Understanding the challenges of intersectoral action in public health through a case study of early childhood programmes and services

Abstract

After two decades of intersectoral public health action, the literature reports considerable ongoing difficulty in achieving this aim. This article analyses two of the challenges of intersectoral action: (1) ensuring convergence among the interests and resources of sectoral actors, and (2) coordinating the multiplicity of sectoral programmes. A case study employing Actor–Network Theory is used to provide an in-depth understanding of the persistence of these problems. In 2008, the Montreal Directorate of Public Health in the province of Quebec, Canada, implemented a vast consultation and mobilization process to address problems highlighted by the Survey of the School Readiness of Montreal Children. The process mobilized regional and local multi-sectoral actors in order to propose solutions. At the local community level, the process resulted in increased coordination leading to intersectoral innovation, while at the regional level it brought about the deployment of additional resources, albeit in sectoral programmes. This study analyses how intersectoral issues raised by the survey have been addressed so as to produce these results. It discusses how the balance between sectoral interests and the common good, as well as between sector autonomy and interdependence, is central to dealing with these two critical challenges.