The 5 Ws of Intersectoral Collaboration
What is intersectoral collaboration (ISC)?
The World Health Organization and the Public Health Agency of Canada (1) define intersectoral action for health as “actions undertaken by sectors outside the health sector, possibly, but not necessarily, in collaboration with the health sector, on health or health equity outcomes or on the determinants of health or health equity.” ISC addresses the social and economic factors that influence the health of a population within and between sectors at the local, regional, provincial, national, and global levels. The NCCDH’s 2014 Environmental Scan identifies intersectoral action as a priority area in addressing the social determinants of health and health equity (2).
Why engage in ISC?
This practice provides a collective approach to address the social determinants of health. ISC makes it possible to work across structural levels, attract a diversity of participants and decision makers, address a variety of health factors, and mobilize social capital to address health equity (3). This approach can coordinate policies to limit structured inequality among governments, service providers, community members, the private sector, and many other stakeholders (4). It is especially important when health is not the explicit focus of the policy. Because policies external to the health sector have a critical impact on health equity, investments in other areas must be considered or opportunities for action on the social determinants will be missed (5).
Where does ISC happen?
ISC often involves small groups of people from different sectors of society working across formal organizational boundaries to coordinate and provide services and programs to address health equity. This can take the form of inter-agency meetings, community coalitions, coordinated care teams, information systems links, and co-location of officials in program delivery. The details of the collaboration can range from informal to formal (written or unwritten agreements, pooling of budgets, integration of service delivery, and coordinated action), horizontal (across sectors at the same level) or vertical (across sectors at different levels), narrow (a specific service) or broad (overall system change) (6).
When is ISC needed?
ISC has been demonstrated to be effective to address service integration problems, duplications, gaps and inconsistencies in service provision, efficient use of limited resources, and pooling of skills and resources to address health on a broad level (7). Although ISC is not necessary for the delivery of individual and behavioral-based health information and services, it can be especially helpful for coordinating service delivery for populations that are difficult to reach. There are a number of challenges with ISC. To do it well takes more than just bringing people to the table. It also takes time, resources (financial and human), visionary leadership, strong and trusting relationships, common and clear goals, and a sense of trust. It is important to consider what is necessary to create conditions of success (4).
Who is part of ISC?
Effective collaborations can be large or small, but most importantly the participants need to “own” a common vision that is described in a language that is understood by everyone. Service providers in the health and non-health sectors, various levels of government, and private sector institutions are all potential collaborators, along with members of the public. The importance of involving community members cannot be overstated – it is from here that solutions appropriate to the local context emerge, often through the use of community based participatory methods (8) and other community engagement tools.
We’d love to hear from you. What kinds of intersectoral collaborations are you involved in? What has been a success for you? What is holding you back?
Check out the resources below (look for the links after the references) and let us know where you are at with your work in this area. Feel free to send me (Dianne Oickle) an e-mail.
- World Health Organization, Public Health Agency of Canada. Health equity through intersectoral action: an analysis of 18 country case studies [Internet]. Geneva: World Health Organization; 2008 [cited 2014 Oct 16]. Available from: http://www.who.int/social_determinants/resources/health_equity_isa_2008_en.pdf
- National Collaborating Centre for Determinants of Health. Boosting momentum: applying knowledge to advance health equity [Internet]. Antigonish, NS: National Collaborating Centre for Determinants of Health, St Francis Xavier University; 2014 [cited 2014 Oct 16]. Available from: https://nccdh.ca/images/uploads/Full_Environmental_scan_2014.pdf
- Alberta Health Services. Social environments and health: Healthy Public Policy concept paper [Internet]. Edmonton, AB: Healthy Public Policy, Health Promotion, Disease and Injury Prevention, Alberta Health Services; 2011 March. [cited 2014 Oct 16]. Available from: http://www.albertahealthservices.ca/poph/hi-poph-hpp-healthy-public-policy-concept-paper.pdf
- Danaher A. Reducing health inequities: enablers and barriers to inter-sectoral collaboration [Internet]. Toronto, ON: Wellesley Institute; 2011 June [cited 2014 Oct 16]. Available from: http://www.wellesleyinstitute.com/wp-content/uploads/2012/09/Reducing-Health-Inequities-Enablers-and-Barriers-to-Intersectoral-Collaboration.pdf
- World Health Organization. The equity action spectrum: taking a comprehensive approach. Guidance for addressing inequities in health [Internet]. Copenhagen, Denmark: WHO Regional Office for Europe; 2014 [cited 2014 Oct 16]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0005/247631/equity-action-090514.pdf?ua=1
- Public Health Agency of Canada: Canadian Best Practices Portal. Population Health Approach: The organizing framework key element 6 – collaborate across sectors and levels [Internet]. Ottawa, ON: Public Health agency of Canada; 2014 March 19 [cited 2014 Oct 16]; [about 7 screens]. Available from: http://cbpp-pcpe.phac-aspc.gc.ca/population-health-approach-organizing-framework/key-element-6-collaborate-sectors-levels/
- Axelsson R, Axelsson SB. Integration and collaboration in public health – a conceptual framework. Int J Health Plan M [Internet]. 2006 [cited 2014 Oct 16];21:75-88:[about 14pp]. Available from: https://www.k4health.org/sites/default/files/axelsson_bihari_axelsson_2006.pdf
- Wallerstein N, Duran B. Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity. Am J Public Health [Internet]. 2010 [cited 2014 Oct 16]; 100(S1):S40-S46: [about 7pp]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2837458/pdf/S40.pdf