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Collective impact – Collaborating to improve conditions for health

Written ByConnie ClementConnie Clement | March 31, 2016
Connie Clement

Connie Clement, BSc

Scientific Director Emerita

Connie Clement joined the National Collaborating Centre for Determinants of Health (NCCDH) in January 2011. Previously, Connie was the Executive Director of Social Venture Partners Toronto, a venture philanthropy collaborative, and Health Nexus/Nexus Santé, Canada’s premiere health promotion consultancy. She was Director of Planning and Policy at Toronto Public Health when six public health units merged, and previously held varied health promotion and sexual health management and front-line positions. Connie holds a BSc in Biology/Sociology from Trent University.

Since its inception, the National Collaborating Centre for Determinants of Health (NCCDH) has sought to encourage and support public health to engage effectively in intersectoral action (1,2) because the conditions that influence health fall far outside the authority of public health organizations. 

Anyone engaged in or following knowledge about intersectoral action today will quickly encounter ‘collective impact.’ The term was coined in a winter 2011 article by John Kania and Mark Kramer (3) that reported their findings about practices used by unusually successful social change collaborative efforts. Collective impact occurs when organizations from different sectors agree to solve a specific complex, social problem using a common vision and action plan, aligning and reinforcing each others’ efforts, and using structured forms of collaboration (3).

Uptake of the approach has rapidly gained momentum, given rise to numerous helpful resources, and created extensive debate and reflection. Of course, the concept of collaborating effectively to change population level outcomes is not new. What is new, is the understanding that utilizing an integrated set of proven collaboration methods – the collective impact approach -- will strengthen outcomes. Collective impact methods can be used to start new, big change initiatives or to transform long-standing collaboratives.

At the heart of the collective impact model are five conditions:


Collective impact researchers and practitioners have identified several preconditions necessary to implement a collective impact approach:


The NCCDH’s interest in collective impact is all about how this approach can advance health equity. Yet, the 2011 article was silent about equity. But not for long, to quote Kania and Karmer:  “The five conditions… are missing a critical dimension: equity. The five conditions of collective impact, implemented without attention to equity, are not enough to create lasting change (3).”Hurrah! Suggestions for how organizations can bring equity inside collective impact echo our public health roles and the kind of reflective practices that we encourage with practitioners in workshops: change from within (apply an equity lens to one’s own organizations, people and practices); navigating through discomfort; developing common language; disaggregating data; undertaking structural (upstream) analysis of disparities; and using storytelling.
The NCCDH’s journey to learn about and help the public health sector apply collective impact lessons started with a staff discussion about the Kania and Karmer article. In the fall of 2014, Lesley Dyck, one of our knowledge translation specialists, attended Tamarack Institute’s first Collective Impact Summit. In 2015, we reached out to learn about public health’s experience using collective impact methods by hosting a 5-site telehealth conference that supported sharing between projects in South Vancouver Island, London, Hamilton, Ottawa and N.S. Early in 2016, we co-hosted the North-West Health Equity Forum, with simultaneous sessions in Prince George, Prince Albert, Grand Prairie and Whitehorse. Participants learned about collective impact research and explored how a collective impact approach might be applied to address regional challenges requiring cross-sector, upstream solutions.

It is clear that public health and community partners have responded positively to what collective impact offers. Public health has a long history of convening and partnering intersectorally; sometimes (but not yet often enough) thinks upstream and seeks structural change; and can contribute resources to joint projects. By combining such contributions with the improved intersectoral practices that comprise the collective impact approach, public health organizations will contribute to escalating societal improvements to further health and health equity.  

In the coming year, watch for a deeper introduction to collective impact methods as a means to advance health equity, and case stories about public health partnership within Canadian collective impact initiatives.  

Further readings:


  1. See Assessing the impact and effectiveness of intersectoral action on the social determinants of health and health equity: An expedited systematic review (NCCDH, 2012).
  2. Regarding terminology, see Glossary of Essential Health Equity Terms (NCCDH, 2015).
  3. Kania, John & Kramer, Mark. Collective impact, Stanford Social Innovation Review, Winter 2011
  4. This description draws upon several sources:; hrrp://;
  5. The conditions are from Kania & Kramer (footnote 4). This diagram is from:
  6. Diagram from: FSG: Preconditions for Collective Impact from:
  7. Re debate & additional views see:;; and

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