摘要：Objectives. This article describes Canadian civil servants’ awareness of, attitudes toward, and self-reported use of ideas about the determinants of health. Methods. Federal and provincial civil servants in departments of finance, labor, social services, and health were surveyed. Results. With civil servants in finance departments a notable exception, most Canadian civil servants see the health of populations as a relevant outcome for their sectors. Many (65%) report that ideas about the determinants of health have already influenced policymaking in their sector, but most (83%) say they need more information about the health consequences of the policy alternatives their departments face. Conclusions. Civil servants should consider developing accountability structures for health and researchers should consider producing and transferring more policy-relevant research. The most recent incarnation of ideas about the determinants of health has been embraced for more than 2 decades by many people in the health sector. Pick almost any country, and people in the health sector of that country can point to one or more prominent documents that have given expression to these ideas. In Canada, it is the Lalonde Report 1 ; in the United States, Healthy People and Healthy People 2000 2, 3 ; and in the United Kingdom, the “Black Report.” 4 These documents highlight the ways in which the environments in which people live, work, and play can have profound implications for the health of populations. But after all this time, we don’t know whether and how these ideas have taken root outside the health sector, where most of their policy implications lie. For example, tax policies, labor market policies, and early childhood development policies, while developed with explicit economic or social objectives, very likely have profound health consequences. 5– 7 This leads us to ask to what extent are civil servants in departments of finance, labor, and social services aware of and disposed toward these ideas, and whether they believe these ideas have influenced policies in their respective sectors. Environmental impact assessments provide a helpful analogy. Civil servants have grown accustomed to considering the environmental consequences of public policies in addition to their explicit economic or social objectives. Are they considering health consequences in the same way? Many policy actors and social movements support a focus on the health of populations, although they are perhaps more preoccupied with vexing issues in their own sectors (such as access to health care) than those who support a focus on the environment. 8 And in the case of some health problems, such as infectious diseases, the poor health of a fellow citizen can affect all of us in as direct a way as a polluted environment. We believe that important lessons can be derived from an assessment of the extent to which Canadian researchers and civil servants in health departments have been able to transfer ideas about the determinants of health to civil servants outside the health sector. The systematic and widespread nature of these efforts makes Canada a helpful test case. Do these civil servants see the health of populations as a relevant outcome for their sectors? Are ideas about the determinants of health sufficiently well developed to have influenced sectors other than the health sector? If not, what is needed to increase the policy relevance and applicability of these ideas? The answers to these questions, which may differ by level of government or by sector, can inform decisions in other countries about whether and how to facilitate the further development and uptake of these ideas.
