Intersectoral Action Research Articles

Addressing Policy Coherence Between Health in All Policies Approach and the Sustainable Development Goals Implementation: Insights From Kenya.

Background: Addressing health in the Sustainable Development Goals (SDGs) calls for intersectoral strategies that mutually enhance both health promotion and sustainable development. Health in All Policies (HiAP) approach aims to address this as well as promote ownership among key stakeholders. Kenya was at the forefront of adopting the SDGs and has committed to the HiAP approach in its Health Policy document for the period 2014-2030. This study aims to assess how the adoption of the HiAP approach can leverage on SDGs implementation in Kenya. Methods: This is an exploratory case study using qualitative data and some descriptive quantitative data. The Organisation for Economic Co-operation and Development’s (OECD’s) eight building blocks for policy coherence on sustainable development was our guiding framework. Qualitative data was derived from a review of relevant peer-reviewed and grey literature, as well as 40 key informant interviews and analyzed in NVIVO. Quantitative data was accessed from the United Nations SDG indicator database and exported to Excel. Results: Kenya has expressed a strong political commitment to achieving the SDGs and has now adopted HiAP. The study showed that Kenya can leverage on local level implementation and long-term planning horizons that it currently has in place to address the SDGs as it rolls out the HiAP approach. The SDGs could be mapped out against the sectors outlined in the Adelaide statement on HiAP. It is also possible to map out how various ministries could coordinate to effectively address HiAP and SDGs concurrently. Funding for HiAP was not addressed in the OECD framework. Conclusion: Kenya can advance a HiAP approach by leveraging the ongoing SDGs implementation. This will be made possible by facilitating coordinated intersectoral action both at national and local level. Funding for HiAP is crucial for its propagation, especially in low- and middle-income countries (LMICs) and can be considered in the budgetary allocations for SDGs.

Stop ringing the alarm; it is time to get out of the building!

The volume of calls for governments and public health officials to take concerted action on climate change has become almost deafening. Public health researchers and practitioners need to look beyond what we know about the health impacts of climate change, to what we are doing as our part in contributing to holding global temperature rise to under 1.5°C. This commentary reflects on the common threads across the articles of a special section in this issue of the Canadian Journal of Public Health, "Moving on IPCC 1.5°C", which sought examples of bold research and action advancing climate change mitigation and adaptation. Among the articles, there are signs that the public health community is gaining momentum in confronting the climate crisis. Three critical lessons emerged: the need for institutional change from the top of public health, the essential power of community in intersectoral action on climate change preparedness, and the importance of centring Indigenous wisdom to decolonize colonial legacy systems. We encourage readers to move public health research and practice from an instrumental relationship with nature to one of reverence and sacred reciprocity.

UK's fruit and vegetable supply increasingly dependent on imports from climate vulnerable producing countries.

Domestic contribution to total fruit and vegetable supply in the UK decreased from 42% in 1987 to 22% in 2013. The impact of this changing pattern of UK fruit and vegetable imports, from countries with different vulnerabilities to projected climate change, on the resilience of the UK food system is currently unknown. Here, we used the UN FAO bilateral trade database over a period of 27 years to estimate changes in fruit and vegetable supply in the UK, and the NDGAIN climate vulnerability categories to assess the climate vulnerability of countries supplying fruit and vegetables to the UK. The diversity of fruit and vegetable supply has increased from 21 crops, comprising the top 80% of all fruit and vegetables supplied to the UK in 1987, to 34 crops in 2013. The contribution of tropical fruits has rapidly increased while that of more traditional vegetables, such as cabbages and carrots, has declined. The proportion of fruit and vegetables supplied to the UK market from climate vulnerable countries increased from 20% in 1987 to 32% in 2013. Sensitivity analyses - using climatic and freshwater availability indicators - supported these findings. Increased reliance on fruit and vegetable imports from climate vulnerable countries could negatively affect the availability, price and consumption of fruit and vegetables in the UK, affecting dietary intake and health particularly of older people and low-income households. Inter-sectoral actions across agriculture, health, environment, and trade are critical in both the UK and countries that export to the UK to increase the resilience of the food system, and support population health.

The Profile of Bicycle Users, Their Perceived Difficulty to Cycle, and the Most Frequent Trip Origins and Destinations in Aracaju, Brazil.

The objective of this study was to describe the profile of bicycle users, their perceived difficulty to cycle, and the most frequent trip origins and destinations in Aracaju, Northeast Brazil. Our cross-sectional study sampled 1001 participants and we collected information through structured interviews. Aged ≥15 years, participants were residents of all Aracaju’s neighborhoods and used a bicycle for commuting to work or for leisure. We observed that bicycle users in Aracaju are predominantly employed male subjects, aged between 18 and 40 years, and were the heads of their households. Most of the them reported “work” as the main reason for their bicycle trips and, “health” and “practicality” aspects as their main motivations for using bicycles. In general, the neighborhoods in the north and center of the city were identified as the most difficult for cycling, and the easiest trips occurred in places with cycle paths. As a conclusion of this study, we reaffirm the need for intersectoral actions that create favorable environments for active commuting and more sustainable cities.

Recommendations for Intersectoral Collaboration for the Prevention and Control of Vector-Borne Diseases: Results From a Modified Delphi Process.

BackgroundIntersectoral collaboration in the context of the prevention and control of vector-borne diseases has been broadly described in both the literature and the current global strategy by the World Health Organization. Our aim was to develop a framework that will distill the currently known multiple models of collaboration.MethodsQualitative content analysis and logic modeling of data abstracted from 69 studies included in a scoping review done by the authors were used to develop 9 recommendation statements that summarized the composition and attributes of multisectoral approaches, which were then subjected to a modified Delphi process with 6 experts in the fields of health policy and infectious diseases.ResultsConsensus for all statements was achieved during the first round. The recommendation statements were on (1–3) sectoral engagement to supplement government efforts and augment public financing; (4) development of interventions for most systems levels; (5–6) investment in human resource, including training; (7–8) intersectoral action to implement strategies and ensure sustainability of initiatives; and (9) research to support prevention and control efforts.ConclusionsThe core of intersectoral action to prevent vector-borne diseases is collaboration among multiple stakeholders to develop, implement, and evaluate initiatives at multiple levels of intervention.

Social Representations of Healthy Eating in Schoolchildren from Cartagena, Colombia

The social representations on healthy eating of the students of a public educational institution in Cartagena de Indias were analyzed. Methods: A mixed investigation was carried out, starting with the collection and analysis of qualitative information, for which twelve interviews and one focus group were applied, and a participant observation was carried out. From this inquiry, the economic access to healthy foods emerged as a relevant factor for healthy eating, which led to the development of a comparison between the food price behavior identified as healthy and unhealthy. The study was performed during 2018. Results: Concerning social representations, it was identified that healthy eating is expensive and difficult for the population to access, which was subsequently demonstrated by analyzing food prices. Other factors, such as taste, ease of preparation, healthy foods availability at school, were also identified as relevant to maintain healthy eating practices. Conclusion: The research identified factors such as access to food, pleasure, the low availability of healthy food at school, customs, and the loss of symbolic value of typical preparations, among others, related to food decision-making in the population. In this sense, it is necessary to highlight that the strategies for improving schoolchildren's nutritional status must include intersectoral actions, actively linking the community, the family, the school, the media, and students.

Promoção de saúde para mulheres em território de vulnerabilidade social: comunidade a Saroba

Objetivo: Descrever as ações de educação e assistência à saúde realizadas para mulheres em situação de vulnerabilidade socioeconômica de Palmas – TO. Métodos: Trata-se de um relato de experiência de ações educativas, promoção à saúde e estratégias preventivas que contemplaram as temáticas do uso abusivo de álcool e outras drogas, saúde sexual e reprodutiva, higiene e também ações intersetoriais para resolução de problemas complexos para as mulheres que residiam na Comunidade Saroba. Resultados: As ações de educação foram pautadas, basicamente em quatro assuntos, sendo abordados de forma intersetorial e integral nos 15 encontros realizados: o uso abusivo de álcool e outras drogas, saúde sexual e reprodutiva, higiene do local, e oportunidade de acolhimento. O maior problema encontrado foi em relação ao padrão de comportamento quanto ao consumo mais intenso de álcool e outras drogas pelas mulheres, que acarreta em maior exposição à riscos, como o desemprego e, consequente, envolvimento com atividades ilícitas e prostituição, além da forte relação com a violência e condição de vida na rua. Conclusão: Apesar das dificuldades enfrentadas pelo grupo para realizarem as ações educativas, a criação de vínculo com a Rede de Atenção e a redução de comportamentos de risco, foi possível evidenciar que é possível a integração entre as mulheres do local com profissionais de saúde, desde que haja total abertura e confiança para discussão dos temas e participação efetiva dos envolvidos nas escolhas.

Lessons from a rural housing crisis: grounded insights for intersectoral action on health inequities

Local communities are struggling with persistent health inequities driven by income disparity, housing inadequacy, and other intersecting factors that constrain individual and community well-being. Increasingly, intersectoral approaches are recognized as essential to tackle such challenges, given their intersecting nature. This paper describes Equity-focused Intersectoral Practice (EquIP), a novel methodology that merges participatory research principles with the purposeful positioning of grounded expertise (lived experience) to shift the gaze of intersectoral actors towards the contextual factors that contribute to health inequities. The EquIP methodology creates uncommon spaces for intersectoral encounter that support critical reflexivity and relationship-building among institutional and community-based intersectoral actors. A case example of the EquIP methodology, implemented in a small, rural Canadian city in the context of a regional housing crisis, illustrates how investment in reflexivity and relational praxis among diverse intersectoral actors supports the identification of existing structures, beliefs, and practices within institutional settings that constrain effective intersectoral response to health inequities.

Intersectoral action on the social determinants of health and health equity in Canada: December 2019 federal government mandate letter review.

Intersectoral action on the social determinants of health and health equity in Canada: December 2019 federal government mandate letter review.

Policy Adoption and the Implementation Woes of the Intersectoral First 1000 Days of Childhood Initiative, In the Western Cape Province of South Africa.

Background: There is a growing interest in implementing intersectoral approaches to address social determinants especially within the Sustainable Development Goals (SDGs) era. However, there is limited research that uses policy analysis approaches to understand the barriers to adoption and implementation of intersectoral approaches. In this paper we apply a policy analysis lens in examining implementation of the first thousand days (FTD) of childhood initiative in the Western Cape province of South Africa. This initiative aims to improve child outcomes through a holistic intersectoral approach, referred to as nurturing care. Methods: The case of the FTD initiative was constructed through a triangulated analysis of document reviews (34), in depth interviews (22) and observations. The analysis drew on Hall’s ‘ideas, interests and institutions’ framework to understand the shift from political agendas to the implementation of the FTD. Results: In the Western Cape province, the FTD agenda setting process was catalysed by the increasing global evidence on the life-long impacts of brain development during the early childhood years. This created a window of opportunity for active lobbying by policy entrepreneurs and a favourable provincial context for a holistic focus on children. However, during implementation, the intersectoral goal of the FTD got lost, with limited bureaucratic support from service-delivery actors and minimal cross-sector involvement. Challenges facing the health sector, such as overburdened facilities, competing policies and the limited consideration of implementation realities (such as health providers’ capacity), were perceived by implementing actors as the key constraints to intersectoral action. As a result, FTD actors, whose decision-making power largely resided in health services, reformulated FTD as a traditional maternal-child health mandate. Ambiguity and contestation between key actors regarding FTD interventions contributed to this narrowing of focus. Conclusion: This study highlights conditions that should be considered for the effective implementation of intersectoral action - including engaging cross-sector players in agenda setting processes and creating spaces that allow the consideration of actors’ interests especially those at service-delivery level. Networks that prioritise relationship building and trust can be valuable in allowing the emergence of common goals that further embrace collective interests.

Drivers and health implications of the dietary transition among Inuit in the Canadian Arctic: a scoping review.

The current study undertook a systematic scoping review on the drivers and implications of dietary changes among Inuit in the Canadian Arctic. A keyword search of peer-reviewed articles was performed using PubMed, Web of Science, CINAHL, Academic Search Premier, Circumpolar Health Bibliographic Database and High North Research Documents. Eligibility criteria included all full-text articles of any design reporting on research on food consumption, nutrient intake, dietary adequacy, dietary change, food security, nutrition-related chronic diseases or traditional food harvesting and consumption among Inuit populations residing in Canada. Articles reporting on in vivo and in vitro experiments or on health impacts of environmental contaminants were excluded. A total of 162 studies were included. Studies indicated declining country food (CF) consumption in favour of market food (MF). Drivers of this transition include colonial processes, poverty and socio-economic factors, changing food preferences and knowledge, and climate change. Health implications of the dietary transition are complex. Micro-nutrient deficiencies and dietary inadequacy are serious concerns and likely exacerbated by increased consumption of non-nutrient dense MF. Food insecurity, overweight, obesity and related cardiometabolic health outcomes are growing public health concerns. Meanwhile, declining CF consumption is entangled with shifting culture and traditional knowledge, with potential implications for psychological, spiritual, social and cultural health and well-being. By exploring and synthesising published literature, this review provides insight into the complex factors influencing Inuit diet and health. Findings may be informative for future research, decision-making and intersectoral actions around risk assessment, food policy and innovative community programmes.

Are Norwegian Municipality policies enabling intersectoral collaboration in migration health?

Abstract Issue Sporadic accounts of initiatives, interventions and good practices in Migrant Health at the Municipality level account for Norways' lower score on “Measures to achieve change” in the Migrant Integration Policy Index (MIPEX). While the structure and organization at the municipality level should enable intersectoral action (as all under one umbrella), the municipal counties say lack of intersectoral collaboration is one of the main barriers for long-term public health work. Description of the Problem 51 municipalities have an immigrant population larger than the national average 17,8% (2019). In a recent Country Assessment (part of Joint Action on Health Equity Europe), limited inter-sectoral action on the social determinants of health including migration was observed. Although multiple agencies are engaged in attempts to address these issues. While there is a drive to promote public health and primary health care in municipalities, these initiatives do not pay special attention to migrants. In the first stage of this project, we have reviewed municipal policy documents to map policy and measures on public health, migrant health and intersectoral collaboration. In the second stage, municipalities will be contacted to engage them in the implementation of intersectoral actions. Results The desk review and mapping show that only 8 of the “top” 32 municipalities mention “intersectoral” in the municipal master plan (5 were not available online), its mentioned in 9 action program/budgets, but not necessarily by the same municipalities. 15 of the municipalities mention migrants, but rarely in relation to health. We observe that, the size of the municipality, financial resources and support from the County are factors that may play a significant role in prioritising migrant health and intersectoral collaboration. Lessons Advocating for and supporting the local/municipal level for intersectoral action is highly relevant, timely and essential. Key messages Intersectoral action on the social determinants of migrants’ health needs to be implemented through municipal policies to reduce inequities in migrants’ health. Implementation on the local level is the main arena for good public health work and is crucial to ensure good health for migrants.

Intersectoral actions for mental health care in areas of high vulnerability in São Paulo/ Brazil

Abstract Background The objective of this research was to analyze the results achieved after intersectoral actions carried out by primary health care teams working in areas of high socio-environmental vulnerability in the city of São Paulo / Brazil. The establishment of intersectoral partnerships to tackle social inequalities and inequalities can be a reality in vulnerable health territories and a way to give sustainability to expanded health care (De Andrade et al, 2015). Methods Primary data were obtained from August to October 2018 in four focus groups formed by a total of 24 health professionals, selected after quantitative analysis. The data were transcribed in full and the qualitative analysis was according to Van Den Hoonaard (2018): a) open coding of the transcriptions; b) identification of recurrent themes and respective subthemes and c) connection of themes and concepts interpreted in the light of social processes. The research was approved by the Research Ethics Committee of the Centro Universitário Saúde ABC. Results The themes found were: a) Search for partnerships for mental health assistance: in a personalized way, the teams entered into partnerships with the sectors of education, social assistance, leisure and justice for assistance; b) Effectiveness of treatment by intersectoral basis: the teams helped to insert people into public policy actions, they realized the reduction in the need to use psychotropics and specialized services in mental health. Conclusions Intersectoral collaboration was established and maintained to resume mental health care for people with psychological distress who were waiting in line for specialized treatment. Key messages Primary health care teams when looking for partners to assist patients in mental health have an expanded look at the citizen who should be embraced by public policies. There is a need to add community-based care for people with mental suffering to care based on intersectoral actions in health territories.

Integrating sustainability in professionals’ training in the field of health promotion and prevention

Abstract Background Climate change poses a number of threats and challenges to our societies and has direct impacts on human health. Raising awareness and training health professionals to sustainable development represents a major strategy in order to respond to climate challenges. This article describes a teaching experience conducted in the context of a Certificate of Advanced Studies (CAS) in public health at the University of Lausanne, where students have been trained to sustainable development, through theoretical lessons and practical exercises. Objectives The integration of the topic of sustainable development in the teaching of health promotion and prevention to the students of the CAS in public health aimed to foster students' knowledge and competences in relation to this emerging topic. The main objective was to transmit concepts, methods and practical resources allowing them to incorporate sustainability into everyday health promotion and prevention practices. Results Health promotion and sustainable development share common goals and methodologies. The experience of teaching sustainability to public health students shows that these two topics can be easily integrated within a public health training, if teachers provide students with a clear theoretical and methodological framework, allowing them to make the appropriate connections between the two fields. Social determinants of health, intersectorial action and multilevel governance represent key topics that teachers can address with students in order to show the connections between public health and sustainability. Conclusions As stated in the 2019 Lancet Countdown on health and climate change, climate change is both a threat and an opportunity for our societies. While it puts health systems and professionals under considerable pressure, it also represents an opportunity to innovate and transform professional training and practices, and generate new knowledge and know-how. Key messages Training health professionals to sustainable development represents a major strategy to respond to climate change and its health impacts. In order to integrate sustainable development in public health training, teachers should provide students with a clear theoretical and methodological framework.

Temporal trend in adolescent mortality from aggression in Brazil, 2000 to 2017

Abstract Background Mortality from aggression in adolescents reflects one of the symptoms of the Brazilian social situation, which makes this population group vulnerable, exposing them to situations that determine their death in an early and violent way. This work contributes to the analysis of the temporal trend of adolescent mortality due to aggression throughout Brazil from 2000 to 2017. Methods A ecological design time series was carried out on the mortality rate of adolescents due to aggression in Brazil, from 2000 to 2017. Data from the Mortality Information System (SIM) of the Ministry of Health of Brazil was used. Mortality rates were analyzed according to sex and age groups (10-14 and 15-19 years). The joinpoint regression method was used to calculate the annual trend in mortality rates. Results The mortality rate among female adolescents aged 10 to 14 years decreased from 1.81 to 1.74 deaths/100 thousand inhab., and in the group aged 15 to 19, increased from 6.64 to 7.87 deaths/100.000 inhab., from 2000 to 2017. The Average Annual Percentage Change (AAPC) of the rates showed a steady trend of mortality in the groups from 10 to 14 years (AAPC = -0.4; 95% CI -1.4-0.7) and 15 to 19 years (AAPC = 0.7; 95% CI -2.3-3.9). In males, the rate for the 10 to 14-year-old group increased from 4.56 to 6.64 deaths/100.000 inhab., and in the 15 to 19 year old group, increased from 73.06 to 122.78 deaths/100.000 inhab., from 2000 to 2017. The AAPC showed an upward trend in the groups between 10 and 14 years old (AAPC = 2.3; 95% CI % 0.2-4.4) and 15 to 19 years (AAPC = 2.8; 95% CI 2.1-3.5). In the 15 to 19-year-old group, the upward trend of the period between 2009 and 2017 stood out [Annual Percentage Change (APC) = 5.1; 95% CI 4.0-6.3)]. Conclusions This analysis can contribute with subsidies for the improvement of public policies and intersectoral actions that act on the vulnerabilities to which adolescents are exposed and that reduce the mortality rates due to aggressions. Key messages Mortality from aggression in adolescents aged 15-19 showed, in the female sex, an increase from 6.64 to 7.87 deaths/100.000 inhab., and in males, an increase from 73.06 to 122.78 deaths/100.000 inhab. The upward trend in the mortality rate in male adolescents aged 15 to 19 was highlighted in the period from 2009 to 2017 [Annual Percentage Variation (APC) = 5.1; 95% CI 4.0–6.3).

A Comparative Analysis of Health Impact Assessment Implementation Models in the Regions of Montérégie (Québec, Canada) and Nouvelle-Aquitaine (France).

Many countries have introduced health impact assessment (HIA) at the national, regional, or local levels. In France and in Québec, there is increasing interest in using HIA to inform decision-makers and influence policies, programs, and projects. This paper aims to compare HIA implementation models in two regions: Nouvelle-Aquitaine (France) and Montérégie (Québec, Canada) using a case study methodology. The objective is to gain a better understanding of the similarities and differences in the approaches used to achieve the operationalization of HIA. The methodological approach involves four steps: (1) design of an analytical framework based on the literature; (2) exchanges within the research team and review of documents concerning the two implementation strategies under study; (3) development of the case studies based on the proposed framework; and (4) cross-comparison analysis of the case studies. The findings show that the two regions share certain similarities, including the strong commitment and political will of the public health organizations involved and a well-established culture of engaging in intersectoral action with municipal partners. Differences mainly concern their different approaches to implementing HIAs in accordance with the regional policies and the organizational and administrative contexts in place. This study identifies potential avenues for supporting the practice of HIA at the municipal level.

Advances in an integrated evaluation of Community health in Medellín (Colombia) during 2014-2019

Abstract Background In accordance with the “Health in All Policies” approach, since 2014 the city of Medellín (Colombia) has implemented a community-based urban health model based on knowledge and action to strengthen community participation, social cohesion, and health equity. Methods A mix method design was carried out to effectively monitor planning actions, as well as specific socio-environmental interventions in two thirds of the communes of Medellín. A standardized operating procedure was built up: toolkit for diagnostic validation were developed; priorities and health needs identified; assets of social, community, institutional and social capital of the intervened communes analyzed and mapped; community capacities and social leadership in health strengthened; governance and intersectoral communication for change and social mobilization increased. Results 45.07 (SD 19.77) was a measurement baseline of Community Social Capital in Health. The interrelation between community health assets was especially relevant in some communes. For example: In the Commune 1 Popular, women's leadership allowed the implementation of relevant salutogenic actions. The intersectoral actions of the Commune 15 Guayabal for child care were evaluated as a case of territorial governance. In the Commune 12 La América, social mobilization actions were evaluated as a case for social communication. By other side, the learning process of a community training program in social participation in health has generated relevant evidence to continue jointly reinforcing citizen empowerment in health decision-making. Conclusions There was a large overlap between the community health interests and the technical decisions for health planning designed by the city health authority, in that sense, assessing social participation in health as a process involves not only planning common actions but also designing and applying participatory knowledge with the community. Key messages Social interactions for social health transformations requires longitudinal process of observation. Implementation evaluation is useful 'just on time' for decision making process.

Impact assessment of the public health product tax in Hungary

Abstract Many countries apply fiscal policies to promote healthy diets to reduce the risk factors of NCDs. In 2011, a public health product tax (PHPT) was introduced in Hungary, taxing non-staple food products that carry proven health risks when consumed. The objectives of PHPT were to promote healthier eating habits by increasing the availability of healthy choices; to encourage reformulation; and to increase revenues for public health. With the purpose of evaluating the social and economic effects of PHPT, impact assessments (IAs) were conducted in 2012, 2014, and in 2018. The IA in 2018 was conducted within the framework of an EU-cofunded development project. To measure the awareness of the population on the law; to assess the population's attitude towards PHPT; to map the consumption patterns and to examine the major factors influencing food choices were fundamental parts of the IAs. We aim to present the findings of the latest IA and compare them to the results of the previous studies. Population surveys with questionnaires including the same questions were applied in the three assessments, hence changes during the 6 years could be detected. A sample of the adult population was involved in form of personal interviews in each IA. Based on the results, the awareness of PHPT was less (66%) in 2018 than in 2012 (72%). The adult population's consumption of the taxed products increased in all categories between 2012 and 2018 (except for salty condiments). Sociodemographic factors and awareness of the law correlated with the consumption of certain PHPT products. Taste was the primary determinant of food choice both in 2012 and 2018. The role of the price and the energy content in food choices were decreased significantly by 2018. A higher proportion of people identified the aims of PHPT correctly and agreed with them in 2018. The results draw attention to the importance of further interventions and the need of targeted health communication. Key messages The impact of the PHPT should continue to be monitored and evaluated. To achieve the aims of PHPT in the long term, it is needed to use more effective health communication, furthermore harmonized intersectoral actions should be also implied to promote healthy diet.

13.B. Round table: Beyond Health in All Policies: How the health sector contributes to the attainment of non-health SDGs

Abstract The Sustainable Development Goals (SDG), adopted by the entire UN System, the European Commission and many countries provide an unprecedented platform for intersectoral action on the social and commercial determinants of health. The 17 sectoral goals come with numerous specific targets that lend themselves to propose suitable action for goal achievement. Working with other sectors, however, has often proven cumbersome, marred by indifference, skepticism, missing political mandates or sheer resistance. All too often, health sector battle cries for healthy public policies or Health in All Policies have been badly received, treated as impositions or as irrelevant to the policy goals of other sectors. An alternative strategy, as proposed in this workshop, is to focus on the so-called co-benefits. Co-benefits are substantial specific benefits to the other sectors that can be gained by investing in health-related actions. In other words, 'don't ask what other sectors can do for health, ask what health can do for other sectors and their achievement of policy goals '. For many of the SDGs complex chains of causality for the co-benefits are well established. For example, health literacy interventions have, via a complex causal chain, proven positive effects on educational attainment, academic performance and labour market participation. Adopting health literacy interventions in educational settings would therefore produce substantial and specific benefits contributing to the achievement of 'SDG4 quality education'. To give policymakers the analysis that they require for intersectoral decision making we would need to estimate the magnitude of these effects. Co-benefits that produce only negligible effects can be left aside. We would also need to understand the return on investment. Small or negative return on investment would not be desirable. Making the case for co-benefits, however is not enough. We would also need to focus on the governance structures for intersectoral dialogue and decision making. They need to facilitate greater degrees of collaboration and cooperation while at the same time fostering accountability. This includes: cabinet committees; parliamentary committees; inter-departmental units and committees; mergers and mega-ministries; joint budgeting; delegated financing; involvement of civil society, stakeholders and industry. Governance instruments for intersectoral implementation can include, just to name a few from a potentially very long list, e.g. Standards of good practice, conflict of interest policies, competitive bidding, contracts. This workshop is based on the preliminary results from a comprehensive study. The panelists will address five key issues Co-benefits and SDGs: scope for joint action (Schmitt)Co-benefits and SDG5 Gender Equality (Falkenbach)Co-benefits and SDG13 Climate Action (Valentine)Co-benefits and SDG11 Sustainable Cities and Communities (Mehdipanah)Co-benefits and SDG17 Partnerships: Aid and trade (Jarman) Key messages The health sector can and should be a vital contributor to achieving all the SDGs. Focusing on co-benefits and shared goals allows us to overcome the limitations of Health in All Policies. Panelists: Tugce Schmitt EUPHA, Utrecht, Netherlands Contact: info@schmitt-t.com Michelle Falkenbach University of Michigan, Ann Arbor, USA Contact: michfalk@umich.edu Nicole Valentine WHO, Geneva, Switzerland Contact: valentinen@who.int Roshanak Mehdipanah University of Michigan, Ann Arbor, USA Contact: rmehdipa@umich.edu Holly Jarman University of Michigan, Ann Arbor, USA Contact: hjarman@umich.edu

Intersectoral collaboration to promote child development: mapping the relationships

Abstract Integrated and intersectoral interventions early in life have the greatest potential to address social inequities, ensuring better opportunities for access to child development support services. The “Projeto Nascente” (Universidade Federal de Minas Gerais and Ministry of Health, Brazil) sought to qualify health and other sectors professionals in actions to promote and monitor early child development, in primary health care. One of its focuses was to stimulate the intersectoral actions to promote child development. The research analyzed the intersectoral network in 31 municipalities in the State of Minas Gerais, Brazil, participating in the 'Projeto Nascente'. A case study with a qualitative approach was developed using document research on the professionals' perception regarding intersectoral networking. The material was ecomaps elaborated by professionals during the training of the “Projeto Nascente”. The ecomaps represented the local intersectoral networks. Initially, 29 ecomaps from eleven municipalities were analyzed. Social Protection, Education, Sports, Culture, churches and non-governmental organizations were cited. Other health services were also included. All ecomaps were represented with the family health team in a central position with the other services around them. In municipalities with more than one ecomap, there was no uniformity neither in the services nor in the quality of the relationships represented. A closer relationship between Education and Social Protection was noticed. However, the quality of the relationships often seemed stressful. Health professionals reported that they invest more energy in relationships than other sectors. Sport and Culture, although less mentioned, seem to be potential partners for new collaborations. The emergence of other health services seems to reflect the fragmentation of the health sector, as well as evidence of the conceptual confusion surrounding intersectoral collaboration. Key messages The identification and mapping of the services networking aimed at promoting child development are essential steps in the process of stimulating and reflecting on intersectoral collaboration. The centrality and self-perceived protagonism of the health professionals may not be the best way to involve and count on the participation of other sectors in intersectoral collaboration.