A collaborative approach to community well-being through intersectoral partnerships
Authors: Edlin Glane Mathias1, Elstin Anbu Raj1, Divya Sussana Patil1
1. Centre for Evidence-informed Decision-making, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
Introduction
In today’s rapidly evolving world, various factors influence the health of individuals and societies which go far beyond conventional health care systems. These determinants of health range from access to healthy food and transport to education and poverty levels. This is where the concept of intersectoral action for health outcomes becomes an important consideration. It encourages different sectors to collaborate to improve public health, recognizing that health is influenced by various social, economic, and environmental factors.
The importance of intersectoral action for health
Intersectoral action for health and well-being involves several approaches that highlight the importance of working collaboratively across sectors (e.g. ministry, government agencies, non-governmental organizations, community, and relevant stakeholders) to improve health and well-being. It fosters the sharing of responsibilities and resources, promoting a holistic understanding of health, which is influenced by various determinants outside the health care realm. By recognizing that the well-being of individuals and communities is shaped by a range of factors, intersectoral collaboration views health as a shared responsibility. The root cause of poor health outcomes cannot be resolved without addressing all the underlying determinants. To address these issues, there is a need for intersectoral collaboration and partnerships between various sectors such as health, education, housing, urban planning, and transportation for achieving better health outcomes and to address the social determinants of health.
The rationale behind intersectoral action
1. Addressing complex health challenges
Modern public health issues have become increasingly complex, requiring multifaceted solutions. For instance, the obesity epidemic cannot be resolved solely by targeting individual eating habits; it necessitates engagement from various sectors to ensure the availability of healthy food options, promote physical activity through urban planning, and limit the marketing of unhealthy foods.
2. Promoting health equity
Health inequities often arise from systemic factors such as income, education, and access to basic needs. Fostering intersectoral collaboration will enable stakeholders to create environments that promote equity. For example, partnerships between the education sector and local governments can enhance access to quality education in disadvantaged communities, directly affecting both health, knowledge, and behavioral choices. Such partnerships can enhance inclusive health policies, which address the needs of individuals across various population. These include vulnerable populations (e.g., in Vietnam, it was identified that through the involvement of multiple stakeholders it was possible to meet the needs of the country’s aging population).
3. Efficient resource allocation
Combining resources across sectors can lead to more effective and efficient use of funds and services. Aligning public policies and budgets can create collaborative efforts that lead to better health outcomes and reduced costs. These collaborations enable the optimal use of resources by avoiding duplication of work done by individual sectors. An example is the collaboration between the health care and transportation sectors to develop safer pedestrian paths, which can decrease injuries, increase physical activity, and provide access to health care.
Key sectors for intersectoral collaboration
1. Health: Health plays a pivotal role in intersectoral collaboration, acting as a bridge that connects various sectors to address complex health challenges. It engages with individual sectors such as education, housing, and transportation to address the social determinants of health, ensuring that health is integrated into all aspects of policymaking. The WHO Commission on the Social Determinants of Health emphasizes the need for comprehensive action on social determinants of health and recommends integrated approaches that engage various sectors to tackle inequalities.
2. Education: Collaborating with educational institutions to implement health education programs can empower children and adolescents with knowledge about nutrition, physical activity, and mental health. This may include initiatives such as school wellness policies, promoting healthy meals, and incorporating physical activity into school programs. For example, the youth health policies in Norway sought to strengthen connections between youth health services and various sectors, including education, social services, and law enforcement. The integrative approach allowed stakeholders to address a variety of issues influencing youth well-being, such as providing comprehensive support and resources for young individuals struggling with mental health challenges, implementing prevention and intervention strategies to reduce substance misuse among youth, and fostering collaboration between law enforcement and health providers to create supportive environments for at-risk youth.
3. Housing and urban development: Housing quality, availability of green spaces, and accessibility to public transport all contribute to community health. Intersectoral action can involve collaboration with urban planners to design neighborhoods that promote walking and cycling, provide access to healthy food, and provide safe housing. For example, the WHO European Healthy Cities Network engages cities across Europe in a collaborative effort to improve health and well-being by integrating health considerations into urban planning and development, thereby creating healthier environments.
4. Transportation: Working with transportation agencies to improve public transit, create bike lanes, and ensure safe pedestrian crossings can have profound effects on population health by facilitating access to health care, employment opportunities, and recreation.
5. Environmental sector: Pollution, climate change, and access to clean water can have far-reaching implications for community well-being. Collaborations between public health and environmental agencies can develop policies that promote sustainability and public health, such as reducing emissions, promoting clean energy, and ensuring safe drinking water.
Successful examples of intersectoral action
A few successful models illustrate the impact of intersectoral collaboration on health outcomes. These include the Californian Health in All Policies Initiative that was launched in 2010, which aimed to embed health considerations into state policies across various sectors. It promotes cross-sector collaboration, leading to policies that address health equity and improve community health. Likewise, low- and middle-income countries such as India have shown how intersectoral collaboration in education, health, and social services can address the health needs of the community.
Key messages
Despite the potential benefits, intersectoral action for health is not without its challenges. Barriers such as inconsistent priorities among sectors, a lack of understanding of health impacts within non-health sectors, limited resources, and inadequate policy frameworks can delay collaboration. To overcome these difficulties, stakeholders should pursue strategies such as identifying shared objectives/goals; building partnerships for effective communication; strengthening governance structures; enhancing education and advocacy for health professionals, policymakers, and community leaders; using data and evidence; promoting community engagement; and monitoring and evaluation to inform policy adjustments and promote accountability.
Conclusion
Health outcomes are influenced by a variety of determinants and not just health care systems. Intersectoral action is important for achieving the SDGs and to tackle the many challenges in public health. By recognizing that health is a shared responsibility influenced by other external factors, stakeholders can work collaboratively to build healthier communities. The diverse benefits of such partnerships, from improved health to reduced health inequities, underscore the importance of a holistic, inclusive approach to public health.
As we continue to grapple with evolving health challenges, embracing intersectoral action will be essential in fostering resilient, vibrant communities that thrive in the face of present and future health challenges. Using tailor-made strategies and prioritizing intersectoral collaboration will result in comprehensive and sustainable health outcomes.
References
Alderwick, H., Hutchings, A., Briggs, A., & Mays, N. (2021). The impacts of collaboration between local health care and non-health care organizations and factors shaping how they work: A systematic review of reviews. BMC Public Health, 21, 1-16. https://doi.org/10.1186/s12889-021-10630-1
Ambuehl, B., Kunwar, B. M., Schertenleib, A., Marks, S. J., & Inauen, J. (2022). Can participation promote psychological ownership of a shared resource? An intervention study of community-based safe water infrastructure. Journal of Environmental Psychology, 81, 101818. https://doi.org/10.1016/j.jenvp.2022.101818
Amri, M., Chatur, A., & O'Campo, P. (2022). An umbrella review of intersectoral and multisectoral approaches to health policy. Social Science & Medicine, 315, 115469. https://doi.org/10.1016/j.socscimed.2022.115469
Belrhiti, Z., Bigdeli, M., Lakhal, A., Kaoutar, D., Zbiri, S., & Belabbes, S. (2024). Unravelling collaborative governance dynamics within health care networks: A scoping review. Health Policy and Planning, 39(4), 412-428. https://doi.org/10.1093/heapol/czae005
Commission of Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final report of the commission on social determinants of health. https://iris.who.int/bitstream/handle/10665/43943/9789241563703_eng.pdf
Delany-Crowe, T., Marinova, D., Fisher, M., McGreevy, M., & Baum, F. (2019). Australian policies on water management and climate change: Are they supporting the sustainable development goals and improved health and well-being? Globalization and Health, 15, 1-15. https://doi.org/10.1186/s12992-019-0509-3
European Union. (2020). Youth policies in Norway. https://national-policies.eacea.ec.europa.eu/sites/default/files/2021-09/Norway_2020.pdf
Friel, S., Akerman, M., Hancock, T., Kumaresan, J., Marmot, M., Melin, T., ... & GRNUHE members. (2011). Addressing the social and environmental determinants of urban health equity: Evidence for action and a research agenda. Journal of Urban Health, 88, 860-874. https://doi.org/10.1007/s11524-011-9606-1
Glazener, A., Sanchez, K., Ramani, T., Zietsman, J., Nieuwenhuijsen, M. J., Mindell, J. S., ... & Khreis, H. (2021). Fourteen pathways between urban transportation and health: A conceptual model and literature review. Journal of Transport & Health, 21, 101070. https://doi.org/10.1016/j.jth.2021.101070
Kickbusch, I., & Gleicher, D. (2012). Governance for health in the 21st century. World Health Organization. Regional Office for Europe. https://iris.who.int/handle/10665/326429
Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., ... & Pate, M. (2018). High-quality health systems in the Sustainable Development Goals era: Time for a revolution. The Lancet Global Health, 6(11), e1196-e1252. https://doi.org/10.1016/S2214-109X(18)30386-3
Loban, E., Scott, C., Lewis, V., Law, S., & Haggerty, J. (2021). Improving primary health care through partnerships: Key insights from a cross-case analysis of multi-stakeholder partnerships in two Canadian provinces. Health Science Reports, 4(4), e397. https://doi.org/10.1002/hsr2.397
Melo, G., Aguilar-Farias, N., Barrera, E. L., Chomalí, L., Moz-Christofoletti, M. A., Salgado, J. C., ... & Caro, J. C. (2023). Structural responses to the obesity epidemic in Latin America: What are the next steps for food and physical activity policies? The Lancet Regional Health–Americas, 21. https://doi.org/10.1016/j.lana.2023.100486
Rudolph, L., Caplan, J., Ben-Moshe, K., & Dillon, L. (2013). Health in all policies: A guide for state and local governments (Vol. 169). Washington, DC: American Public Health Association. https://www.phi.org/thought-leadership/health-in-all-policies-a-guide-for-state-and-local-government/
Singh, S., Miller, E., & Closser, S. (2024). Nurturing transformative local structures of multisectoral collaboration for primary health care: Qualitative insights from select states in India. BMC Health Services Research, 24(1), 634. https://doi.org/10.1186/s12913-024-11002-2
Vo, M. T. H., Nakamura, K., Seino, K., Moncatar, T. R. T., Han, T. D. T., Siongco, K. L. L., ... & Van Vo, T. (2024). Can collaboration among health and social care workers play a role in addressing geriatric care challenges? A qualitative case study in Central Vietnam. International Health, 16(4), 387-398. https://doi.org/10.1093/inthealth/ihad082
Walton, L., Skillen, E., Mosites, E., Bures, R. M., Amah-Mbah, C., Sandoval, M., Thigpen Tart, K., Berrigan, D., Star, C., Godette-Greer, D., Kowtha, B., Vogt, E., Liggins, C., & Lloyd, J. (2024). The intersection of health and housing: Analysis of the research portfolios of the National Institutes of Health, Centers for Disease Control and Prevention, and U.S. Department of Housing and Urban Development. PLoS One, 19(1), e0296996. https://doi.org/10.1371/journal.pone.0296996
World Health Organization. (2008). School policy framework: implementation of the WHO global strategy on diet, physical activity and health. https://iris.who.int/bitstream/handle/10665/43923/9789241596862_eng.pdf
World Health Organization. (2017a). Advocating intersectoral action for health equity and well-being: the importance of adapting communication to concept and audience. WHO Regional Office for Europe. https://iris.who.int/handle/10665/329507
World Health Organization. (2017b). Governing for health equity and sustainable development in Montenegro: current progress and opportunities for cross sectoral action on social determinants to improve equity in health. World Health Organization. Regional Office for Europe. https://iris.who.int/handle/10665/362353
World Health Organization. (2024). WHO European Healthy Cities Network. https://www.who.int/europe/groups/who-european-healthy-cities-network
To link to this article - DOI: https://doi.org/10.70253/YESG3423
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