So, why should we work together?
1. Because health is a product of healthy communities, and we cannot build those alone.
The recent (2009) release of the Senate Subcommittee on Population Health's final Report, A Healthy, Productive Canada: A Determinant of Health Approach (Note 1)
is part of a population health movement that spans decades. The report notes that health disparities have not been reduced and that we risk seeing them become greater.
||Senator Pépin, the subcommittee's Deputy Chair, said that, “Even if well integrated, health care services alone, do not make a community healthy. [Governments at all levels] should support an overall, community-based approach to health and human development and assist with the integration of health and social services, wherever possible, and where it makes sense for the users”. (Note 2)|
The subcommittee report says that in order to address these issues “a whole of government approach is required with intersectoral action embracing business, volunteers and community organizations. This will not be easy, but it can and must be done. We cannot afford to do otherwise.” (Note 3)
The Subcommittee's work supports what many have been publicly and privately maintaining for years: that health is affected not only by the health care system but is strongly subject to social factors; that Canada's population continues to experience wide disparities in health due to factors that affect different population groups to differing degrees; and that the public responses necessary to address these factors are across sectors and will therefore call for multisectoral responses.
2. Because the social factors affecting health are everyone's responsibility, and everyone has a role to play.
Predating the Subcommittee's Report by over 20 years, The World Health Organization's Ottawa Charter for Health Promotion of 1986 set out the groundwork for healthy public policy and identified intersectoral action as a key to this. The Charter refers to “coordinated approaches”, “complementary action”, and “puts health on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health.” (Note 4)
Nor is health promotion just the domain of the health sector, or governments. The Ottawa Charter also claims that, “[the] prerequisites and prospects for health cannot be ensured by the health sector alone. More importantly, health promotion demands coordinated action by all concerned: by governments, by health and other social and economic sectors, by nongovernmental and voluntary organization[s], by local authorities, by industry and by the media.” (Note 5)
Between these two essential factors, a collective inability to do it all ourselves, and a collective responsibility to promote health, we have a recipe for an intersectoral imperative.
If we wish to advance knowledge and capacity in the area of healthy public policy we must collectively improve our capacities for working intersectorally. At the National Collaborating Centre for Healthy Public Policy, we have taken the Intersectoral Imperative to heart in all of our work.
Projects to date include:
• Working with not-for-profit organizations to examine their policy influencing practices
• Examining two Canadian integrated governance initiatives to look for lessons about how governments can implement horizontal management or whole of government approaches. (We have also developed a glossary of terms relating to integrated governance to help make sense of them.)
• Developing capacity and resources in deliberative processes which directly or indirectly create multisectoral discourse around an issue.
• Working intensively in the area of health impact assessment which, among other goals, creates intersectoral discussion and understanding pertinent to health effects of policies, programs or initiatives.
Besides this work at the program level, working intersectorally is part of the underlying philosophy of the Centre. Our basic positioning is at the intersection of public policy and public health, sharing knowledge and developing links between and among researchers, practitioners, policy-makers, those who work with non-governmental organizations, think tanks, community groups, and others with an interest in healthy public policy.
Learn about public policies and their effects on health
Generate and use knowledge about healthy public policies
Identify models and actors for intersectoral collaboration
Influence the development of healthy public policies
A Healthy, Productive Canada: A Determinant of Health Approach. The final report of the Senate Subcommittee on Population Health, 2009.
Senate subcommittee on population health. Health Disparities: Unacceptable for a Wealthy Country such as Canada. News release, June 4, 2009. Accessed at
http://www.parl.gc.ca/40/2/parlbus/commbus/senate/Com-e/popu-e/subsite-Jun09-e/Report_Home-e.htm, October 15, 2010.
Ibid., same page.
World Health Organization, 1986. Ottawa Charter for Health Promotion, p.2.
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