ARCHIVED - Introduction

British Columbians are among the healthiest people in Canada. The population has the lowest standardized mortality rates due to chronic disease compared to people in the other provinces and territories in the country. [1] Nevertheless, British Columbia (BC) is not exempt from the increasing rates of preventable chronic disease prevailing in the rest of Canada and globally as populations age and live longer. [1]

According to the World Health Organization (WHO), a high proportion of heart disease, stroke, and type 2 diabetes and an estimated 40% of cancers could be avoided if common lifestyle risk factors like smoking, physical inactivity, unhealthy eating, obesity, and alcohol misuse were eliminated. [2] The required public health response to address risk factors, and to promote health in general, is characterized by multiple strategies operating in a coordinated manner, collaboratively and in partnership across health and non-health sectors. The literature provides a number of terms, some with overlapping meanings, that capture the essence of such an approach, such as integration, intersectoral action for health, whole-of-government, and joined-up government.

In this report, we present the intersectoral and integrated approach to health promotion launched in 2005 in BC, an initiative called ActNowBC. We chose ActNowBC for a case study because it is a unique health promotion initiative in several regards (see Table 1). First, the ActNowBC initiative strives to achieve health promotion targets, an uncommon feature of government-led initiatives. Second, ActNowBC is tightly linked to the Winter Olympics to be held in BC in 2010. When BC won the Olympic bid, the government pledged to make the province the healthiest jurisdiction ever to host the Games and declared 2010 as the highly symbolic target year for the health goals in ActNowBC. ActNowBC is the means by which the Olympic Games are to deliver a health promotion legacy to the people of BC. Third, ActNowBC uses an integrated approach that simultaneously targets multiple risk factors. Fourth, ActNowBC implements a whole-of-government approach and strengthens accountability for population health. Finally, the ActNowBC initiative is developing strong partnerships with a coalition of NGOs, a process that started with what is believed to be the largest transfer of funds ($25.2 million) in Canada from a provincial government to the NGO sector in the field of health promotion.

Table 1: Unique Features of ActNowBC in Canada

This case study on ActNowBC was undertaken with the objective of better understanding the factors facilitating or constraining effective intersectoral action for health. In this report, we examine two aspects of ActNowBC in detail: 1) the factors and mechanisms facilitating contributions from all sectors of government to ActNowBC, and 2) the factors and mechanisms facilitating partnerships between the BC government and a coalition of civil society organizations to reach the ActNowBC targets.

This report is divided into four sections. The first section briefly outlines our case study methodology. In the second section, we define the concept of intersectoral action for health by highlighting its two key dimensions: 1) a vertical dimension referring to linkages between different levels of government or between different types of organizations, and 2) a horizontal dimension referring to the use, at one level of government, of a whole-of-government approach. We then focus on the horizontal dimension, which is the initial and core component of ActNowBC, by examining key issues associated with whole-of-government approaches through a scoping review of the literature. We present the case study findings in the third section, which contains four subsections. We start with a brief overview of ActNowBC and its history. We examine the whole-of-government component of ActNowBC and describe how this government-led initiative gradually established partnerships with a coalition of NGOs. This is followed by a brief overview of initial outcomes, with special attention given to equity considerations. Finally, we present the main sustainability challenges for ActNowBC from the perspective of the study participants. The fourth section discusses the case study findings in light of the international literature on intersectoral action for health and highlights lessons learned from developing and implementing ActNowBC to date.