意的结果，解释人口健康生产的动态。需要一种不同的方法（复杂系统建模）来选择最有效的干预措施，以改善人口健康。(3)改善人口健康的干预框架。2 × 5的网格似乎很有用。大多数干预策略要么是改善性的，要么是根本性的纠正。网格的另一个维度涵盖了五个一般类别的干预措施：儿童发展，社区发展，成人自我实现，社会经济福祉和调制等级结构。(4)公共政策制定过程：这个过程有两个阶段。在最初阶段，公众达成共识，形成一个授权环境，从价值观和文化到问题的确定，从研究和经验中发展知识，提高公众意识，制定国家议程。后一阶段，采取政策行动，从政治参与开始，发展到利益集团的激活，公共政策的审议和通过，最终监管和修订。这些框架将用于帮助理解联合王国的唐纳德·艾奇逊爵士报告《健康不平等问题独立调查》的39项建议，这是迄今为止为制定改善人口健康的全面计划所作的最雄心勃勃的尝试。
Four conceptual frameworks provide bases for constructing comprehensive public policy strategies for improving population health within wealthy (OECD) nations. (1) Determinants of population health. There are five broad categories: genes and biology, medical care, health behaviors, the ecology of all living things, and social/societal characteristics. (2) Complex systems: Linear effects models and multiple independent effects models fail to yield results that explain satisfactorily the dynamics of population health production. A different method (complex systems modeling) is needed to select the most effective interventions to improve population health. (3) An intervention framework for population health improvement. A two-by-five grid seems useful. Most intervention strategies are either ameliorative or fundamentally corrective. The other dimension of the grid captures five general categories of interventions: child development, community development, adult self-actualization, socioeconomic well-being, and modulated hierarchical structuring. (4) Public policy development process: the process has two phases. The initial phase, in which public consensus builds and an authorizing environment evolves, progresses from values and culture to identification of the problem, knowledge development from research and experience, the unfolding of public awareness, and the setting of a national agenda. The later phase, taking policy action, begins with political engagement and progresses to interest group activation, public policy deliberation and adoption, and ultimately regulation and revision. These frameworks will be applied to help understand the 39 recommendations of the Independent Inquiry into Inequalities in Health, the Sir Donald Acheson Report from the United Kingdom, which is the most ambitious attempt to date to develop a comprehensive plan to improve population health.