超越领导力：卫生政策协调的政治策略

Beyond leadership: Political strategies for coordination in health policies

"将健康融入所有政策"是指通过发挥不同部门的优势和积极性以改善人群健康状况。然而,在具体实施的过程中会面临各种官僚制度障碍,需要进行跨部门治理,而其中涉及的基本问题已经在公共管理学和政治学领域做过阐述。通过查阅文献发现,建立"将健康融入所有政策"跨部门治理的难点被分解为两大类问题:一是在所有部门中开展协调性行动(协调性),二是确保这些部门可以适应不同的政治环境(持续性)。本文还发现,决策者的应对策略也可以归纳为三种类型:明显的政治意愿(如各种计划和目标)、官僚制度改革(如引进卫生影响力评估或机构重组)以及各种间接策略(如各种数据发布以及从外部组织获得支持以向政府施加压力)。由此可以看出,与众多公共卫生政策一样,"将健康融入所有政策"也要依赖于可以做出并有效履行承诺的决策者,但这在不断变换的政治环境中往往不堪一击。三种应对策略则暗示了决策者该如何建立一种跨部门的治理制度,以扩大有效政策建议的范围。

Health in All Policies（ HiAP） promises to improve population health by harnessing the energies and activities of various sectors. Nevertheless,it faces well-documented bureaucratic obstacles and appears to require intersectoral governance if it is to be established. The basic problems of establishing intersectoral governance for HiAP are known to public administration and political science. On reading that literature,we find that the difficulty of establishing intersectoral governance for HiAP breaks down into two kinds of problems： that of establishing coordinated actions at all（ coordination）; and ensuring that they endure in changed political circumstances（ durability）. We further find that policymakers＇ solutions fall into three categories： visible ones of political will（ e. g.,plans and targets）;bureaucratic changes such as the introduction of Health Impact Assessment or reorganization; and indirect methods such as data publication and support from outside groups to put pressure on the government. It can seem that Health in All Policies,like much of public health,depends on effective and committed policymakers but is vulnerable to changing political winds. The three kinds of strategies suggest how policymakers can,and do,create intersectoral governance that functions and persists,expanding the range of effective policy recommendations.