David Goff   美国威克森林大学Baptist医学中心

    <International circulation>:  Do you feel that the WHO Steps program is the most important first step or that there should be other first steps taken before people implement the WHO STEPS program?

    《国际循环》：Goff教授您好，请问您认为世界卫生组织（WHO）的STEPS计划就是最重要的第一步，还是您认为在人们参与WHO的STEPS计划之前还应该完成其他的第一步？
 
    Prof. Goff:  The STEPS program is a good step but perhaps even before that countries should know about their policy landscape.  In different countries there may be different policy landscapes.  In the United States it is very important to know what is going on at the state and local levels because there are very few federal policies that affect cardiovascular health specifically.  For example， smoking bans at workplaces， restaurants， and bars is not made at the federal level but rather at the state or local level.  If we are going to make progress at preventing cardiovascular disease by promoting the adoption of smoke-free policies we need to know the status of this type of policy at the state and local level across the United States.  This may also be true in many countries that do not have a federal policy but may have policies the sub-jurisdictional level.  Policies on sodium in the food supply may also be a federal or state level policy， depending on the country.  Policies on things like access to enhanced 911， emergency medical care services would also be useful to know about before things like STEPS.  Availability of fresh fruits and vegetables， availability of low-fat dairy， these are policy and environmental surveillance tools that may be more important than knowing an individual person’s cholesterol level or dietary practices.  If fruits and vegetables are not available then a person cannot be consuming them.  It is quite important for administrative leaders at federal， state， and local levels to know whether there is good access to healthy food before going out to investigate whether people are consuming healthy food.  STEPS is very important but it might not be the appropriate first step.

    Goff教授：STEPS计划是一个很好的开始，但是可能在实施这项计划之前各个国家应该详细了解该国的政策全貌。不同国家的政策全貌可能是不同的。在美国，就必须知道在各个州和局部地区发生了生么情况，因为在美国特定地影响心血管健康的联邦政策很少。例如，在工作场所、餐馆和酒吧禁烟并不是联邦政府制定的政策，而是各个州或局部地区自己制定的政策。如果我们想要通过促进采用禁止吸烟政策在预防心血管疾病方面取得进步，我们就必须知道这种政策在全美国不同州和局部地区的颁布情况。在很多没有联邦政策但是可能有次级行政区级别政策的国家，同样存在这种情况。在不同的国家，食品供应中食盐的限量政策也可能是联邦政府级别或者州级别的政策。在制定开展911紧急定位技术和急诊医疗护理服务之类的政策之前了解STEPS也非常有用。能方便的得到新鲜水果和蔬菜、方便的获取低脂肪奶制品，这些可能是比了解人们个体胆固醇水平或饮食习俗更为重要的政策和外界监督机制。如果没有可用的水果和蔬菜，人们就不能消费它们。很重要的一点是，联邦政府、州和局部地区级别的行政领导在开始调查人们是否在消费健康食物之前必须知道他们是否能很方便的获得健康食物。STEPS是非常重要的计划，但是它可能并不是适当的第一步。