Reshaping Food Policy and Governance to Incentivize and Empower Disadvantaged Groups for Improving Nutrition

The coronavirus disease 2019 (COVID-19) pandemic has exacerbated global malnutrition challenges, disrupted food supply chains, and left poor and vulnerable people unable to produce and access safe and affordable food, especially in developing countries. Food policy and governance are currently malfunctioning, despite their recognized roles in improving food security and public nutrition in many local and national contexts. This article reviews existing food policies and governance with implications for disadvantaged groups in the food systems, particularly smallholder farmers, women, and small- and medium-sized enterprises (SMEs), highlighting the importance of reshaping food policies and governance. To end malnutrition in the post-COVID era, multiple sectors, including health, agriculture, social protection, education, and infrastructure, must make greater collaborative efforts to develop and implement food and nutrition policies. Several recommendations for reshaping food policy interventions and governance are summarized.     

Calorie Offsets: Environmental Policy for the Food Environment

Although obesity continues to challenge the public’s health, effective policy solutions are wanting. Borrowing from environmental protection efforts, we explored the potential for a “calorie offset” regulatory mechanism, which is similar to the carbon emission offsets used to curb greenhouse gas emissions, to mitigate the harmful health externalities of unhealthy food production. This approach might have a number of advantages over traditional policy tools, and warrants attention from health policymakers and industry alike.Over the past 30 years, the prevalence of obesity has increased 3-fold in many high-income countries. This increase in obesity has partially driven the current chronic disease epidemics, including diabetes mellitus, and cardiac and cerebrovascular disease.In the United States, health demographers have suggested that obesity may underlie a forthcoming decline in life expectancy, the first in more than a century.1 Although recent reports have suggested a slowing of the rate of obesity, particularly among children,2 this evidence has been contested.3 Obesity remains among the most important public health challenges of our time.2     

基于政策工具的我国国家级试点城市长期护理保险政策分析

目的:分析我国国家级试点城市在推进长期护理保险中政策工具的使用情况,揭示现有政策工具在应用中的特点与问题,并提出相应的政策建议,以期为推动形成国家层面的长期护理保险政策提供参考。方法:基于政策工具和利益相关者两个维度构建二维分析框架,采用内容分析法,对96项长期护理保险政策文本、359条政策工具进行分析。结果:政策工具结构不均衡,供给型政策工具占25.90%、需求型政策工具占17.00%、环境型政策工具占57.1%;利益相关者不协调,政府占41.23%、定点护理机构占19.22%、商业保险公司占19.78%、参保人占12.53%、社会组织占7.24%。结论:试点城市现有长期护理保险政策在政策工具应用上以环境型为主,应结合发展趋势优化三种政策工具使用比例;在利益相关者维度,政策工具使用时应均衡各方利益,引导和鼓励各方参与到长期护理保险中。     

政策工具视角下我国县域医共体政策文本分析

目的 对我国县域医共体建设相关政策进行分析,探讨其侧重点及不足之处,以期为我国县域医共体建设提供参考。方法 以政策工具方法为理论指导,制定政策分析二维框架,研究对象为2017年1月-2022年3月我国政府层面发布的县域医共体相关政策,对符合纳入条件的政策文本进行编码、分类和统计分析。结果 X政策工具维度共有100条编码,分类后供给型、环境型、需求型工具分别为34个、64个、2个。Y系统论维度共有100条编码,分类后内部子模指标59个,外部子模指标41个。结论 政策工具的推动及拉动作用未发挥最佳功效;子工具应用结构不合理,使用不充分;政策未能适时动态调整,忽视地区情况的差异性;内外部子模差异较大,技术、经济和社会系统使用较少。应多元化使用政策工具,优化组合政策工具使用与结构,动态化使用政策,优化系统内外部工具比例。     

基于政策工具的我国三医联动政策量化分析

目的:对我国发布的27份三医联动政策文件的政策工具进行分析,探究我国三医联动政策体系的着重点与缺失点,为健全我国三医联动政策体系提供参考。方法;以我国2014—2019年发布的27份三医联动政策文件为研究对象,以政策工具为视角对纳入分析的政策文件进行摘录和编码,采用内容分析法和定量分析法对各项政策工具进行统计分析,并确定其运用情况。结果:260个政策编号中,需求型,供给型和环境型政策工具分别占6.9%、24.6%和68.5%;医疗、医保和医药政策工具分别占54.2%、24.6%和21.2%。由此可以看出,我国三医联动改革对环境现状的依赖程度较大,需求与供给政策相对不足,而医疗则是三医联动改革的核心关键点。结论:应适当增加需求型和供给型政策工具,着重解决医疗方面的重难点问题,促使医疗、医保、医药三个利益主体达成合力,形成“三医既联又动”的协同发展机制。     

政策工具视角下我国医疗救助政策分析及优化策略研究*

目的：总结我国医疗救助政策的关键要素与不足,为后续我国医疗救助相关政策调整和完善提供依据。方法： 基于政策工具视角,采用内容分析法,对2013年11月—2022年2月我国政府颁布的医疗救助相关政策进行统计分析。结果：共梳理52份政策文件,其中,政策工具方面,供给型政策工具77项(27.02%)、环境型政策工具91项(31.93%)、需求型政策工具117项(41.05%)。结论：我国医疗救助相关政策存在供给型政策工具应用较少,环境型政策工具缺乏考核激励类工具,需求型政策工具内部运用不均衡等问题。因此,应增加供给型政策工具应用,重视资金支持、财政投入以及基层能力建设;关注环境型政策工具中考核评估工具的应用,加强对医疗救助政策实施过程中监测与评估;关注需求型政策工具中提高统筹层次等方面工具的应用。     

The Precautionary Principle: implications for risk management strategies

The European Commission has published a Communication on the Precautionary Principle and a White Book on Governance. These provide us (as research civil servants of the Commission) an institutional framework for handling scientific information that is often incomplete, uncertain, and contested. But, although the Precautionary Principle is intuitively straightforward to understand, there is no agreed way of applying it to real decision-making. To meet this perceived need, researchers have proposed a vast number of taxonomies. These include ignorance auditing, type one-two-three errors, a combination of uncertainty and decision stakes through post-normal science and the plotting of ignorance of probabilities against ignorance of consequences. Any of these could be used to define a precautionary principle region inside a multidimensional space and to position an issue within that region. The role of anticipatory research is clearly critical but scientific input is only part of the picture. It is difficult to imagine an issue where the application of the Precautionary Principle would be non-contentious. From genetically-modified food to electro-smog, from climate change to hormone growth in meat, it is clear that: 1) risk and cost-benefit are only part of the picture; 2) there are ethical issues involved; 3) there is a plurality of interests and perspectives that are often in conflict; 4) there will be losers and winners whatever decision is made. Operationalization of the Precautionary Principle must preserve transparency. Only in this way will the incommensurable costs and benefits associated with different stakeholders be registered. A typical decision will include the following sorts of considerations: 1) the commercial interests of companies and the communities that depend on them; 2) the worldviews of those who might want a greener, less consumerist society and/or who believe in the sanctity of human or animal life; 3) potential benefits such as enabling the world's poor to improve farming; 4) risks such as pollution, gene-flow, or the effects of climate change. In this paper we will discuss the use of a combination of methods on which we have worked and that we consider useful to frame the debate and facilitate the dialogue among stakeholders on where and how to apply the Precautionary Principle.