Intersectoral action for health equity
associations to particular diseases, many authors have critiqued
the population health movement in not adequately accounting for
power relations in society [11] and the long-standing relationship
of the current neoliberal political economy to the production of
ill health and health disparities [12–15]. Indeed, in the face of
systemic health inequity, community health workers are often
limited in their ability to tackle the root causes of health inequalities.
This has required practitioners to seek the aid of other
sectors through collaboration.
Collaboration is understood as being a central component of
ISA in the face of complex or ‘wicked’ problems. ISA is useful
because it promotes a nuanced understanding of a given problem
from multiple angles [16]. ISA on health issues refers to:
A recognised 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 [17].
In achieving greater efficiency in promoting health and wellness,
ISA offers numerous strengths. Coordinated efforts between
sectors can be dynamic and often encourage a more efficient use of
resources that may result in more effective approaches to building
health equity [2]. Further, collaboration improves health services
response to the health needs of diverse populations, improves
communication and information sharing, develops new skills
and knowledge, expands our understanding of human health and
commits to planning cooperatively with shared authority and
power [18,19]. However, capitalizing on these strengths is easier
said than done.
A PHAC and WHO review of several different approaches to
ISA [3] reveals additional findings from the front lines. First,
making a strong case for ISA is integral. Through the use of
political champions and advocacy campaigns, a compelling storyline
is required to demonstrate the scale, scope and complexity
of a particular health issue. This requires developing a common
goal through consensus building and the engagement of all relevant
stakeholders. Secondly, trusting relationships between collaborating
actors/sectors must be forged. Trust may be pre-existing
between collaborative partners or developed in formal agreements
which exemplify a shared responsibility for the goals of a particular
project and any risks involved [20]. Thirdly, evaluating ISA and
the collaboration therein is useful in benchmarking what works
well and what is challenging in conducting particular types of
work [19,20]. Finally, collaboration is context dependent. New
strategies for engaging stakeholders may be required in a given
context to most effectively address the nature of a given problem
and its implications for health equity.
When problems of large scope and scale have profound implications
for human health, consulting diverse perspectives is likely
to bring about an emergent and representative understanding of the
problem. Recognizing that individuals are embedded and interact
within numerous political, social, economic and environmental
contexts helps us understand the complexity of human health.
However, contributions from various sectors or stakeholders may
be insufficient in and of themselves if power inequalities exist
between collaborating actors and a single perspective is allowed to
dominate research and policy dialogues. These power differences
between actors and sectors pose challenges to ISA. In the next
section, I outline how CSH can further an understanding of the
benefits of ISA approaches for health equity by making explicit the
power relations that undergird collaboration.