- 學位論文
馬紹爾群島共和國營養不良防治計畫推動之利害關係人分析
A Stakeholder Analysis of Malnutrition Prevention Initiatives in the Republic of the Marshall Islands
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摘要
作為非傳染性疾病的重要防治因子，改善營養不良已經成為全球公認的重要公共衛生議題，聯合國永續發展目標也明文旨在西元2030年以前消弭所有形式的營養不良。自國際到地方層級的各式援助計畫及資源紛紛投入，使得非傳染性疾病盛行、飲食仰賴進口加工食品的太平洋島國地區成為改善營養不良的重點區域之一。馬紹爾群島共和國自2012年發布非傳染性疾病防治國家緊急命令起亦大幅提高對營養議題及民眾健康生活型態的重視，公私部門合作推展各項營養教育、物資捐贈等營養不良防治工作，多年來的實際成效卻相當有限。 本研究透過作者過往執行在地公共衛生計劃經驗及人脈網絡，訪談15位不同背景、分屬11個不同組織的馬國營養不良防治計畫一線工作者經驗，了解各方利害關係人對推行營養不良防治計畫的觀點與感受，並輔以106篇文本資料內容交叉比對，呈現出馬國營養不良防治計畫的真實現場，探討組織個別的投入程度、彼此互動關係以及對計畫整體方針的影響力。 研究結果呈現馬國營養不良防治主要由群體健康、農業生產及教育體系三大面向投入各式計劃項目，組織間的互動勾勒錯縱複雜的利害關係人生態，也一線工作者經驗中歸納出政治領導力、家戶財務困境及永續性為計畫能否在馬國成功推行的重要要素，同時延伸探討馬國社會經濟條件、政策治理、文化認知、健康的政治性因素對推動營養不良防治帶來的結構性影響與困難、點出政策制定過程中的多面性考量。 透過這項研究，希望能增加馬紹爾群島共和國營養不良防治計畫幕後政策形成的重要學術紀錄，同時展示出營養不良防治在統計數據以外的成果或困境，成為相關公共衛生政策推行或未來計畫效益評估的重要參考資訊。
並列摘要
As a crucial measure to address risk factors of non-communicable diseases (NCDs), malnutrition prevention has been recognized as an imperative public health issue globally. The United Nations Sustainable Development Goal 2.2 aims to end all forms of malnutrition by 2030. Numerous health projects and resources have been dedicated to malnutrition prevention at both international and domestic levels, with Pacific Island countries—characterized by high prevalence of NCDs and reliance on processed foods—being significant focal points. There has been heightened attention to nutrition issues and the promotion of healthy lifestyles since the Republic of the Marshall Islands (RMI) declared a state of health emergency due to the NCD epidemic in 2012. Both public and private sectors have collaborated on various initiatives (including nutrition education programs, food aids, and donations) to prevent malnutrition. However, the actual effectiveness of these efforts remains questioned. Drawing on the author’s grassroots working experience and local community network, this research interviewed 15 frontline workers from diverse backgrounds across 11 entities involved in RMI malnutrition prevention initiatives. The study aimed to gain insights into the perspectives and experiences of stakeholders implementing these programs. Supplemented by 106 pieces of documentary data, this research offered a comprehensive view of the policy ecology, examining stakeholder involvement, interconnections, and influences within the initiatives. The research identified key inputs in malnutrition prevention in three domains: population health, food production, and the educational system, forming a complex stakeholder ecology with interconnected interactions. Stakeholder experiences highlighted critical challenges, including political leadership, income barriers, and program sustainability, which are essential for effective implementation in the RMI. The study also delineated significant factors influencing policy progress, which include socioeconomic conditions, governance, cultural ideology, and, notably, the political determinants of health. These findings underscore the multifaceted nature of addressing malnutrition and the necessity of considering diverse, intersecting influences for policy development. This research contributes valuable insights to the policy formation of malnutrition prevention in the RMI, revealing outcomes and challenges beyond statistical figures and serving as a critical reference for future decision-making and project evaluation.
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