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Evidence on intersectoral work & its role on a successful change

towards health equity: Global and Canadian Experiences

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Purpose of the Presentation:

• Provide high-level summary of the global Intersectoral Initiative between WHO and PHAC;

• Provide learnings from the Canadian Case Study;

• Discuss needs for ISA; and tools/processes/mechanisms to implement ISA.

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ISA and Changing Definitions

"Intersectoral action" (for health) refers to “a recognized 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,

International Conference on Intersectoral Action for Health 1997, p. 3)

"Intersectoral action" (for health) refers to actions affecting health outcomes undertaken by sectors outside the health sector, possibly, but not necessarily, in collaboration with the health sector." (PHAC-WHO 2008, p.2)

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PHAC and WHO Joint Initiative: Overview

GOAL:Increase knowledge on use of intersectoral action to reduce health inequities, and identify next steps and supports.

ACTIVITIESPhase 1 – Crossing Sectors - Experiences in ISA, Public Policy And Health (Literature Review)

Phase 2 – Case studies from 18 countries

Phase 3 – Facilitation of an international dialogue, June 2007

Phase 4 – Health Equity Through Intersectoral Action: An Analysis of 18 Country Case Studies, May 2008.

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PHAC and WHO Joint Initiative: Overview

GOAL:Increase knowledge on use of intersectoral action to reduce health inequities, and identify next steps and supports.

ACTIVITIESPhase 1 – Crossing Sectors - Experiences in ISA, Public Policy And Health (Literature Review)

Phase 2 – Case studies from 18 countries

Phase 3 – Facilitation of an international dialogue, June 2007

Phase 4 – Health Equity Through Intersectoral Action: An Analysis of 18 Country Case Studies, May 2008.

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Health Equity Through Intersectoral Action: An Analysis of 18 Country Case Studies - Key lessons

• The goals of intersectoral action vary. Depends on framing of the issue.

• Intersectoral action looks different at different levels of decision-making.

• Building a strong case for intersectoral action is vital;

• Building trust among players is key to developing and maintaining intersectoral action;

• Models and structures to organize intersectoral action need to take a variety of forms depending on the context and conditions;

• Monitoring the on-going processes and outcomes of intersectoral work is critical; and

• The role of the health sector needs to be flexible (lead vs. participant).

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Summarizing Challenges from the Learnings

• Making the case for working across sectors• Aligning vertically & horizontally• Building relationships of trust• Evaluating & attributing outcomes • Sustaining interest over time and through

political change• Better understanding of the role of health

sector• Importance of ‘context’

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Eight Canadian Case Studies

1. Vancouver Agreement (urban development)2. Family Violence Prevention3. Homelessness Partnership Initiative4. Gender Based Analysis5. First Nations Self Government Agreements6. Manitoba Child Health7. Saskatchewan Human Service Integration

Networks 8. Québec Public Health Law (Health Impact

Assessment)

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Eight Canadian Case Studies: Facilitators

Cases selected to include:– Variety of determinants – Health sector led and health sector supported– Different levels of government

Facilitators• Political/Community leaders- National Homelessness Initiative (NHI)• Central government support - NHI, Aboriginal Self-Government

Agreements• Creative governance models - Healthy Child Manitoba (HCM)• Shared & flexible funding - Family Violence Initiative (FVI) • Explicit goal to work across sectors – FVI • Strong policy framework & evidence base - HCM• Role of Legislation – Quebec Public Health Law• Collaborative culture – seen in all cases examined

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Eight Canadian Case Studies - Challenges

• Human and financial resources• Mandate challenges• Lack of models, tools and accountability

frameworks• Changes in government/ long term

sustainability• Lack of leadership• Insufficient support for issue

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Eight Canadian Case Studies: Innovations

• Application of a community development approach/planning - can be a powerful silo breaker;

• Adoption of the Population Health Model; • Use of legislation as a tool; • A new ‘culture’ that recognizes ISA as the way business

is done today; • Creation of horizontal accountability frameworks; • Governance/committee structures (rotating or non-

health sector led committee chairs); • Whole-of-government can effectively mean “those most

interested”; and• Health needs to better support health enhancing policy

led by other sectors

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ISA Needs: CapacitiesRelating with other Sectors• Understanding mandates, approaches, & needs of

other sectors• Identifying opportunities for mutual health and social

gains• Negotiation, consensus building, cross-department

communicationMeasurement & Evaluation• Skills in HIA, HIIACase building for ISA• Evidence of effectiveness of the approach, arguments

for added investment of time & resources

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ISA Needs: Tools

• Clearly understandable storyline

• Models/frameworks for addressing health and social equity

• Frameworks for shared accountability and evaluation (including monitoring tools, indicators / targets etc)

• Incentives structures for Deputy Ministers to work horizontally

• Process maps (linking health and social inputs & outputs)

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Further Development: Needs & Supports

• Range of health sector roles (when & how to play each role, how to measure value added by health sector);

• Methods of vertical & horizontal alignment in countries with complex systems of governance;

• Collaborative vs. parallel work across sectors-when to use each;

• Scaling–up promising local initiatives (when & how);

• Analysis of mechanisms for cross-sector policy development & implementation; and

• Defining, documenting & sharing promising practices.

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Closing the Gap in Generation – WHO CSDH Report: ISA Positioning

• Policy coherence – key mechanism to support health equity in all policies across all levels of government.

• Moving beyond government - engaging key people, institutions and civil society has been identified as vital steps towards integrated action for health equity.

• Intersectoral Action for health - a key strategy to achieve policy coherence and for addressing, more generally, the social determinants of health and health equity.

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Tools/Processes/Mechanisms needed to implement ISA.

Where do we need to go in terms of understanding of the scope of tools and mechanisms being used to support intersectoral strategies for tackling health inequities, with reference to their implementation contexts?