ARCHIVED - Crossing Sectors - Experiences in Intersectoral Action, Public Policy and Health

2. Defining Key Terms and Describing the Methodology

Definitions

The following definitions are derived from the work of the WHO Commission on Social Determinants of Health.

Intersectoral action for health

Drawing from the work of the 1997 Conference, this paper adopts the following definition of Intersectoral Action for Health:

A recognised relationship between part or parts of the health sector with part or parts of another sector which has been formed to take action on an issue to achieve health outcomes (or intermediate health outcomes) in a way that is more effective, efficient or sustainable than could be achieved by the health sector acting alone. (WHO Health 1997, p. 3)

For the purposes of this synthesis, the following sectors are considered to fall within the broad public sector (or government) category: health, environment, education, finance/ treasuries, defence, and natural resources. The non-government sector includes actors from the private sector, including professional and media organisations.

Social determinants of health

Social determinants of health (SDH) are understood as “the social conditions in which people live and work” (WHO Commission on SDH 2005a, p. 4), which may have an impact on population or individual health. Frequently-cited social determinants of health include education, socio-economic status, early childhood development, physical and social environments, gender, and culture.

Health equity

Health equity is defined as “the absence of unfair and avoidable or remediable differences in health among populations or groups defined socially, economically, demographically or geographically.” (WHO Commission on SDH 2005a, p. 5)

While all three of these terms are considered central to the discussion of IA within the context of the WHO Commission on Social Determinants of Health, this synthesis focuses primarily on IA. It should be noted, however, that while many of the experiences dealt with in this synthesis are not explicitly directed toward addressing SDH or health equity, they could potentially be applied to the advancement of health equity goals.

For working definitions of other related terms used throughout the paper, see Appendix A – Glossary of Terms.

Methodology

This paper examines experiences documented by academics, policy-makers and practitioners in more than 15 countries. Sources, which date from the mid-1990’s to the present, include more than 100 articles, government and non-government publications, presentations, and commissioned papers, as well as work under way for the WHO Commission on Social Determinants of Health. Primarily, experiences have been drawn from high-income countries. Materials relating to European and Canadian initiatives predominate, although the paper also addresses significant IA initiatives in Australia, New Zealand, Sri Lanka and Brazil.

The search for materials was a collaborative effort among EQUINET, the Health Systems Knowledge Network (HSKN) hub, and the Public Health Agency of Canada. Keywords included: “intersectoral action for health”; “health equity”; “health inequalities”; “health impact assessment”; “health action zones”; “social security”; “social development”; “social exclusion”; “strengthening/implementing initiatives, actions and mechanisms: government”; and, “public sector”. EQUINET searched all internet-accessible databases, all United Nations sites, a range of research institution and civil society sites commonly tapped by EQUINET, and Google. The HSKN hub selectively accessed additional materials through WHO Commission on SDH contacts and manually checked reference lists of important documents. All three collaborating organisations provided additional documents. Source types included articles, reports of government and non-government organisations, consultants and donor organisations.

While the scope of this paper was fairly extensive, there were three main limitations:

1. The keywords used in selecting sources may have limited the scope of the paper to experiences with a clear health sector lead or partner role. This paper did not systematic-ally explore broader public policy literature sources on intersectoral and inter-jurisdictional collaboration. Because of this limitation, documented experiences in intersectoral action for broader social policy objectives—an area where health is an important indicator of progress—may have been missed.

2. As a paper-based review, the scope of the synthesis is limited to documented, readily-available experiences. In most countries, the confidential nature of formal decision documents, such as Cabinet and Treasury documents, restricts access to information providing details on issue framing, intersectoral collaboration mechanisms and accountability arrangements.

3. Information on process and outcome evaluation related to intersectoral efforts is relatively limited. The questions explored in this paper can be answered, in part, by documented experiences. Phase two of the project, which will involve context-specific case studies, is expected to supply additional answers to these questions.