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目前,世界各国普遍采取跨部门行动解决健康的宏观社会和经济决定因素。“将健康融入所有政策(Hi AP)”是各国采取跨部门行动的策略之一,它以广义的健康决定因素而非单纯的卫生服务为目标,在决策过程中系统解决健康问题。近几十年来出现了很多关于Hi AP的案例,但这些案例成功或失败的原因并未得到系统的研究,这就导致以证据为基础的有关促进或阻碍Hi AP策略实施的相关因素的研究较少。本文基于现实主义视角,采用解释性案例研究,分析了不同地区Hi AP策略的实施情况。本研究在提出概念性框架的基础上,分析了与Hi AP可持续实施有关的背景、社会机制及结果,并利用相关文献以及从关键知情人访谈中得到的证据,寻找相关的模式和主题对现象加以解释。最后,通过对瑞典和加拿大魁北克实施卫生影响力评估的情况进行比较,揭示了Hi AP成功实施的经验。此方法能够帮助研究者对某一地区内成功实施Hi AP的社会机制和背景因素的大量证据信息加以审核并做三角测量,还可用于分析其他形式的部门间行动,以减少不同背景、不同地区之间的卫生不公平性现象。
At present, the macroeconomic social and economic determinants of health are widely adopted across the world for cross-sectoral actions. “Integrating Health into All Policies (Hi APs)” is one of the strategies adopted across countries for cross-sectoral actions that systematically address health issues in the decision-making process with the goal of broad-based health determinants rather than purely health services. There have been many cases of Hi AP in recent decades, but the reasons for the success or failure of these cases have not been systematically studied, which led to evidence-based research on the related factors that promote or hinder the implementation of HiAP strategy less. Based on the realism perspective, this article uses explanatory case studies to analyze the implementation of HiAP policies in different regions. Based on the conceptual framework, this study analyzes the background, social mechanisms and outcomes related to the sustainable implementation of HiAP and uses relevant literature and evidence from interviews with key insiders to find relevant models and topics Phenomenon to be explained. Finally, a comparison of the health impact assessments carried out in Sweden and Quebec, Canada, revealed the successful implementation of Hi AP. This method can help researchers to review and triangulate a large amount of evidence about the successful implementation of HiAP’s social mechanisms and contextual factors in a region and can also be used to analyze other forms of intersectoral action to reduce the impact of different backgrounds, Health inequity between the phenomenon.