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Article(id=1241025213412987713, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409440, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1726934400000, receivedDateStr=2024-09-22, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773813068011, onlineDateStr=2026-03-18, pubDate=1744214400000, pubDateStr=2025-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773813068011, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773813068011, creator=13701087609, updateTime=1773813068011, updator=13701087609, issue=Issue{id=1241025201983508979, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='7', pageStart='1153', pageEnd='1344', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773813065285, creator=13701087609, updateTime=1773815493878, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241035388320543403, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241035388320543404, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1268, endPage=1273, ext={EN=ArticleExt(id=1241025214579004248, articleId=1241025213412987713, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research on policy texts for hypertension prevention and control in China:based on a three-dimensional analytical framework of policy tools, policy intensity, and four-level prevention, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To conduct a quantitative analysis of national-level hypertension prevention and control policies and provide suggestions for the improvement and optimization of these policies.

Methods

Hypertension prevention and control policies from 2009 to 2023 were retrieved. A three-dimensional analytical framework of policy tools, policy intensity, and four-level prevention was constructed. Content analysis was used to conduct single-dimension and cross-analysis of policies related to hypertension prevention and control.

Results

A total of 68 policy texts were included in this study, forming 110 coding units.The proportions of environmental, supply-based, and demand-based policy tools were 56.4%, 25.5%, and 18.2%, respectively.The average score of policy intensity was 3.1 (score range: 1-6). The proportions of policy texts for zero-level prevention, primary prevention, secondary prevention, and tertiary prevention were 27.3%, 20.9%, 45.5%, and 6.4%, respectively. Crossanalysis showed that there were significant differences in policy intensity among different types of policy tools. The policy intensity of prevention strategies at all levels was relatively balanced. The environmental policy tools had the highest proportion among prevention strategies at all levels. There were significant differences in supply-based and demand-based policy tools among different prevention strategies.

Conclusion

There is a lack of internal balance in hypertension prevention and control policy tools, and the use of supply-based and demand-based tools needs to be strengthened. The overall policy intensity is relatively weak. Attention should be paid to the overall relevance of policy content. It is urgent to move forward the prevention threshold of hypertension and strengthen the synergistic effect of four-level prevention.

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目的

对国家层面高血压防控政策进行量化分析，为高血压防控政策的完善和优化提供建议。

方法

检索2009—2023年高血压防控政策，构建政策工具、政策力度、四级预防的三维分析框架，利用内容分析法对高血压防控相关政策进行单维度以及交叉分析。

结果

本文共纳入政策文本68份，形成110个编码单元，环境型、供给型、需求型政策工具占比分别为56.4%、25.5%、18.2%；政策力度平均得分为3.1分（分数范围1～6）；零级预防、第一级预防、第二级预防、第三级预防政策文本占比分别为27.3%、20.9%、45.5%、6.4%。交叉分析发现，不同政策工具类型间政策力度差异较大，各级预防策略的政策力度相对均衡，环境型政策工具在各级预防间占比最高，供给型、需求型政策工具在不同预防策略间差异较大。

结论

高血压防控政策工具内部均衡性不足，供给型和需求型工具的使用有待加强；政策力度整体偏弱，需重视政策内容整体相关性，亟需前移高血压预防关口，并加强四级预防的协同效应。

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曹世义，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=QHwq8Pc7Euddp+3QTdXJCg==, magXml=tdrnaTIjTxDI82oWc2q+cQ==, pdfUrl=null, pdf=+eRJXHkqzmqoupt6xQvBcw==, pdfFileSize=816202, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=5rYK4JTM2Xllljs7RC8Hiw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=vnvq1VWrqBvb1IuPmNFFhw==, mapNumber=null, authorCompany=null, fund=null, authors=

钟荣霞（2001—），女，硕士在读，研究方向：卫生政策分析、慢性流行病学

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Quantitative research on China's medi-cal association policy: a content analysis based on policy objectives， tools and strength[J]. China Health Service Management， 2021， 38(5): 352-356， 374.(In Chinese), articleTitle=Quantitative research on China's medi-cal association policy: a content analysis based on policy objectives， tools and strength, refAbstract=null), Reference(id=1241025229259068000, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, doi=null, pmid=null, pmcid=null, year=2014, volume=15, issue=4, pageStart=376, pageEnd=378, url=null, language=null, rfNumber=[19], rfOrder=31, authorNames=李云, 杨鹏, 吴寿岭, journalName=中国预防医学杂志, refType=null, unstructuredReference=李云，杨鹏，吴寿岭，等.高血压病的三级预防策略[J].中国预防医学杂志，2014，15（4）：376-378., articleTitle=高血压病的三级预防策略, refAbstract=null), Reference(id=1241025229342954083, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, doi=null, pmid=null, pmcid=null, year=2014, volume=15, issue=4, pageStart=376, pageEnd=378, url=null, language=null, rfNumber=[19], rfOrder=32, authorNames=Li Y, Yang P, Wu SL, journalName=China Preventive Medicine, refType=null, unstructuredReference=Li Y，Yang P，Wu SL， et al. Tertiary prevention strategies for hyper-tension[J]. China Preventive Medicine， 2014， 15(4): 376-378.(In Chinese), articleTitle=Tertiary prevention strategies for hyper-tension, refAbstract=null), Reference(id=1241025229418451557, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, doi=null, pmid=null, pmcid=null, year=2020, volume=36, issue=12, pageStart=1729, pageEnd=1733, url=null, language=null, rfNumber=[20], rfOrder=33, authorNames=詹思怡, 许锐恒, 傅传喜, journalName=中国公共卫生, refType=null, unstructuredReference=詹思怡， 许锐恒， 傅传喜.重视第四级预防构建五级预防理论框架[J].中国公共卫生，2020，36（12）：1729-1733., articleTitle=重视第四级预防构建五级预防理论框架, refAbstract=null), Reference(id=1241025229510726247, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, doi=null, pmid=null, pmcid=null, year=2020, volume=36, issue=12, pageStart=1729, pageEnd=1733, url=null, language=null, rfNumber=[20], rfOrder=34, authorNames=Zhan SY, Xu RH, Fu CX, journalName=Chinese Journal of Public Health, refType=null, unstructuredReference=Zhan SY， Xu RH， Fu CX. Importance of fourth-level prevention strategy and theoretical framework construction for five-level pre-vention: a brief discussion[J]. Chinese Journal of Public Health， 2020， 36(12): 1729-1733.(In Chinese), articleTitle=Importance of fourth-level prevention strategy and theoretical framework construction for five-level pre-vention: a brief discussion, refAbstract=null), Reference(id=1241025229573640810, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, doi=null, pmid=null, pmcid=null, year=2022, volume=19, issue=16, pageStart=42, pageEnd=45, url=null, language=null, rfNumber=[21], rfOrder=35, authorNames=张硕, 段锦龙, 王擎擎, journalName=中国医药导报, refType=null, unstructuredReference=张硕，段锦龙，王擎擎，等.中医药对正常高值血压防治的研究进展[J].中国医药导报，2022，19（16）：42-45., articleTitle=中医药对正常高值血压防治的研究进展, refAbstract=null), Reference(id=1241025229640749676, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, doi=null, pmid=null, pmcid=null, year=2022, volume=19, issue=16, pageStart=42, pageEnd=45, url=null, language=null, rfNumber=[21], rfOrder=36, authorNames=Zhang S, Duan JL, Wang QQ, journalName=China Medical Herald, refType=null, unstructuredReference=Zhang S，Duan JL，Wang QQ， et al. Research progress of traditional Chinese medicine on prevention and treatment of normal high blood pressure[J]. China Medical Herald， 2022， 19(16): 42-45.(In Chinese), articleTitle=Research progress of traditional Chinese medicine on prevention and treatment of normal high blood pressure, refAbstract=null)], funds=[Fund(id=1241025225064763860, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, awardId=2024WKYXQN008, language=CN, fundingSource=中央高校基本科研业务费专项资金资助(2024WKYXQN008), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241025216986533933, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, xref=1., ext=[AuthorCompanyExt(id=1241025217003311152, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, companyId=1241025216986533933, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, 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journalId=1227665162245664772, articleId=1241025213412987713, companyId=1241025217217220677, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.华中科技大学同济医学院附属同济医院神经内科)])], figs=[ArticleFig(id=1241025221793206613, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=EN, label=Figure 1, caption=Three-dimensional analytical framework of hypertension prevention and control policy, figureFileSmall=6315I2sFNXCawg9n7n042g==, figureFileBig=5rYK4JTM2Xllljs7RC8Hiw==, tableContent=null), ArticleFig(id=1241025223269601627, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=CN, label=图1, caption=高血压防控政策三维分析框架, figureFileSmall=6315I2sFNXCawg9n7n042g==, figureFileBig=5rYK4JTM2Xllljs7RC8Hiw==, tableContent=null), ArticleFig(id=1241025223449956709, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=EN, label=Figure 2, caption=Dimensional distribution of different types of policy instruments, figureFileSmall=5tm1xjs9AyvFjutx8x5n0Q==, figureFileBig=SIsh4nME2oBdkthmFlh04w==, tableContent=null), ArticleFig(id=1241025223529648492, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=CN, label=图2, caption=不同类型政策工具维度分布, figureFileSmall=5tm1xjs9AyvFjutx8x5n0Q==, figureFileBig=SIsh4nME2oBdkthmFlh04w==, tableContent=null), ArticleFig(id=1241025223626117489, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=EN, label=Figure 3, caption=Dimension distribution of the four levels of prevention, figureFileSmall=d968vpzZIhtL0sAP1pIkNg==, figureFileBig=5pUf+EH+JMBFG+diEVX2/Q==, tableContent=null), ArticleFig(id=1241025223710003574, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=CN, label=图3, caption=四级预防维度分布, figureFileSmall=d968vpzZIhtL0sAP1pIkNg==, figureFileBig=5pUf+EH+JMBFG+diEVX2/Q==, tableContent=null), ArticleFig(id=1241025223810666875, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=EN, label=Figure 4, caption=Results of cross-analysis of policy instruments and four-level prevention-policy intensity, figureFileSmall=2kjJPtuyCjPrqhPXli/0Dw==, figureFileBig=k2rmncCzrA2y9/a9IMwu8g==, tableContent=null), ArticleFig(id=1241025223902941570, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=CN, label=图4, caption=政策工具与四级预防-政策力度交叉分析结果, figureFileSmall=2kjJPtuyCjPrqhPXli/0Dw==, figureFileBig=k2rmncCzrA2y9/a9IMwu8g==, tableContent=null), ArticleFig(id=1241025223974244746, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=EN, label=Figure 5, caption=Results of the cross-cutting analysis of the four-level prevention and policy instrument and policy strength, figureFileSmall=mRqvjZphrV9mfYhyKvLA4Q==, figureFileBig=CLumlNFdIZ22oYYh9X27mw==, tableContent=null), ArticleFig(id=1241025224066519441, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=CN, label=图5, caption=四级预防与政策工具-政策力度交叉分析结果, figureFileSmall=mRqvjZphrV9mfYhyKvLA4Q==, figureFileBig=CLumlNFdIZ22oYYh9X27mw==, tableContent=null), ArticleFig(id=1241025224158794135, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=EN, label=Table 1, caption=

Hypertension prevention and control documents (excerpts)

, figureFileSmall=null, figureFileBig=null, tableContent=
编号政策名称年份（年）发文机构
1国务院办公厅关于印发深化医药卫生体制改革2022年重点工作任务的通知2022国务院办公厅
2国务院办公厅关于印发“十四五”国民健康规划的通知2022国务院办公厅
…………
67关于深入开展“互联网+医疗健康”便民惠民活动的通知2018卫生健康委、中医药局
68关于印发健康扶贫三年攻坚行动实施方案的通知2018卫生健康委、发展改革委、财政部、医保局、扶贫办
), ArticleFig(id=1241025224217514395, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=CN, label=表1, caption=

高血压防控文件（节选）

, figureFileSmall=null, figureFileBig=null, tableContent=
编号政策名称年份（年）发文机构
1国务院办公厅关于印发深化医药卫生体制改革2022年重点工作任务的通知2022国务院办公厅
2国务院办公厅关于印发“十四五”国民健康规划的通知2022国务院办公厅
…………
67关于深入开展“互联网+医疗健康”便民惠民活动的通知2018卫生健康委、中医药局
68关于印发健康扶贫三年攻坚行动实施方案的通知2018卫生健康委、发展改革委、财政部、医保局、扶贫办
), ArticleFig(id=1241025224297206177, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=EN, label=Table 2, caption=

Example of policy text encoding (excerpt)

, figureFileSmall=null, figureFileBig=null, tableContent=
编号政策名称编码单元编码号
1国务院办公厅关于印发深化医药卫生体制改革2022年重点工作
任务的通知		推进高血压、高血糖、完善慢性病健康管理适宜技术和
服务模式		1-1
2国务院办公厅关于印发“十四五”国民健康规划的通知高血压、Ⅱ型糖尿病患者基层规范管理服务率达到65%以上2-1
…………
109关于深入开展“互联网+医疗健康”便民惠民活动的通知健全高血压、糖尿病等老年慢性病以及食源性疾病管理网络67-1
110关于印发健康扶贫三年攻坚行动实施方案的通知重点加强高血压、糖尿病、结核病、严重精神障碍等慢病患者的规范化管理与服务68-1
), ArticleFig(id=1241025224402063782, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=CN, label=表2, caption=

政策文本编码示例（节选）

, figureFileSmall=null, figureFileBig=null, tableContent=
编号政策名称编码单元编码号
1国务院办公厅关于印发深化医药卫生体制改革2022年重点工作
任务的通知		推进高血压、高血糖、完善慢性病健康管理适宜技术和
服务模式		1-1
2国务院办公厅关于印发“十四五”国民健康规划的通知高血压、Ⅱ型糖尿病患者基层规范管理服务率达到65%以上2-1
…………
109关于深入开展“互联网+医疗健康”便民惠民活动的通知健全高血压、糖尿病等老年慢性病以及食源性疾病管理网络67-1
110关于印发健康扶贫三年攻坚行动实施方案的通知重点加强高血压、糖尿病、结核病、严重精神障碍等慢病患者的规范化管理与服务68-1
), ArticleFig(id=1241025224523698606, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=EN, label=Table 3, caption=

Distribution types of hypertension prevention and control policy tools

, figureFileSmall=null, figureFileBig=null, tableContent=
工具类型名称工具含义
供给型标准规范规范高血压防控相关筛查、诊疗等行为
信息技术提供高血压防控的信息支持及服务
技术指导为基层医疗卫生机构或医务人员开展高血压防控工作提供技术指导
健康管理提供高血压防控健康管理相关服务
人才培养培养高血压防控人才
中医药防治加强中医药服务在高血压防控中的应用
环境型目标规划总体规划高血压防控的发展
监督考核对高血压防控相关政策落实、执行情况进行考核
机构/部门合作各类卫生机构、部门、内部为促进高血压防控工作进行合作
宣传引导推动、引导高血压防控所进行各种形式的宣传
配套设施支撑为开展高血压防控服务制定的配套制度
策略措施为推动高血压防控服务制定的策略性制度措施
需求型政府采购政府通过购买服务的方式向提供高血压防控服务的医疗卫生等人员拨付对应经费
试点示范鼓励指定地区或医疗机构探索、开展高血压防控新模式
医疗补助为促进高血压防控工作提供的疾病医疗服务
), ArticleFig(id=1241025224611778998, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=CN, label=表3, caption=

高血压防控政策工具分布类型

, figureFileSmall=null, figureFileBig=null, tableContent=
工具类型名称工具含义
供给型标准规范规范高血压防控相关筛查、诊疗等行为
信息技术提供高血压防控的信息支持及服务
技术指导为基层医疗卫生机构或医务人员开展高血压防控工作提供技术指导
健康管理提供高血压防控健康管理相关服务
人才培养培养高血压防控人才
中医药防治加强中医药服务在高血压防控中的应用
环境型目标规划总体规划高血压防控的发展
监督考核对高血压防控相关政策落实、执行情况进行考核
机构/部门合作各类卫生机构、部门、内部为促进高血压防控工作进行合作
宣传引导推动、引导高血压防控所进行各种形式的宣传
配套设施支撑为开展高血压防控服务制定的配套制度
策略措施为推动高血压防控服务制定的策略性制度措施
需求型政府采购政府通过购买服务的方式向提供高血压防控服务的医疗卫生等人员拨付对应经费
试点示范鼓励指定地区或医疗机构探索、开展高血压防控新模式
医疗补助为促进高血压防控工作提供的疾病医疗服务
), ArticleFig(id=1241025224687276477, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=EN, label=Table 4, caption=

Criteria for dividing the policy intensity of hypertension prevention and control policies

, figureFileSmall=null, figureFileBig=null, tableContent=
序号发文机关得分
（分）
力度1全国人民代表大会及常务委员会发文6
力度2中共中央办公厅和国务院办公厅联合发文5
力度3中共中央办公厅单独发文或国务院办公厅单独发文4
力度43个及以上部委联合发文3
力度52个部委联合发文2
力度6各部委单独发文1
), ArticleFig(id=1241025224783745477, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025213412987713, language=CN, label=表4, caption=

高血压防控政策的政策力度划分标准

, figureFileSmall=null, figureFileBig=null, tableContent=
序号发文机关得分
（分）
力度1全国人民代表大会及常务委员会发文6
力度2中共中央办公厅和国务院办公厅联合发文5
力度3中共中央办公厅单独发文或国务院办公厅单独发文4
力度43个及以上部委联合发文3
力度52个部委联合发文2
力度6各部委单独发文1
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Distribution of hypertension prevention and control policies

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得分（分）政策数目构成比（%）
622.9
500
43145.6
31522.1
2913.2
11116.2
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高血压防控政策力度分布

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得分（分）政策数目构成比（%）
622.9
500
43145.6
31522.1
2913.2
11116.2
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中国高血压防控政策文本研究——基于政策工具、政策力度、四级预防三维分析框架
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钟荣霞 1 , 蒋青青 1, 2 , 虢妍 1 , 楼依玲 1 , 王芙蓉 2, 3 , 曹世义 1
现代预防医学 | 卫生政策与管理 2025,52(7): 1268-1273
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现代预防医学 | 卫生政策与管理 2025, 52(7): 1268-1273
中国高血压防控政策文本研究——基于政策工具、政策力度、四级预防三维分析框架
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钟荣霞1, 蒋青青1, 2, 虢妍1, 楼依玲1, 王芙蓉2, 3, 曹世义1
作者信息
  • 1.华中科技大学同济医学院公共卫生学院，湖北 武汉 430030
  • 2.华中科技大学同济医学院护理学院
  • 3.华中科技大学同济医学院附属同济医院神经内科

    • 钟荣霞（2001—），女，硕士在读，研究方向：卫生政策分析、慢性流行病学

通讯作者:

曹世义，E-mail:
Research on policy texts for hypertension prevention and control in China:based on a three-dimensional analytical framework of policy tools, policy intensity, and four-level prevention
Rong-xia ZHONG1, Qing-qing JIANG1, 2, Yan GUO1, Yi-ling LOU1, Fu-rong WANG2, 3, Shi-yi CAO1
Affiliations
  • School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
出版时间: 2025-04-10 doi: 10.20043/j.cnki.MPM.202409440
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摘要
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目的

对国家层面高血压防控政策进行量化分析，为高血压防控政策的完善和优化提供建议。

方法

检索2009—2023年高血压防控政策，构建政策工具、政策力度、四级预防的三维分析框架，利用内容分析法对高血压防控相关政策进行单维度以及交叉分析。

结果

本文共纳入政策文本68份，形成110个编码单元，环境型、供给型、需求型政策工具占比分别为56.4%、25.5%、18.2%；政策力度平均得分为3.1分（分数范围1～6）；零级预防、第一级预防、第二级预防、第三级预防政策文本占比分别为27.3%、20.9%、45.5%、6.4%。交叉分析发现，不同政策工具类型间政策力度差异较大，各级预防策略的政策力度相对均衡，环境型政策工具在各级预防间占比最高，供给型、需求型政策工具在不同预防策略间差异较大。

结论

高血压防控政策工具内部均衡性不足，供给型和需求型工具的使用有待加强；政策力度整体偏弱，需重视政策内容整体相关性，亟需前移高血压预防关口，并加强四级预防的协同效应。

高血压  /  政策工具  /  政策力度  /  四级预防
Objective

To conduct a quantitative analysis of national-level hypertension prevention and control policies and provide suggestions for the improvement and optimization of these policies.

Methods

Hypertension prevention and control policies from 2009 to 2023 were retrieved. A three-dimensional analytical framework of policy tools, policy intensity, and four-level prevention was constructed. Content analysis was used to conduct single-dimension and cross-analysis of policies related to hypertension prevention and control.

Results

A total of 68 policy texts were included in this study, forming 110 coding units.The proportions of environmental, supply-based, and demand-based policy tools were 56.4%, 25.5%, and 18.2%, respectively.The average score of policy intensity was 3.1 (score range: 1-6). The proportions of policy texts for zero-level prevention, primary prevention, secondary prevention, and tertiary prevention were 27.3%, 20.9%, 45.5%, and 6.4%, respectively. Crossanalysis showed that there were significant differences in policy intensity among different types of policy tools. The policy intensity of prevention strategies at all levels was relatively balanced. The environmental policy tools had the highest proportion among prevention strategies at all levels. There were significant differences in supply-based and demand-based policy tools among different prevention strategies.

Conclusion

There is a lack of internal balance in hypertension prevention and control policy tools, and the use of supply-based and demand-based tools needs to be strengthened. The overall policy intensity is relatively weak. Attention should be paid to the overall relevance of policy content. It is urgent to move forward the prevention threshold of hypertension and strengthen the synergistic effect of four-level prevention.

Hypertension  /  Policy tools  /  Policy intensity  /  Four-level prevention
钟荣霞, 蒋青青, 虢妍, 楼依玲, 王芙蓉, 曹世义. 中国高血压防控政策文本研究——基于政策工具、政策力度、四级预防三维分析框架. 现代预防医学, 2025 , 52 (7) : 1268 -1273 . DOI: 10.20043/j.cnki.MPM.202409440
Rong-xia ZHONG, Qing-qing JIANG, Yan GUO, Yi-ling LOU, Fu-rong WANG, Shi-yi CAO. Research on policy texts for hypertension prevention and control in China:based on a three-dimensional analytical framework of policy tools, policy intensity, and four-level prevention[J]. Modern Preventive Medicine, 2025 , 52 (7) : 1268 -1273 . DOI: 10.20043/j.cnki.MPM.202409440
正文
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高血压已成为全球患病人数最多的心血管疾病，是导致心脏病、中风和慢性肾脏病等严重并发症的主要风险因素，同时也是全球过早死亡和失能的主要危险因素[1-3]。高血压是中国目前最重要的公共卫生问题之一，造成了严重的健康负担和经济负担，中国心血管健康调查资料显示，2019年中国成年人高血压患病率高达27.9%[4-6]。人口老龄化程度加重、高血压年轻化、社会结构改变的趋势相重叠，高血压患病情况呈现出愈发严重的态势[7]。加强高血压防控工作，是维护中国国民健康的一项重要任务[8]。
高血压防控逐渐从专家行为向政府行为转变，政府通过制定政策法规、宣传教育、监测筛查、跨部门合作等手段，全面、系统地推动高血压防控工作，降低高血压相关的健康风险，提高人民群众的健康水平[9]。政策文本研究在政策研究和制订中具有重要的作用，为政策理解、评估、比较、制定和实施提供支持[10]。目前，国内针对高血压防控的研究多聚焦于地方案例[11-12]、效果评价[12]、体系建设[13]等，缺乏从政策工具、四级预防角度分析高血压防控政策的研究。本研究首次构建政策工具、政策力度、四级预防三维分析模型，分析目前高血压防控政策现况，提出针对性建议，以期为高血压防控政策完善提供参考，保障人民健康。
1　资料与方法
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1.1　数据来源
本研究选取的政策文本均为公开已发表国家层面政策，以“高血压”“高血压防控”为检索词，在国务院政策文本库和北大法宝中进行检索，并以国家卫生健康委员会等官方网站作为补充，获取与高血压防控相关的政策文件99份。
纳入标准：与高血压防控整体或部分内容密切相关；国家层面文件，发文机构为全国人民代表大会及常务委员会等，具有一定的效力且覆盖全面；政策发文时间为2009—2023年。排除标准：宣布失效的文件；宣布已撤销的文件；出现高血压、高血压防控关键词，但实际内容与研究主题不相关的文件；排除2020—2022年新冠疫情防控政策相关的高血压文件。
经筛查核对，最终纳入有效政策文件68份，见表1，按照“政策文本编号-政策文本分析单元顺序”进行编码，得到110个编码单元，见表2。
1.2　研究方法
内容分析法是通过对研究内容进行层层剖析，从中寻找研究内容内部之间联系的一种客观、系统、定量的研究方法[14]。本文采用内容分析法对高血压防控相关政策文件进行分析，构建政策工具、政策主体、四级预防的三维分析框架，全面分析和评估高血压防控政策的有效性，见图1。借助Excel、NVivo 14软件对政策文本进行汇总、筛选、整理，分析内部特征，秉持“不可细分原则”进行最小单元编码，归纳不同维度下政策文本数据特征，利用交叉分析进一步评估不同维度政策文本特征。
1.2.1　X维度-政策工具
政策工具是政策主体为实现政策目标所采取的一系列行政治理手段，是将政策理念落地实施的关键路径[15]。本文采用Rothwell和Zegveld提出的政策工具分类法，将政策工具划分为需求型、供给型及环境型三个类别[16]。
供给型政策工具指政策主体通过多方面支持，直接推动高血压防控进一步完善，环境型政策工具指通过外部因素，间接为高血压防控提供有利发展环境，需求型政策工具指政府通过市场化和社会化方式，拉动高血压防控事业发展。政策工具分类及具体解释，见表3。
1.2.2　Y维度-政策力度
政策力度由发文主体层级与政策类型决定，用于衡量相关政策的实施力度及重要程度；一般情况下政策主体层级越高、联合发布单位越多，政策力度越大[17]。政策力度的测量参考了石敏等[18]建立的划分标准，见表4。
1.2.3　Z维度-四级预防
高血压的发生是一个连续过程，利用四级预防策略来调控高血压的发生过程对高血压防治十分有效[19]。四级预防策略包括零级预防、第一级预防、第二级预防、第三级预防，分别从全人群、高危人群、高血压患者出发，由整体及个体，维护人体健康[20]。零级预防以政府为主体，发布相应的政策、措施，基于全人群，预防危险因素的流行，使整个预防工作前移[20]。第一级预防是在疾病尚未发生时针对病因或危险因素采取措施，预防或推迟疾病的发生[19]。第二级预防旨在通过“三早”预防，通过缩短疾病的持续时间来减少疾病的流行[20]。第三级预防旨在降低残疾和残障给个体、家庭、社会带来的负担[19]。
2　结果
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2.1　单维度分析
政策工具层面，纳入分析的编码单元、覆盖政策工具三大分类及其细分条目全部内容，但政策工具间及工具内部均呈不均衡的态势。环境型、供给型、需求型政策工具使用占比分别为56.4%、25.5%、18.2%，见图2。进一步分析二级条目发现，在环境型政策工具中，策略措施、目标规划、配套设施支撑、宣传引导四者占总政策工具比值较高；在供给型政策工具中，健康管理、人才培养占比相对较大，均为5.5%，标准规范占比较少；在需求型政策工具中，医疗补助、试点示范、政府采购三者占总体政策工具的比值依次为10.9%、6.4%、0.9%。
政策力度层面，对高血压防控政策力度进行统计后发现，政策力度的平均得分为3.1分，其中，得分为4政策数量最多，见表5。
四级预防层面，第二级预防政策文本占比最高，其次是零级预防和第一级预防，第三级预防政策文本占比最低，见图3。
2.2　交叉分析
从政策工具、政策力度、四级预防维度交叉分析结果来看，不同政策工具类型间政策力度差异较大，需求型政策工具的力度最高，供给型政策工具的力度最低；政策力度在四级预防维度层面相对均衡，零级预防、第二级预防、第三级预防政策力度依次为3.0、3.2、3.1，第一级预防的政策力度最低且差异较大，见图4、图5。从政策工具与四级预防交叉结果来看，环境型政策工具在各级预防间占比最高，供给型、需求型政策工具在不同预防策略间差异较大，见图4。
3　讨论
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3.1　不同高血压防控政策工具亚类使用存在差异，其内部均衡性有待优化
政策工具使用占比的合理性、均衡性决定了政策体系的完整性以及落实的可行性。政策工具层面，我国高血压防控政策工具整体及其内部细分条目的使用存在不同程度的失衡。应该适当降低环境型政策工具使用频率，提高供给型和需求型政策工具使用频率，充分发挥政府推动力，利用市场化、社会化方式拉动高血压防控事业发展。优化环境型政策工具内部占比，调整二级工具使用比例。通过监督考核对高血压防控政策落实执行情况进行考核评价，机构或部门合作保障高血压防控政策在推行过程中的连续性、整体性，促进高血压防控相关政策有序推行。维持配套设施支撑在环境型政策工具中的使用频率，确保家庭医生签约服务、分级诊疗、医疗医联体的顺利推进，增强配套设施支撑内部制度的联动性，尝试寻找新的配套设施促进高血压防控事业的发展。重视供给型政策工具的推动作用，人才是第一资源，加大高血压防控专业人才的培养力度，并为其提供足够的经济、技术等支持，完善从业人员激励制度。创新是第一动力，将信息技术与高血压防控事业结合起来，为高血压防控事业注入新鲜活力。重视中医药治疗，特别是在高血压前期预防具有重要作用，真正做到未病先防[21]。在目前存在的政策文件中，需求型政策工具的使用存在严重缺位，工具内部呈现出“聚集-离散”状态，需大力提高其使用频率，平衡目前需求型政策工具内部使用严重失衡的状态，加大政府采购力度、提高财政补贴、优化医保政策、落实“两个允许”相关分配激励机制等，保障各级预防策略顺利实施。
3.2　高血压防控政策文件效力有待提高，应重视政策内容整体相关性
政策力度层面，我国目前已公布的国家层面高血压防控政策的相关性及效力与高血压严峻现状并不匹配。高血压防控是一项系统工程，需要全社会共同参与。亟需加强顶层设计，协同各部门及其下属机构部门相互做好衔接配合，为落实高血压防控措施提供更有力的政策支持和社会基础。高效力的政策文件，如带有强制意义的法律法规，在一定程度上能够保障高血压防控政策的落地。目前我国与高血压相关的政策文件90.0%以上都是意见、通知等非强制性的，重点在于人治，政策文件的突出特点之一为公平性，强调法治；破除高血压防控政策“人治和法治”之间的失衡困境，十分有必要出台以高血压或者慢性病防控为主题、全局指导高血压防控的法律法规。
3.3　高血压防控政策的四级预防联动性不足，亟需前移预防关口
四级预防层面，各级预防之间存在严重失衡的情况，第二级预防使用过溢，零级预防及第一级预防使用不足，与当下“预防关口前移、预防为主”大方向不符，第三级预防使用严重缺位，说明目前政策对于高血压患者的后效保障明显不足。高血压防控逐渐从以医院为中心、专家行为、医疗科研向以社区为中心、政府行为、社区综合防治、预防为主转变，由专业部门参与向全社会参与转变[9]。前移预防关口，厘清高血压预防重点，加强零级预防、第一级预防的使用频率及政策强度。从全人群出发，采用“最划算的干预措施”，通过政策引导等进一步提高高血压知晓率，鼓励居民开展健康生活方式，做好健康管理，努力做到未病先治，全面保障人群健康。从患者角度出发，改善目前高血压“三高三低”现状，通过家庭医生签约服务、多病共管共治、医保报销等手段实现对高血压患者管理和保障工作，同时积极倡导高血压患者通过定期测量血压、健康饮食等方式实现自我管理。
基金
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  • 中央高校基本科研业务费专项资金资助(2024WKYXQN008)
文献
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doi: 10.20043/j.cnki.MPM.202409440
  • 接收时间：2024-09-22
  • 首发时间：2026-03-18
  • 出版时间：2025-04-10
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  • 收稿日期：2024-09-22
基金
中央高校基本科研业务费专项资金资助(2024WKYXQN008)
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    1.华中科技大学同济医学院公共卫生学院，湖北 武汉 430030
    2.华中科技大学同济医学院护理学院
    3.华中科技大学同济医学院附属同济医院神经内科

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Number of
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Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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