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首页> 美国卫生研究院文献>International Journal of Health Policy and Management >The Development of Public Policies to Address Non-communicable Diseases in the Caribbean Country of Barbados: The Importance of Problem Framing and Policy Entrepreneurs
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The Development of Public Policies to Address Non-communicable Diseases in the Caribbean Country of Barbados: The Importance of Problem Framing and Policy Entrepreneurs

机译：解决加勒比国家巴巴多斯非传染性疾病的公共政策的发展：问题框架和政策企业家的重要性

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>Background: Government policy measures have a key role to play in the prevention and control of non-communicable diseases (NCDs). The Caribbean, a middle-income region, has the highest per capita burden of NCDs in the Americas. Our aim was to examine policy development and implementation between the years 2000 and 2013 on NCD prevention and control in Barbados, and to investigate factors promoting, and hindering, success. >Methods: A qualitative case study design was used involving a structured policy document review and semi-structured interviews with key informants, identified through stakeholder analysis and ‘cascading.’ Documents were abstracted into a standard form. Interviews were recorded, transcribed verbatim and underwent framework analysis, guided by the multiple streams framework (MSF). There were 25 key informants, from the Ministry of Health (MoH), other government Ministries, civil society organisations, and the private sector. >Results: A significant policy window opened between 2005 and 2007 in which new posts to address NCDs were created in the MoH, and a government supported multi-sectoral national NCD commission was established. Factors contributing to this government commitment and funding included a high level of awareness, throughout society, of the NCD burden, including media coverage of local research findings; the availability of policy recommendations by international bodies that could be adopted locally, notably the framework convention on tobacco control (FCTC); and the activities of local highly respected policy entrepreneurs with access to senior politicians, who were able to bring together political concern for the problem with potential policy solutions. However, factors were also identified that hindered multi-sectoral policy development in several areas, including around nutrition, physical activity, and alcohol. These included a lack of consensus (valence) on the nature of the problem, often framed as being predominantly one of individuals needing to take responsibility for their health rather than requiring government-led environmental changes; lack of appropriate detailed policy guidance for local adaptation; conflicts with other political priorities, such as production and export of alcohol, and political reluctance to use legislative and fiscal measures. >Conclusion: The study’s findings indicate mechanisms to promote and support NCD policy development in the Caribbean and similar settings.
机译：>背景：政府的政策措施在预防和控制非传染性疾病（NCD）中起着关键作用。加勒比是一个中等收入地区，在美洲，非传染性疾病的人均负担最高。我们的目标是研究巴巴多斯在2000年至2013年之间制定和实施非传染性疾病预防和控制政策，并调查促进和阻碍成功的因素。 >方法：采用了定性案例研究设计，其中包括通过利益相关者分析和“级联”确定的结构化政策文件审阅和对主要信息提供者的半结构化访谈。文件被抽象为标准格式。在多流框架（MSF）的指导下，记录访谈，逐字记录并进行框架分析。来自卫生部（MoH），其他政府部门，民间社会组织和私营部门的25名主要信息提供者。 >结果：在2005年至2007年之间打开了一个重要的政策窗口，其中在卫生部中设立了应对非传染性疾病的新职位，并建立了由政府支持的多部门国家非传染性疾病委员会。促使政府做出承诺和提供资金的因素包括：整个社会对非传染性疾病负担的高度了解，包括媒体对当地研究结果的报道；国际机构是否有可能在当地采用的政策建议，特别是烟草控制框架公约（FCTC）；以及与高级政客接触的当地备受尊敬的政策企业家的活动，他们能够将对问题的政治关注与潜在的政策解决方案结合在一起。但是，还发现了一些因素，这些因素阻碍了多个领域的多部门政策制定，包括围绕营养，体育锻炼和酒精的发展。其中包括对问题的性质缺乏共识（效价），通常被认为主要是需要对自己的健康负责而不是要求政府主导的环境变化的个人之一；缺乏适当的详细政策指导以适应当地情况；与其他政治优先事项（例如酒精的生产和出口）发生冲突，以及政治上不愿使用立法和财政措施。 >结论：该研究结果表明了在加勒比海地区和类似地区促进和支持NCD政策发展的机制。

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