Health equity through intersectoral action: An analysis of 18 country case studies
Author(s)/Editor(s) Peake S, Gallagher G, Valentine N et al.
Publisher/Journal: WHO, Minister of Health, Canada
Publication date: 2008
Number of pages: 52
“….The vision of the Commission on Social Determinants of Health, launched by the World Health Organization (2005-2008), is “a world in which all people have the freedom to lead lives they have reason to value”. The complexities of the social, political, economic and environmental factors that influence health and inequalities in health, and the fact that most of these determinants lie outside of the exclusive jurisdiction of the health sector, requires the health sector to act in collaboration with other sectors of government and society in order to more effectively address those factors that influence health and well-being.
Recognition of the intersectoral dimensions of the determinants of health has stimulated international efforts on systematic learning about how the action of different sectors can positively influence health and health equity.
The World Health Organization (WHO) and the Public Health Agency of Canada (PHAC) have supported the development of this collaborative work by jointly commissioning a set of 18 case studies from high, middle, and low income countries. The case studies outline diverse experiences of action across sectors with positive impacts for health and health equity.
This paper, part of a joint multi-phase initiative of PHAC and the Secretariat to the WHO Commission on Social Determinants of Health, provides an analysis of key learnings from those 18 case studies. The case studies analyzed here represent a broad array of initiatives that ranged from relatively small-scale programs that used a community development approach with a marginalized group in one city, to broad, policy-focused initiatives from national governments. Socio-political, economic and cultural contexts are important in each of the case studies reviewed, creating the landscape within which intersectoral action was initiated and carried out.
The plethora of approaches reflects the different contexts in which initiatives arose, the specific priorities that they addressed and the resources that were made available to them. …”
“…..The analysis of the 18 case studies followed a qualitative approach using content analysis. Key themes present in each of the case studies were identified and organized in groups. A number of questions guided the analysis and theme identification. These questions, many of which were identified through the previous phases of this initiative, included:
- What are some of the ways that each country’s sociopolitical, economic and decision-making contexts have an effect on how intersectoral efforts were conceptualized, planned, implemented and evaluated?
- What kinds of models or frameworks for organizing intersectoral action exist, and what contextual elements make the emergence of different models more likely?;
- What are examples of machinery, processes and tools that have been effective in implementing intersectoral action in the case studies?;
- How has the demand for intersectoral action been built in the case studies?;
- How have other sectors been motivated to buy in to the notion of social determinants, and take action towards them?;
- What has been the most useful role for the health sector?;
- What benefit/detriment has the setting of targets demonstrated on successful intersectoral action?;
- What attributes of intersectoral action are important for sustainability and scaling up?;
- What are some particularly innovative practices that countries used to overcome challenges to intersectoral action for health?, and
- What questions still remain? What further work still needs to be done to better understand those factors and processes that will best support intersectoral action?