如何建设健康社会:相关概念框架的专题分析

IF 3.1 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES International Journal of Health Policy and Management Pub Date : 2023-11-07 DOI:10.34172/ijhpm.2023.7451
Devaki Nambiar, Amy Bestman, Siddharth Srivastava, R. Marten, Sonam Yangchen, Kent Buse
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引用次数: 0

摘要

背景:随着 2030 年可持续发展目标最后期限的临近,人们开始更多地关注卫生部门以外的健康问题,换言之,关注健康社会的创建。然而,这一领域的行动和改革却没有跟上步伐,部分原因在于人们只关注范围较窄的干预措施,以及缺乏针对健康不平等问题的上游行动。为了指导改革行动和政治参与,我们对寻求建立健康社会的概念进行了专题分析。方法:本文对自 1974 年以来发表的 68 份文件(包括政治宣言、报告、同行评审文献和指南)进行了定性专题分析。三位独立审查员提取数据,以确定、讨论和批评健康社会的公共政策杠杆和 "推动因素",即 "如何"。结果:第一个杠杆涉及监管和财政措施。第二个杠杆是跨部门行动。最后一个杠杆是围绕社会转型和成果的全球共识的转变。三个推动因素包括政治领导和问责制、民众动员以及知识的产生和利用。结论:文件主要侧重于技术而非政治解决方案。即使政治领导的重要性得到了承认,但对权力的分析却很有限。以权利为基础的方法通常被忽视,评估在拉动杠杆或投资于促进因素方面哪些有效、哪些无效也被忽视。框架通常不承认或质疑流行的意识形态,也不试图确定如何让政府或公司对失败负责。最后,一些观点和方法似乎在几十年间反复出现,却没有增加更多的细微差别或分析。这表明需要更多的上游、批判性和激进的方法来实现健康的社会。
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How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks
Background: As the Sustainable Development Goals deadline of 2030 draws near, greater attention is being given to health beyond the health sector, in other words, to the creation of healthy societies. However, action and reform in this area has not kept pace, in part due to a focus on narrower interventions and the lack of upstream action on health inequity. With an aim to guide action and political engagement for reform, we conducted a thematic analysis of concepts seeking to arrive at healthy societies. Methods: This paper drew on a qualitative thematic analysis of a purposive sample of 68 documents including political declarations, reports, peer reviewed literature and guidance published since 1974. Three independent reviewers extracted data to identify, discuss and critique public policy levers and ‘enablers’ of healthy societies, the "how." Results: The first lever concerned regulatory and fiscal measures. The second was intersectoral action. The final lever a shift in the global consensus around what signifies societal transformation and outcomes. The three enablers covered political leadership and accountability, popular mobilization and the generation and use of knowledge. Conclusion: Documents focused largely on technical rather than political solutions. Even as the importance of political leadership was recognized, analysis of power was limited. Rights-based approaches were generally neglected as was assessing what worked or did not work to pull the levers or invest in the enablers. Frameworks typically failed to acknowledge or challenge prevailing ideologies, and did not seek to identify ways to hold or governments or corporations accountable for failures. Finally, ideas and approaches seem to recur again over the decades, without adding further nuance or analysis. This suggests a need for more upstream, critical and radical approaches to achieve healthy societies.
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来源期刊
International Journal of Health Policy and Management
International Journal of Health Policy and Management Health Professions-Health Information Management
CiteScore
5.40
自引率
14.30%
发文量
142
审稿时长
9 weeks
期刊介绍: International Journal of Health Policy and Management (IJHPM) is a monthly open access, peer-reviewed journal which serves as an international and interdisciplinary setting for the dissemination of health policy and management research. It brings together individual specialties from different fields, notably health management/policy/economics, epidemiology, social/public policy, and philosophy into a dynamic academic mix.
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