将健康融入所有政策视角下慢性病防控的挑战与对策——基于我国健康城市的典型调查

目的：基于将健康融入所有政策的视角，分析我国慢性病防控存在的问题与挑战，并提出政策建议。方法：运用文献综述、个人深入访谈和专题小组座谈等形式，收集上海、苏州和长春三个健康城市慢性病防控资料；从慢性病防控部门合作的组织形式、政策与制度支持、活动开展及保障措施四个方面进行分析。结果：调研城市都有慢性病防控或者健康促进的多部门合作组织；各城市均在市政府层面制定了健康城市和慢性病防控相关政策，但政策主要由卫生部门执行；非卫生部门工作以被动应付为主，主动行动较少；多部门合作慢性病工作以阶段性项目为主。结论：多部门合作“政策制定的起点较高，但政策执行的落点较低”，缺乏有效的监督和制约机制；多部门合作工作缺乏可持续性，难以满足慢性病的长期防控需要。建议：成立由政府主导的多部门合作组织，促进不同利益相关部门充分参与；利用健康影响评价和健康视角项目等治理工具，形成有效监督和制约部门行动的机制；推进国家层面工作规划的落实，将慢性病防控的阶段性项目与长期规划有机结合，促进慢性病综合防控的可持续开展。

Challenges and strategies of non-communicable disease prevention and control from the perspective of Health in All Policies: A survey in typical health cities in China

Objectives： Based on international Health in All Policies（HiAP） perspective, the paper discussed China＇s status and problems by filed survey and literature reviews, and made policy recommendations for the control and prevention of non-communicable diseases （NCDs） in China. Methods ： By typical sampling, we studied Shanghai, Suzhou and Changchun, all of which did well in healthy cities construction and NCD control and prevention. Indepth interview and focus group discussions were conducted with administrators, managers and related key inform- ants. The paper analysed NCDs control and prevention in terms of organizational structure, regulatory work, activities implementation and financial support. Results： Different multi-departmental organizations were established in the sur- veyed cities. Policies on NCDs control or health promotion were made at the municipal level in each city. Policies were mainly carried out by the health department, and most non-health departments carry out work ＂assigned＂ to them, but make implementations passively, not actively. Activities on NCDs prevention were carried out through pro- grams or campaigns. Conclusions： Policy making was conducted at a high level, but policy implementation mainly re- lied on health sectors. Most multi-departmental work was conducted in the form of programs, and there was a lack of long-term, sustainable control of NCDs. Efficient monitoring and evaluation system is badly needed. Recommenda- tions ： Establishing a multi-departmental cooperation system with support of the government. With Health Impact Assessment and Health Lens instruments, setting up supervision and incentive mechanisms for multi-departmental cooperation and facilitating the implementation of national development plans and strategies with detailed performance evaluation and monitoring indicators for multi-departmental cooperation of NCDs control and prevention.