Intersectoral Action For Health Research Articles

Current gaps in data and health information system in the European Region

Abstract When the SDGs were adopted in 2015, it was already clear that major issues regarding data availability would need to be tackled to enable comprehensive and policy-relevant monitoring and reporting. The SDG Report 2019 found that most MS were still not regularly collecting data for more than half of the global indicators. The measurement framework (MF) of the EPW builds on the SDGs. Also here, important data gaps for the included health-related SDG indicators exist. These gaps relate, e.g., to coverage of treatment for substance use disorders and the proportion of women with satisfied family planning needs. In addition, the MF exposed data gaps for several other areas that are highly relevant for the WHO European Region, such as health inequalities, intersectoral action for health, ageing populations and mental health. To help overcome these gaps, the EPW MF includes a development list. This list contains 20 indicator areas for which either no well-defined measures have yet been included in Region-wide international data collections or where data are available only for a limited number of MS. It will serve as a priority list for developmental work on indicators in the European Region in the coming years. Data gaps as described above are not stand-alone problems but are linked to wider issues with the functioning of HISs. In the European Region, the main HIS challenges relate to limited resources and capacity; insufficient coordination and collaboration, leading to fragmentation and problems with interoperability; lack of central governance; and limited use of health information for decision-making. In this presentation, we will give an overview of the main gaps in data and HISs in the European Region and explain the roadmap for the implementation of the EPW MF, which will be an important tool to achieve sustainable improvement of data availability and quality for key indicators. Tools to improve HIS performance overall will be addressed in the next presentation.

A tool to identify NCD interventions to achieve the SDG target

A tool to identify NCD interventions to achieve the SDG target

Intersectoral Action for Addressing NCDs through the Food Environment: An Analysis of NCD Framing in Global Policies and Its Relevance for the African Context.

Noncommunicable diseases contribute the greatest to global mortality. Unhealthy diet—a prominent risk factor—is intricately linked to urban built and food environments and requires intersectoral efforts to address. Framings of the noncommunicable disease problem and proposed solutions within global and African regional diet-related policy documents can reveal how amenable the policy landscape is for supporting intersectoral action for health in low-income to middle-income countries. This study applied a document analysis approach to undertake policy analysis on global and African regional policies related to noncommunicable disease and diet. A total of 62 global and 29 African regional policy documents were analysed. Three problem frames relating to noncommunicable disease and diet were identified at the global and regional level, namely evidence-based, development, and socioeconomic frames. Health promotion, intersectoral and multisectoral action, and evidence-based monitoring and assessment underpinned proposed interventions to improve education and awareness, support structural changes, and improve disease surveillance and monitoring. African policies insufficiently considered associations between food security and noncommunicable disease. In order to effectively address the noncommunicable disease burden, a paradigm shift from ‘health for development’ to ‘development for health’ is required across non-health sectors. Noncommunicable disease considerations should be included within African food security agendas, using malnutrition as a possible intermediary concept to motivate intersectoral action to improve access to nutritious food in African low-income to middle-income countries.

Intersectoral action for health: Challenges and opportunities in the WHO European Region

Intersectoral action for health: Challenges and opportunities in the WHO European Region

Intersectoral action for health: Challenges and opportunities in the WHO European Region

Intersectoral action for health: Challenges and opportunities in the WHO European Region

2.B. Round table: Policy decision-making – approaches for inter-sectoral action for health and sustainable development

2.B. Round table: Policy decision-making – approaches for inter-sectoral action for health and sustainable development

2.B. Round table: Policy decision-making – approaches for inter-sectoral action for health and sustainable development

2.B. Round table: Policy decision-making – approaches for inter-sectoral action for health and sustainable development

Intersectoral action for health: preventing psittacosis spread after one reported case.

Zoonotic diseases are a significant health threat for humans and animals. To better understand the epidemiology, etiology, and pathology of infectious agents affecting humans and animals combined approaches are needed. Here we describe an epidemiological investigation conducted by physicians and veterinarians after a reported case of psittacosis. Upon admission suffering from respiratory distress syndrome in a hospital and with a history of bird contact, a female patient was serologically diagnosed with psittacosis. After the case notification, veterinarians were able to investigate the source of infection by detecting Chlamydia psittaci in her pet cockatiel. The bird was hospitalized and successfully treated. In addition, the establishment where the pet bird was purchased was traced and through molecular techniques other birds intended to be sold as pets tested positive for C. psittaci. As a result, sanitary measures were applied and the establishment then was closed down. The birds intended for the pet commerce were treated and retested with negative molecular results for C. psittaci, thus avoiding disease propagation. Reliable data about zoonotic diseases can only be generated through the application of multidisciplinary approaches which take into account the epidemiological factors and interactions of humans, animals and their environments as an integrated system.

Transforming Regions into High-Performing Health Systems Toward the Triple Aim of Better Health, Better Care and Better Value for Canadians.

A study on the impact of regionalization on the Triple Aim of Better Health, Better Care and Better Value across Canada in 2015 identified major findings including: (a) with regard to the Triple Aim, the Canadian situation is better than before but variable and partial, and Canada continues to underperform compared with other industrialized countries, especially in primary healthcare where it matters most; (b) provinces are converging toward a two-level health system (provincial/regional); (c) optimal size of regions is probably around 350,000-500,000 population; d) citizen and physician engagement remains weak. A realistic and attainable vision for high-performing regional health systems is presented together with a way forward, including seven areas for improvement: 1. Manage the integrated regionalized health systems as results-driven health programs; 2. Strengthen wellness promotion, public health and intersectoral action for health; 3. Ensure timely access to personalized primary healthcare/family health and to proximity services; 4. Involve physicians in clinical governance and leadership, and partner with them in accountability for results including the required changes in physician remuneration; 5. Engage citizens in shaping their own health destiny and their health system; 6. Strengthen health information systems, accelerate the deployment of electronic health records and ensure their interoperability with health information systems; 7. Foster a culture of excellence and continuous quality improvement. We propose a turning point for Canada, from Paradigm Freeze to Paradigm Shift: from hospital-centric episodic care toward evidence-informed population-based primary and community care with modern family health teams, ensuring integrated and coordinated care along the continuum, especially for high users. We suggest goals and targets for 2020 and time-bound federal/provincial/regional working groups toward reaching the identified goals and targets and placing Canada on a rapid path toward the Triple Aim.

모든 정책의 건강: 건강증진과 부문 간 협력의 진화

'Health in All Policies' is a new strategy for governance for health in 21st century. The evolution of health promotion has affected the creation of the strategy through the efforts to tackle health inequalities by addressing social determinants of health. More concern about health inequalities, involving wider policy areas, and higher level of institutionalization distinguish the strategy from the old intersectoral collaboration such as intersectoral action for health and healthy public policy. Making intersectoral collaboration the mainstream of policy making is important to address integrated policy agendas such as 'Health in All Policies' and 'Sustainable Development Goals.' Political leadership and interpersonal skills are also required to strengthen the capacity of public health sector for implementing 'Health in All Policies' in local, national, and international circumstances.

A scoping review of definitions and frameworks of intersectoral action.

Intersectoral action is rooted in all health promotion activities because the determinants of health lie outside of the health sector. Despite the increasing use of these terms (intersectoral action, intersectoral action for health, intersectoral collaboration), often interchangeably, we noted a lack of consensus on their definitions and conceptualizations. The objective of this paper is to report the results of a scoping review of the use of definitions for a set of related terms as well as for conceptual frameworks, including the discussion of the evolution of those definitions and the sectors that use them. Finally, we propose a single definition for each term. We conducted a systematic search for documents published between January, 1960 and March, 2011 in English, French, Spanish and Portuguese. We retrieved 11 to 15 definitions per main term. Using a content analysis approach, an integrative conceptual definition was proposed for four main terms. Furthermore, in reviewing frameworks for potential use, we noted the lack of a comprehensive framework for intersectoral processes.

Liverpool Active City 2005-2010: Increasing Population Physical Activity Levels Through Intersectoral Action.

The process of working together across sectors to improve health and to influence its determinants is often referred to as intersectoral action for health. The Liverpool Active City strategy and action plan were launched in 2005, bringing together partners from diverse sectors such as education, transport, and civil society to boost levels of physical activity among the city's residents. The research material was based on semistructured interviews with key stakeholders and on review and analysis of gray literature and media reports. A case-study method was used to analyze the experience. The results show that Liverpool Active City succeeded in boosting levels of physical activity among the city's residents and demonstrate how intersectoral action benefited the goals of the program and promoted common aims. Important lessons can be drawn from the experience of Liverpool Active City for public health professionals and policy makers. Success factors include the involvement of a broad range of agencies from a variety of sectors, which reinforced the sense of partnership in the physical activity agenda and supported the implementation of activities. The experience also demonstrated how intersectoral action brought benefits to the physical activity goals of Liverpool Active City.

Intersectoral action for health: the experience of a Danish municipality.

The aim was to build up evidence on intersectoral action for health at local government level by identifying both challenges and facilitating factors in collaboration between sectors when developing and implementing an intersectoral health policy in Varde, Denmark. The study was carried out in 2011 using the case-study method. Approximately 500 pages of documents from the period 2007-2011 were analysed, and semi-structured interviews were carried out with nine key informants. The following challenges were identified: the policy was perceived as an additional task by employees outside the health sector; initially no direct funding was allocated to intersectoral projects; the level of ambition was not balanced between sectors; there was a lack of ownership of the policy; baseline measures were lacking and the policy had no clear objectives. Facilitating factors were considered to be: significant political support; public involvement; use of local media; establishment of a 'Fund for Health'; establishment of 'Health Networks' within sectors; and collaboration with a research group. Important practical lessons can be drawn from this experience for other cities planning to introduce similar formal intersectoral health policies in order to increase the chance of successful intersectoral action in further development and implementation of the intersectoral health policy in varde in the future, the challenges and facilitating factors identified in this study should be considered more evidence is required on the long-term health impacts of such policies.

Intersectoral action: local governments promoting health.

Many local governments around the world promote health through intersectoral action, but to date there has been little systematic evidence of these experiences. To bridge this gap, the World Health Organization Centre for Health Development conducted a study in 2011-2013 on intersectoral action for health (ISA) at local government level. A total of 25 cases were included in the final review. Various approaches were used to carry out ISA by local governments in low-, middle- and high-income countries. Several common facilitating factors and challenges were identified: national and international influences, the local political context, public participation and use of support mechanisms such as coordination structures, funding mechanisms and mandates, engaging sectors through vertical and horizontal collaboration, information sharing, monitoring and evaluation, and equity considerations. The literature on certain aspects of ISA, such as monitoring and evaluation and health equity, was found to be relatively thin. Also, the articles used for the study varied as regards their depth of information and often focused on the point of view of one sector. More in-depth studies of these issues covering multiple angles and different ISA mechanisms could be useful. Local governments can offer a unique arena for implementing intersectoral activities, especially because of their proximity to the people, but more practical guidance to better facilitate local government ISA processes is still needed.

A health in all policies approach to promote active, healthy lifestyle in Israel.

In December 2011, Israel launched the National Program to Promote Active, Healthy Lifestyle, an inter-ministerial, intersectoral effort to address obesity and its contribution to the country’s burden of chronic disease. This paper explores the National Program according to the “Health in All Policies” (HiAP) strategy for health governance, designed to engage social determinants of health and curb health challenges at the causal level. Our objective is twofold: to identify where Israel’s National Program both echoes and falls short of Health in All Policies, and to assess how the National Program can be utilized to enrich the Health in All Policies research-base.We review Health in All Policies’ evolution, why it developed and how it is diverges from other approaches to intersectoriality in health. We describe why obesity and related chronic diseases necessitate an intersectoral response, cite obstacles and gaps to implementation and list examples of HiAP-type initiatives from around the world. We then analyze Israel’s National Program as it relates to Health in All Policies, and propose directions through which the initiative may constitute a useful case study.We contend that joint planning, implementation and to a limited extent, budgeting, between the Ministries of Health, Education and Culture and Sport reflect an HiAP-approach, as does integrating health into the policymaking of other ministries. To further incorporate health in all Israeli policies, we suggest leveraging the Health Ministry’s presence on governmental and non-governmental committees in areas like building, land-use and urban planning, institutional food policy and environmental health, and focusing on knowledge translation according to the policy needs, strengths and limitations of other sectors. Finally, we suggest studying the National Program’s financing, decision-making and evaluation mechanisms in order to complement existing research on the implementation of Health in All Policies and intersectoral action for health.

Schistosomiasis control and the health system in P.R. China

Over the last sixty years advances have been made in the control of schistosomiasis in P.R. China. There are, however, difficult challenges still to be met. This paper looks at the extent to which the health system offers a positive environment for the control of the disease. It starts by tracing three phases in schistosomiasis control: disease elimination strategy through snail control (1950s-early 1980s); morbidity control strategy based on chemotherapy (mid 1980s to 2003); integrated control strategy (2004+). Each one of these phases took place in distinct policy-making environments. The paper partly draws on these phases to set out five issues of disease control and discusses them in the context of the health system and its recent trends. These cover the policy-making process, intersectoral action for health, equity and access to health services, funding for public goods and externalities, and strengthening resource management and planning. These issues form the basis of an agenda for integrating research and capacity strengthening in the Chinese health system with a view to creating a more positive enabling environment for schistosomiasis control. In so doing it is important to emphasize the role and integrity of the public sector against its commercialization, the underlying value of equity, a systems wide perspective, and the role of advocacy.

Equity and the Social Determinants of Health in European Cities

Equity in health has been the underlying value of the World Health Organization's (WHO) Health for All policy for 30years. This article examines how cities have translated this principle into action. Using information designed to help evaluate phase IV (2003-2008) of the WHO European Healthy Cities Network (WHO-EHCN) plus documentation from city programs and websites, an attempt is made to assess how far the concept of equity in health is understood, the political will to tackle the issue, and types of action taken. Results show that although cities continue to focus considerable support on vulnerable groups, rather than the full social gradient, most are now making the necessary shift towards more upstream policies to tackle determinants of health such as poverty, unemployment, education, housing, and the environment, without neglecting access to care. Although local level data reflecting inequalities in health is improving, there is still a long way to go in some cities. The Healthy Cities Project is becoming an integral part of structures for long-term planning and intersectoral action for health in cities, and Health Impact Assessment is gradually being developed. Participation in the WHO-EHCN appears to allow new members to leap-frog ahead established cities. However, this evaluation also exposes barriers to effective local policies and processes to reduce health inequalities. Armed with locally generated evidence of critical success factors, the WHO-EHCN has embarked on a more rigorous and determined effort to achieve the prerequisites for equity in health. More attention will be given to evaluating the effectiveness of action taken and to dealing not only with the most vulnerable but a greater part of the gradient in socioeconomic health inequalities.

Intersectoral action for health: more research is needed!

A plethora of explanatory models of health and health disparities that give prominence to social determinants have been published during the past two decades. From the Dalhgren-Whitehead ecolo-social model of health (Dahlgren and Whitehead 1991) to the WHO Commission’s pathway model of the social determinants of health inequalities (WHO 2008), all these models explicitly recognize that health is produced in everyday life using resources and services, the availability and accessibility of which are determined by actors situated mostly outside of the health sector. As a consequence, numerous policy documents have pleaded for the health sector to take leadership in reaching out other sectors of activity in order to improve the conditions and resources that shape population health (WHO 1986). Intersectoral action is thus broadly defined as the alignment of intervention strategy and resources between actors from two or more sectors within the public sphere in order to achieve complementary objectives that are relevant and valued by all parties. Healthy school projects are often cited as success stories of intersectoral action. Such projects entail the coordination and pooling of resources from both the health and education sectors, two distinct spheres of government activity that most often compete for the same scarce resources. There is abundant literature demonstrating that to be successful, such projects require much more integration between public health and the education sector than just having a public health nurse servicing local schools. Despite the appealing rhetoric of intersectoral action, very few among health promotion professionals and researchers would be able to describe successful initiatives that involve sectors other than education. There would be even fewer people being able to list the conditions of success of such initiatives. The reason for this is quite simple: such projects are not that frequent and only a very small proportion of them have been studied. Although some case reports have been compiled for the WHO Commission on the Social Determinants of Health (WHO and Public Health Agency of Canada 2008), there is still a dearth of in-depth analysis of how they come about and the process by which they overcome the formidable obstacles that the normal functioning of public administration represent for intersectoral coordination and intervention. In this issue of IJPH, we publish three original studies that were submitted following an international call for paper on intersectoral action. Altogether these papers provide examples of intersectoral action at the municipal, provincial and international levels. Spiegel et al. (this issue) examine the complex interplay of municipal sectors involved in municipal government in Cuba, showing that specific practices and structures are required for their proper functioning. For their part, Dewa et al. (this issue) interviewed program developers involved in a partnership between the mental health and the justice sectors in the Canadian province of Ontario. They showed the greater demands put on both systems by such partnerships and how greater flexibility is required from both systems in order for such partnerships to function. Finally, the scoping review published by Shankardass et al. (this issue) confirms our diagnosis on the scarcity of empirical knowledge about the practices and structures involved in intersectoral action. Although they found a fair number of articles published and from the grey literature describing intersectoral This Editorial is part of the special issue ‘‘Intersectoral action to address the social determinants of health’’.

Prevention, control, and elimination of neglected diseases in the Americas: pathways to integrated, inter-programmatic, inter-sectoral action for health and development.

BackgroundIn the Latin America and Caribbean region over 210 million people live below the poverty line. These impoverished and marginalized populations are heavily burdened with neglected communicable diseases. These diseases continue to enact a toll, not only on families and communities, but on the economically constrained countries themselves.DiscussionAs national public health priorities, neglected communicable diseases typically maintain a low profile and are often left out when public health agendas are formulated. While many of the neglected diseases do not directly cause high rates of mortality, they contribute to an enormous rate of morbidity and a drastic reduction in income for the most poverty-stricken families and communities. The persistence of this "vicious cycle" between poverty and poor health demonstrates the importance of linking the activities of the health sector with those of other sectors such as education, housing, water and sanitation, labor, public works, transportation, agriculture, industry, and economic development.SummaryThe purpose of this paper is three fold. First, it focuses on a need for integrated "pro-poor" approaches and policies to be developed in order to more adequately address the multi-faceted nature of neglected diseases. This represents a move away from traditional disease-centered approaches to a holistic approach that looks at the overarching causes and mechanisms that influence the health and well being of communities. The second objective of the paper outlines the need for a specific strategy for addressing these diseases and offers several programmatic entry points in the context of broad public health measures involving multiple sectors. Finally, the paper presents several current Pan American Health Organization and other institutional initiatives that already document the importance of integrated, inter-programmatic, and inter-sectoral approaches. They provide the framework for a renewed effort toward the efficient use of resources and the development of a comprehensive integrated solution to neglected communicable diseases found in the context of poverty, and tailored to the needs of local communities.

Introducing Health Impact Assessment: an analysis of political and administrative intersectoral working methods

Intersectoral Action for Health (IAH) and its Health Impact Assessment (HIA) tool are built on collaboration between actors and sectors, requiring multidimensional and horizontal way of working. The study aims to analyse the enablers and barriers when such a new way of working and tool have been initiated to replace a traditional, vertical operation at the local level in Slovakia-a country in transition-in 2004. Up to date, there are few studies that have analysed intersectoral initiatives in relation to politics. In this study the conceptual framework of Kingdon has been used by which the actual problems, the governmental actions (or non-actions) (politics) and the understanding, implementation and evaluation of the initiative (policy) could be analysed. All actors involved, civil servants, politicians, representatives of the local public health institute and researchers, were interviewed and made to answer a questionnaire. The results showed that there were a number of factors behind the initiation of HIA, which either delayed or accelerated the process. The problems identified were e.g. the prevailing traditional health care focus and the deteriorating health status of the population. There was a lack of multi-intersectoral knowledge, co-operation and function between sectors and actors. Enablers on the other hand were the membership of international organizations which called for new solutions, and the strong political commitment and belief that intersectorality would have a positive effect on health. The actors on the local level would have the capacity to work intersectorally to bring about policy change if HIA was to be more supported/institutionalized.