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1.
Evidence for effective government policies to reduce exposure to alcohol’s carcinogenic and hepatoxic effects has strengthened in recent decades. Policies with the strongest evidence involve reducing the affordability, availability and cultural acceptability of alcohol. However, policies that reduce population consumption compete with powerful commercial vested interests. This paper draws on the Canadian Alcohol Policy Evaluation (CAPE), a formal assessment of effective government action on alcohol across Canadian jurisdictions. It also draws on alcohol policy case studies elsewhere involving attempts to introduce minimum unit pricing and cancer warning labels on alcohol containers. Canadian governments collectively received a failing grade (F) for alcohol policy implementation during the most recent CAPE assessment in 2017. However, had the best practices observed in any one jurisdiction been implemented consistently, Canada would have received an A grade. Resistance to effective alcohol policies is due to (1) lack of public awareness of both need and effectiveness, (2) a lack of government regulatory mechanisms to implement effective policies, (3) alcohol industry lobbying, and (4) a failure from the public health community to promote specific and feasible actions as opposed to general principles, e.g., ‘increased prices’ or ‘reduced affordability’. There is enormous untapped potential in most countries for the implementation of proven strategies to reduce alcohol-related harm. While alcohol policies have weakened in many countries during the COVID-19 pandemic, societies may now also be more accepting of public health-inspired policies with proven effectiveness and potential economic benefits.  相似文献   

2.
ObjectivesWe examine the public policies that have been formulated to reduce the incidence of dog bites. We do so to encourage the adoption of policies aligned with One Health promotion.MethodsThis case-study research involved an ethnographic approach. Our qualitative analysis derived from participant observation, policy documents, media coverage, and interviews with stakeholders in Montreal (Quebec).ResultsFollowing on from a human fatality due to dog bite injuries, the City of Montreal decided to ban certain types of dogs based on their ‘breed.’ In the ensuing discussions, the ‘Calgary model’ emerged as an alternative to breed-specific legislation. These discussions led to a change in policy direction for Montreal, and for Quebec as a whole. Furthermore, we discerned marked improvements with respect to intersectoral coordination in the wake of this controversy.Conclusion‘Policy mobilities’ offer a useful conceptual apparatus for understanding how public policies for dog bite prevention are polarized around controversial proposals, to the detriment of discussions that focus on policy implementation.  相似文献   

3.
BACKGROUND: In Europe important differences exist concerning policies for the prevention of common diseases. In most cases these cannot be explained by the underlying epidemiology. However, successful policies should have a measurable effect on disease epidemiology. There has been little research comparing the effect of national preventive policies on disease-specific mortality. OBJECTIVES: To describe the mortality trends for three health problems representing the three levels of prevention in Germany and in selected European countries, which are of interest for the disease under question. To relate epidemiological trends to preventive policies at the national level and at the level of the European Union (EU). METHODS: Comparison of age-standardized mortality rates for road traffic accidents, cervical cancer and diabetes mellitus in the period 1970-2002, using routine data. Analysis of disease-specific prevention policies in countries that deviate from the general trend in the EU, with a special focus on developments in Germany. RESULTS: The development of mortality rates during the last 30 years for road traffic accidents, cervical cancer and diabetes mellitus varied substantially across Europe. Although the evidence linking specific public policies to epidemiological trends is sparse and often limited to ecological studies, a number of epidemiological changes can be plausibly linked to specific policies in the countries concerned. CONCLUSION: Successful preventive policies exist for all health problems reviewed. The current status of implementation of these policies can only be interpreted in the historical and political context of the countries concerned. The role of epidemiology to guide health policy decisions is under-utilized, as is the regulatory framework for disease and injury prevention at the level of the EU. Less formal policy measures such as European clinical guidelines are equally scarce. More rigorous comparative health services research is needed to formulate evidence-based policies for disease prevention.  相似文献   

4.
Despite a significant commitment to tackling childhood overweight and obesity, questions remain about the progress the Thai Government has made in implementing childhood obesity prevention policies and actions. This study aimed to review and assess the implementation of the government’s policies and actions for childhood obesity prevention in Thailand compared with the recommendations of the Commission on Ending Childhood Obesity and to identify the implementation gaps. Policy data were collected from governmental and NGO websites and publications and via direct contact with government officials. Stakeholder meetings were held to seek further information and advice on implementation gaps and to give recommendations. The analysis of each policy was conducted against pre-determined criteria formulated from literature assessments and stakeholder consultations. The policies and actions that were implemented by the Government were consistent with 33 broad policy actions and 55 specific policy actions. Preconception and pregnancy care was the policy area that was most implemented. Six broad policy actions were assessed as ‘high’ performance, these were: sugar-sweetened beverage taxation, nutrient labeling, nutrition guidance for preconception and pregnancy care, the International Code of Marketing of Breast-milk Substitutes, regulatory measures for supporting maternal breastfeeding, and regulations on the marketing of complementary foods and beverages. Policy coherence and monitoring and evaluation (M&E) were identified as major implementation gaps. Increasing the effectiveness of childhood obesity prevention in Thailand will require national immediate attention towards building infrastructure to enhance coherence among the policies and to put in place M&E mechanisms for each policy.  相似文献   

5.
Stachenko S 《Public health》2008,122(10):1038-1041
A number of major challenges face surveillance systems in the field of chronic disease. The complex interplay of risk factors and determinants that result in chronic disease is calling into question traditional surveillance systems in terms of what is collected to inform policy decisions. At the same time, the complexity presents an opportunity to broaden the evidence base on which arguments can be based for chronic disease intervention to increase their potential to influence policy makers. This article describes some initiatives in Canada to enhance the capacity and utility of surveillance systems and their associated data to inform policy making in the field of chronic disease.  相似文献   

6.
Policy diffusion is a process whereby political bodies 'learn' policy solutions to public health problems by imitating policy from similar jurisdictions. This suggests that diffusion is a critical element in the policy development process, and that its role must be recognised in any examination of policy development. Yet, to date, no systematic work on the diffusion of smoke-free spaces bylaws has been reported. We examined the diffusion of municipal smoke-free bylaws over a 30-year period in the provinces of Alberta and Ontario, Canada, to begin to address this gap and to determine whether spatial patterns could be identified to help explain the nature of policy development. Bylaw adoption and change were analysed within local, regional, and provincial contexts. Geographical models of hierarchical and expansion diffusion in conjunction with the diffusion of innovations framework conceptually guided the analyses. Study findings contribute to a broader understanding of how and why health policies diffuse across time and place. Policy development can be a powerful mechanism for creating environments that support healthy decisions; hence, an understanding of policy diffusion is critical for those interested in policy interventions aimed at improving population health in any jurisdiction.  相似文献   

7.
We examine the scope of inquiry into the measurement and assessment of the state public health policy environment. We argue that there are gains to be made by looking systematically at policies both within and across health domains. We draw from the public health and public policy literature to develop the concepts of interdomain and intradomain policy comprehensiveness and illustrate how these concepts can be used to enhance surveillance of the current public health policy environment, improve understanding of the adoption of new policies, and enhance evaluations of the impact of such policies on health outcomes.The 2011 Institute of Medicine report For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges called public policy “among the most powerful tools to improve population health.”1(p18) However, the institute’s recommendation that legislators and government agencies “familiarize themselves with the array of legal and policy tools available”1(p68) poses substantial challenges in the absence of conceptual and methodological clarity on how these tools should be measured, classified, adopted, and used, especially at the state level.2–4 Categorizing and assessing different provisions of state policies is a complex task, made even more difficult by the absence of standardized methods.5,6 Different approaches to operationalizing policy measures have also led, in some cases, to conflicting evidence of their effectiveness.7–9 Furthermore, these assessments have largely treated public health issues as independent silos, with little reference to how policies may work in concert or at odds with one another either within or across public health domains.10Several authors have highlighted the important limitations of existing studies that fail to account for the full range of policies that may have contributed to the outcome in question.10,11 To date, however, there is still relatively little systematic surveillance of the complete set of public health policies adopted by states across multiple public health arenas, and there has been even less of a focus on the evolution and impact of these different combinations of policies on health outcomes.We argue here that an integrated and systematic assessment of public health policies within and across health domains is necessary for measuring the effectiveness of any individual health policy or law. Such an assessment is also necessary to understand how and why US states and localities have constructed vastly different health policy landscapes over time. Note that by “policy” we refer to the enactment or modification of laws, the development or modification of regulatory measures, and the setting of funding priorities, including the development of specific public sphere programs. By “health policy landscape,” we refer to the total number of health policies in place in a given jurisdiction at any given time.Our objective is to respond to growing interest among policymakers and advocates in understanding the ways policy tools can be used to improve population health both within and across health areas.3 Indeed, findings from a 2007 Association of State and Territorial Health Officials (ASTHO) survey indicated that state health agencies ranked “developing effective health policy” among their top 5 priorities.12 Our argument is thus meant to engage researchers and advocates in considering how to apply a more thorough approach to their work in policy development and analysis and to assist them in communicating these ideas to policymakers.In developing a framework for conceptualizing the broader state health policy landscape, we begin by introducing 2 new constructs: intradomain policy comprehensiveness and interdomain policy comprehensiveness. We discuss the ways in which these constructs aid in illuminating the composition of different state policy landscapes and discuss how they may influence the study, measurement, and effects of public health policies. To illustrate our arguments, we construct a data set of 27 public health policies in all 50 states between 1980 and 2000 and discuss observed patterns in public health policy adoption. We then review the literature on internal and external determinants of policy adoption and diffusion and consider the ways these determinants may be associated with the comprehensiveness of states’ health policy landscapes. We end with a series of research questions that stem from our approach.  相似文献   

8.
目的 探讨我国癌症防治相关政策中存在的问题,以期为后续癌症防治政策的制定与优化调整提供参考借鉴。方法 运用Rothwell & Zegveld政策工具分类方法,对我国国家层面癌症防治相关政策文本进行编码分类和统计分析。结果 研究共纳入15份国家层面癌症防治相关政策文件,累计编码235条。其中环境型政策工具(66.81%)使用最多,供给型政策工具(25.53%)次之,需求型政策工具(7.66%)应用最少。结论 目前国家层面的癌症防治政策制定还有待优化:环境型政策工具使用过溢,内部结构不均衡,同时供给型和需求型政策工具应用不足。建议加快供给型和需求型政策工具制定与完善,增加政策的拉力与推力,使政策工具各方面平衡协调与优化,逐步推进我国癌症防治事业的发展。  相似文献   

9.
Through improved screening, detection, better and more targeted therapies and the uptake of evidence-based treatment guidelines, cancers are becoming chronic diseases. However, this good-news story has implications for human resource planning and resource allocation. Population-based chronic disease management is a necessary approach to deal with the growing burden of chronic disease in Canada. In this model, an interdisciplinary team works with and educates the patient to monitor symptoms, modify behaviours and self-manage the disease between acute episodes. In addition, the community as a whole is more attuned to disease prevention and risk factor management. Trusted, high-quality evidence-based protocols and healthy public policies that have an impact on the entire population are needed to minimize the harmful effects of chronic disease. Assuming we can overcome the challenges in recruitment, training and new role development, enlightened healthcare teams and community members will work together to maintain the population's health and wellness and to reduce the incidence and burden of chronic disease in Ontario.  相似文献   

10.
目的 探讨执行突发公共卫生事件社区防控政策的影响因素及其作用机制,并提出相应对策.方法 于2020年2-9月按照目的、理论和滚雪球抽样结合扎根理论研究方法对我国7个省(市)的122名社区管理人员、基层医疗机构医务人员、志愿者和社区居民进行半结构化访谈,经开放编码、主轴编码和选择性编码构建执行突发公共卫生事件社区防控政策...  相似文献   

11.
陈露  马芳  马蕊  马国芳 《现代预防医学》2022,(21):3944-3950
目的 评估我国疾病预防控制体系建设相关政策文件效力和实施效果,为我国疾病预防控制体系政策制定建言献策。方法 通过国家卫生健康委员会官网、“北大法宝”检索系统以“疾病预防控制”、“疾控体系”、“疾控”为主要检索词检索2003—2022年中央、国家及各部委发布的政策文件,经筛选后最终纳入52项疾病预防控制相关政策。将政策效力划分为政策力度、政策措施、政策目标3个维度,用疾病预防控制支出表示政策效果,通过构建多元线性回归模型对环境型、供给型、需求型三种不同政策工具疾病预防控制体系建设政策实施效果进行回归分析。结果 2003—2022年,我国疾控体系建设相关政策数量与总体效力值呈现平稳波动,且具有明显的正相关关系,政策平均效力值呈M型稳定变化趋势,整体水平偏低; 政策措施得分最高,政策目标次之,政策力度得分最低。相较于其他两种政策工具,环境型政策工具使用频率最高,需求型政策工具使用频率最低; 环境型(Coef.=0.732,P=0.015)、供给型(Coef.=0.64,P=0.010)、需求型(Coef.=0.523,P=0.035)三种政策工具对政策实施效果均具有促进作用,滞后期保持在1~2年; 上一年度的疾控支出对下一年度的政策效果具有促进作用(Coef.=0.74,P=0.032)。结论 我国疾病预防控制政策效力不断提高主要源于政策颁布数量的累计效应; 不同政策工具使用过程中存在不平衡、不充分问题; 三类政策工具均对我国疾病预防控制体系政策实施效果起到一定影响,且环境型政策工具最优; 疾病预防控制相关支出会强化政策实施效果,推动疾控体系建设快速发展。  相似文献   

12.
在新冠肺炎疫情治理期间,各级政府在短时期内密集制订和出台了千余个公共政策,涉及到疫情治理的各个方面.较多政策产生了积极的价值效应,如政策具有及时性和强回应性,对疫情防控起到了决定性作用;但也有一些政策价值比较有限,如政策的协同性和科学合理性不够.研究基于新冠肺炎疫情防控政策,提出建立价值政策挖掘和开发机制,完善突发公共...  相似文献   

13.
Objective. In this article, we adopt a syndemic approach to immigrant tuberculosis (TB) in Canada as a way of challenging contemporary epidemiological models of infectious diseases that tend to racialize and medicalize the risk of infections in socio-economically disadvantage populations and obscure the role of social conditions in sustaining the unequal distribution of diseases in these populations. Design. A syndemic approach unravels social and biological connections which shape the distribution of infections over space and time and is useful in de-racializing and de-medicalizing these epidemiologic models. The socio-historic framework allows us to examine social factors which, refracted through medical science, were central to the development of TB control in Canada at the beginning of twentieth century. Results. We expose the ideological assumptions about race, immigration, and social status which underpin current policies designed to control TB within the immigrant population. We argue that TB control policies which divert the attention from structural health determinants perpetuate health and social inequities of racialized populations in Canada. Medical screening and surveillance is an ineffective control policy because the proportion of TB cases attributed to immigrants increased from 18 to 66% between 1970 and 2007. Conclusion. More effective TB control policies require shifting the focus from the individual disease carriers toward social inequities which underlie the problem of immigrant TB in Canada. In addition, de-racialization and de-medicalization of the contemporary epidemiological models of infectious diseases entail an in-depth exploration of how the categories of ethnicity, culture, and immigration status are played out in everyday health-related experiences of racialized groups.  相似文献   

14.
BackgroundCOVID-19 transmission rates in South Asia initially were under control when governments implemented health policies aimed at controlling the pandemic such as quarantines, travel bans, and border, business, and school closures. Governments have since relaxed public health restrictions, which resulted in significant outbreaks, shifting the global epicenter of COVID-19 to India. Ongoing systematic public health surveillance of the COVID-19 pandemic is needed to inform disease prevention policy to re-establish control over the pandemic within South Asia.ObjectiveThis study aimed to inform public health leaders about the state of the COVID-19 pandemic, how South Asia displays differences within and among countries and other global regions, and where immediate action is needed to control the outbreaks.MethodsWe extracted COVID-19 data spanning 62 days from public health registries and calculated traditional and enhanced surveillance metrics. We use an empirical difference equation to measure the daily number of cases in South Asia as a function of the prior number of cases, the level of testing, and weekly shifts in variables with a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano–Bond estimator in R.ResultsTraditional surveillance metrics indicate that South Asian countries have an alarming outbreak, with India leading the region with 310,310 new daily cases in accordance with the 7-day moving average. Enhanced surveillance indicates that while Pakistan and Bangladesh still have a high daily number of new COVID-19 cases (n=4819 and n=3878, respectively), their speed of new infections declined from April 12-25, 2021, from 2.28 to 2.18 and 3.15 to 2.35 daily new infections per 100,000 population, respectively, which suggests that their outbreaks are decreasing and that these countries are headed in the right direction. In contrast, India’s speed of new infections per 100,000 population increased by 52% during the same period from 14.79 to 22.49 new cases per day per 100,000 population, which constitutes an increased outbreak.ConclusionsRelaxation of public health restrictions and the spread of novel variants fueled the second wave of the COVID-19 pandemic in South Asia. Public health surveillance indicates that shifts in policy and the spread of new variants correlate with a drastic expansion in the pandemic, requiring immediate action to mitigate the spread of COVID-19. Surveillance is needed to inform leaders whether policies help control the pandemic.  相似文献   

15.
The ongoing obesity pandemic threatens the health of hundreds of millions globally. However, to date, no country has had much success in limiting its growth, let alone reversing it. This commentary demonstrates the relevance to the obesity pandemic of the public health conceptual framework of epidemiologist Geoffrey Rose, first published as “Sick Individuals and Sick Populations” in 1985. That framework provides a useful way to analyze the pandemic’s prevention and control options, based on the notions of primordial, primary, secondary and tertiary prevention—the full spectrum of “more upstream and more downstream” approaches, each with its pros and cons. Based on an analysis of key studies to date, this commentary argues strongly that only the primordial prevention approach is likely to be successful against the obesity pandemic—but its onerous requirements for society-wide behavioural and cultural change may make that public health struggle a long one.  相似文献   

16.
The Oregon Public Health Policy Institute (PHPI) was designed to enhance public health policy competencies among state and local health department staff. The Oregon Health Authority funded the College of Public Health and Human Sciences at Oregon State University to develop the PHPI curriculum in 2012 and offer it to participants from 4 state public health programs and 5 local health departments in 2013.The curriculum interspersed short instructional sessions on policy development, implementation, and evaluation with longer hands-on team exercises in which participants applied these skills to policy topics their teams had selected. Panel discussions provided insights from legislators and senior Oregon health experts.Participants reported statistically significant increases in public health policy competencies and high satisfaction with PHPI overall.Innovative policy solutions to address public health problems are becoming increasingly important, particularly because chronic diseases constitute a growing share of the disease burden in the United States. Public health policies increasingly aim to shape an environment that encourages healthy behaviors, such as physical activity or healthy eating.1,2Although traditional public health programs often target smaller groups, such as those infected with or at elevated risk of particular infectious diseases, public health policies can influence the behavior or environment of large populations. Such policies, which include laws, regulations, rules, or operational decisions intended to improve population health, can help jurisdictions meet population health goals because they work “upstream” of heath care services and even many traditional health promotion programs.The Public Health Division (PHD) of the Oregon Health Authority (OHA) is working to enhance the competencies of the state and local health agencies in Oregon to develop, implement, and evaluate public health policies; these competencies receive limited attention in existing degree programs or in-service training. The PHD funded Oregon State University (OSU) to develop a Public Health Policy Institute (PHPI) tailored to the state’s institutional and political environment, and designed to train public health professionals to address public health problems with upstream policy solutions. We describe the existing public health policy background and training resources nationwide and in Oregon, and outline the structure and content of the PHPI curriculum. We present the results from the evaluation of the first offering of PHPI and reflections on lessons for other states.  相似文献   

17.
Health policies on disease prevention differ widely between countries. Studies suggest that different countries have much to learn from each other and that significant health gains could be achieved if all countries followed best practice. This paper describes the policy development and planning process relating to prevention activities in Italy, through a critical appraisal of Regional Prevention Plans (RPPs) drafted for the period 2010–2012. The analysis was performed using a specific evaluation tool developed by a Scientific Committee appointed by the Italian Ministry of Health. We appraised nineteen RPPs, comprising a total of 702 projects, most of them in the areas of universal prevention (62.9%) and prevention in high risk groups (27.0%). Italian Regions established prevention activities using an innovative combination of population and high-risk individuals approaches. However, some issues, such as the need to reduce health inequalities, were poorly addressed. The technical drafting of RPPs required some improvement; e.g. the evidence of the effectiveness and cost-effectiveness of the health interventions proposed was seldom reported. There were significant geographical differences across the Regions in the appraisal of RPPs. Our research suggests that continuous assessment of the planning process of prevention may become a very useful tool for monitoring, and ultimately strengthening, public health capacity in the field of prevention. Further research is needed to analyze determinants of regional variation.  相似文献   

18.
BackgroundCOVID-19 was first reported in 2019, and the Chinese government immediately carried out stringent and effective control measures in response to the epidemic.ObjectiveNonpharmaceutical interventions (NPIs) may have impacted incidences of other infectious diseases as well. Potential explanations underlying this reduction, however, are not clear. Hence, in this study, we aim to study the influence of the COVID-19 prevention policies on other infectious diseases (mainly class B infectious diseases) in China.MethodsTime series data sets between 2017 and 2021 for 23 notifiable infectious diseases were extracted from public data sets from the National Health Commission of the People’s Republic of China. Several indices (peak and trough amplitudes, infection selectivity, preferred time to outbreak, oscillatory strength) of each infectious disease were calculated before and after the COVID-19 outbreak.ResultsWe found that the prevention and control policies for COVID-19 had a strong, significant reduction effect on outbreaks of other infectious diseases. A clear event-related trough (ERT) was observed after the outbreak of COVID-19 under the strict control policies, and its decreasing amplitude is related to the infection selectivity and preferred outbreak time of the disease before COVID-19. We also calculated the oscillatory strength before and after the COVID-19 outbreak and found that it was significantly stronger before the COVID-19 outbreak and does not correlate with the trough amplitude.ConclusionsOur results directly demonstrate that prevention policies for COVID-19 have immediate additional benefits for controlling most class B infectious diseases, and several factors (infection selectivity, preferred outbreak time) may have contributed to the reduction in outbreaks. This study may guide the implementation of nonpharmaceutical interventions to control a wider range of infectious diseases.  相似文献   

19.
[目的]了解基层疾病控制业务技术骨干对国家疾病控制政策的认识及业务技术素质提高需求,为国家制定相关政策提供参考依据。[方法]自行设计调查问卷,于2012年6月对参加山东全省疾控业务骨干培训的县级学员每县10人合计1400人进行问卷调查。[结果]发放问卷1400份,回收合格问卷1389份,合格率为99.2%。对与疾病控制有重要关系的基本公共卫生政策比较了解的1037人(占74.6%),并认可的835人(占60.1%)。114人(占80.2%)的人认为财政支持力度不足是当前疾病控制存在的主要问题,546人(占39.3%)认为专业技术人员数量不足是基层疾控队伍的主要问题,958人(占69.0%)认为慢病防制是当前要解决的首要的公共卫生问题,1028人(占74.0%)认为健康教育在疾病控制工作中的地位应该加强。基本技能更受基层业务技术人员重视,1097人(占79.0%)希望通过相对长期正规的途径学习,782人(占56.3%)选择影响学习的最主要因素是工作忙没时间。[结论]国家应切实加强对疾病控制和公共卫生的重视,加大财政投入,从体制上提高疾控机构人员编制人数,使之与日益繁重的疾控任务相适应。  相似文献   

20.
Since healthy eating and physically active lifestyles can reduce diabetes mellitus (DM) risk, these are often addressed by population-based interventions aiming to prevent DM. Our study examined the impact of nutritional and physical activity policies, national diabetes plans and national diabetes registers contribute to lower prevalence of DM in individuals in the member states of the European Union (EU), taking into account the demographic and socioeconomic status as well as lifestyle choices. Datasets on policy actions, plans and registers were retrieved from the World Cancer Research Fund International’s NOURISHING and MOVING policy databases and the European Coalition for Diabetes report. Individual-based data on DM, socioeconomic status and healthy behavior indicators were obtained via the European Health Interview Survey, 2014. Our results showed variation in types and numbers of implemented policies within the member states, additionally, the higher number of these actions were not associated with lower DM prevalence. Only weak correlation between the prevalence of DM and preventive policies was found. Thus, undoubtedly policies have an impact on reducing the prevalence of DM, its increasing burden could not be reversed which underlines the need for applying a network of preventive policies.  相似文献   

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