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

1. Introduction

In 1997, the World Health Organisation (WHO)’s Conference on Intersectoral Action for Health explained why there is a need to advance intersectoral action for health (WHO 1997):

• We need a new vision for health that establishes the health sector as one of a number of intersectoral players in a “web” that makes use of new kinds of leadership, skills, information and intelligence.

• We need new systems of governance to manage partnerships and alliances, leading to new roles and responsibilities, delivery and financing methods, and monitoring, accountability and outcome tools and measures.

• We need improved evidence demonstrating the impact of intersectoral action on health and health interventions.

• We must strengthen understanding and use of health and social indicators, which are often narrow and skewed toward economic factors, to inform and strengthen policy and program decisions.

• We need to capture health opportunities as well as burdens.

In the ten years since the Conference, many regions, nations and communities have embarked on intersectoral action. Results have been mixed. While there is ample documentation of the need to work across sectors, there has been less exploration of experiences in initiating, sustaining and evaluating the impact of intersectoral efforts for health in a variety of decision-making contexts.

The purpose of this paper is to synthesize and analyse documented experiences and learnings in intersectoral action (IA) for health. The paper draws from a range of different social and political contexts, and where possible, examines intersectoral action addressing social determinants of health toward the goal of health equity. It attempts to respond to the following key questions:

• What public problems have been addressed through IA?
• What tools, mechanisms and strategies were used to facilitate IA?
• What role(s) did the health sector and other sectors play in initiating and sustaining IA?
• What has been learned?

This paper, the first phase of a Canadian initiative on intersectoral action for health, is intended to contribute to the World Health Organisation’s Commission on Social Determinants of Health (SDH). It is the result of collaboration between the Health Systems Knowledge Network of the Commission on SDH and the Public Health Agency of Canada. Information gleaned from this paper will shape questions to be explored in subsequent case studies and analyses and a report of country and regional experiences in IA. It is also expected to inform the final report of the Health System Knowledge Network (HSKN) of the WHO Commission on Social Determinants of Health.

The paper is organised as follows:

• Section One: Introduction;
• Section Two: Defining the Terms and Describing the Methodology;
• Section Three: Intersectoral Action for Health: A Broad Spectrum of Approaches;
• Section Four: Intersectoral Action: Navigating Barriers and Enablers;
• Section Five: Approaches to Facilitate Joint Action;
• Section Six: Roles and Responsibilities;
• Section Seven: Issues Arising from Intersectoral Action; and
• Section Eight: Spotlight on the Future.