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

8. Spotlight on the Future

Remaining questions

While this paper does not conclusively identify appropriate models of categorising IA, it notes the benefits of using global, regional, national, sub-national, and community or local levels of governance as a useful entry point for undertaking intersectoral action. It introduces broad descriptions of approaches – staged, targeted, broad, and combined – as a practical way to approach the challenge of health equity, address the social determinants of health, and, where appropriate, act across sectors to realise health gains.

Questions arising from this paper include:

What arguments were most/least persuasive in making the case for intersectoral action? Cabinet discussions are held in camera in many countries, so the “inside story” on what was most persuasive is not usually captured in government documents outlining lessons learned, evaluations, or the academic literature.

Which policy levers were most effective, efficient and equitable in advancing health equity? In addressing public policy problems, policy levers are typically tested for effectiveness, i.e., will the intervention work within the specific context in question? The efficiency test examines whether value is received for the resources that were invested: i.e., do the benefits warrant the investment costs? Finally, what impacts does the intervention have on equity, i.e., the equitable distribution of social determinants? The health sector may raise the equity test in contributing to the development and implementation of policy proposals for other sectors.

What roles did other actors play? How can the health sector refine its role in the absence of other key partners’ (e.g., the public, the media, central decision-makers, other social sector actors, and the economic sector actors) consideration and awareness? A better understanding of which sectors did not engage- and why not- may assist in refining approaches to effective intersectoral action for shared objectives.

How was commitment sustained over time? Examples are provided in some of the literature, with an emphasis on leaders from health and other sectors. In developing health sector organisations, attention should focus on the types of leadership and other contributions required to work both within organisational boundaries, and with other key sectors.

How can the health sector strengthen its capacity for intersectoral action? If the health sector is calling on other sectors for equitable distribution of determinants of health, it must sustain a focus within the health sector to lead efforts in equitable access to health services for which it is directly responsible. This requirement, coupled with the growing complexity and interdependence of sectors and social problems, poses considerable challenges to the health sector.

The role of the health sector is no longer straight-forward. It must be able to shift and adapt. It must know when to lead, when to follow, and what type of input to seek. It must also be vigilant in ensuring that the health aspects of complex files led by other sectors are identified and addressed. It must be sensitive to timing, able to distinguish among short-, medium-, and long-term gains, and prepared to make decisions on appropriate entry points and strategies.

What tools, models or resources are needed to support IA? Developing a well-planned, systematic approach to intersectoral action that will yield both health and broader socio-economic benefits requires considerable support. Much of the literature outlined barriers and enablers to intersectoral action, and some tools to support intersectoral action were identified. Further work is needed to assess the needs of a range of actors and the fit with available tools and resources. Collaboration with other sectors may uncover a host of existing tools, such as integrated planning and evaluation models, which could serve as useful examples.

Conclusion

Just as the concept of health has evolved over the past decades, the concept of intersectoral action for health appears to be shifting. Experiences reviewed in this paper demonstrate some successes in working vertically and horizontally for health gains. Given the resource implications of intersectoral efforts, however, a critical assessment of when, where and how to act is required. While a range of approaches has been used, at different levels of governance, there does not appear to be a “one size fits all” model.

There is an emerging need to shift from IA for health to IA for shared societal goals. Equity, with health as one important indicator, offers an entry point that may hold promise in many political contexts. This shift requires a health sector that balances determinants within which it holds the policy levers, and those for which other sectors are the lead.

This paper provided a high-level overview of approaches to intersectoral action at the global, sub-regional, national, sub-national, and com-munity levels. In the ten years since the 1997 WHO Conference on Intersectoral Action for Health took place, there has been some progress in exploring the health sector’s new role, as a partner among partners. New kinds of leadership, skills, information, and intelligence are being applied around the globe. New systems of governance to manage partnerships and alliances are being considered and tested. Some progress has been made in strengthening the understanding the health impacts of interventions. Yet, in this paper, solid evidence demonstrating the effectiveness of intersectoral action for health was difficult to locate.

Many questions remain. It is our hope that as the tenth anniversary of the 1997 conference approaches, this paper and subsequent case studies will contribute to a more refined understanding of intersectoral approaches that is adapted to specific contextual needs.