《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?
<International circulation>: From the experience of the United States instituting surveillance, do you know of any pitfalls that a country starting from scratch might want to look out for?
《国际循环》:从美国建立监督机制的经验来看,您认为刚刚开始制定这些监督机制的国家需要注意避免哪些容易发生的错误?
Prof. Goff: There are a lot of pitfalls because there are just so many things to look out for. Avoiding some of the problems that other countries have run into to in a country that doesn’t provide data for local action is challenging. In the United States much of public health is locally administered, so there are not a lot of public health policies implemented at the national level. I mentioned the smoking policy as an example. Most of our policies are designed in such a way that we get an idea of what is going on in the nation as a whole, but we have very little information about what is going on at the state and local level, where policy is actually developed, implemented, and needs to be evaluated. One of the major pitfalls is to avoid the reasonable approach of trying to come up with national data, but rather to focus on collecting data that is going to be most important for driving change. Those data are local data. It is difficult to say because it sounds expensive and logistically scary to try to come up with local data that is comprehensive and drive change. The fact of the matter is that national data does not drive change, at least in the United States. It may catalyze change more so in smaller countries where there is more of a national consensus around a particular policy issue. In places where policy is being driven at the local level, than that is the level that data is needed at.
Goff教授:由于在这一过程中有很多问题需要注意,所以也会存在很多误区。在一个还没有提局部行为资料的国家想要避免其他国家已经碰到的问题是非常有挑战性的。在美国很多公共卫生设施是各地区自行管理的,因此并没有太多国家实施的公共卫生政策。在这里我以吸烟政策为例。我们的大多数政策都是这样设计的:我们掌握了全国的整体情况,但是我们对各个州和地区级别的情况所知很少,而这些地方实际上才是政策制定、履行和需要评估的地区。一个主要误区是没有通过合理的方法得到全国性资料,而不是关注收集那些常常变动的资料。这些数据应该是局部地区的资料。但是这也很难说,因为完善全面而易变的局部地区资料听起来成本很高并且不合逻辑。问题实际上在于全国性资料并不常常变化,至少在美国是这样。在那些对颁布的特殊政策能更大程度达到全民共识的更小国家这种变化的可能性就越大。那些由地方推动政策的地区,所需的应该就是本地区的资料。