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Intersectoral Collaboration on Intersectoral Collaboration on Non-Medical Determinants of Health:Non-Medical Determinants of Health:The Role of Health Regions in CanadaThe Role of Health Regions in Canada
Dr. James FrankishInstitute of Health Promotion Research, College for Interdisciplinary Studies, UBC
Every sin is the result of collaboration" (SEvery sin is the result of collaboration" (S. C. Crane rane 1871)1871)
Research Team
J. Frankish, Institute of Health Promotion Research, UBC G. Moulton, Institute of Health Promotion Research UBC D. Quantz, Vancouver Coastal Health A. Carson, Centre on Aging, University of Victoria A. Casebeer, Community Health Sciences, U of Calgary J. Eyles, Geography & Earth Sciences, McMaster University R. Labonte, Community Medicine, U of Ottawa B. Evoy, Vancouver Coastal Health J. Gerbrandt, Institute of Health Promotion Research, UBC Cathy Pryce, Calgary Health Authority Susan Tirone, Dalhousie University
Current & Recent Projects
Training Program in Community Partnership Research
Homelessness & Poverty-Related Research
Health Literacy, & Literacy & Health Research
Health-System Reform & Marginalized Groups
Measuring the Health of Communities
Non-Medical Determinants of Health
Income & Social Status Social Support Networks Education Employment & Working
Conditions Social Environments Physical Environment Personal Health Practices Healthy Child Development Culture Gender
(From Health Canada – Excludes Health Services & Biology /Genetics)
Rationale - A Continuum of Absurdities
Health Regions are ToHealth Regions are Totally tally ResponsibleResponsible for Non-Medical for Non-Medical Determinants of HealthDeterminants of Health
There is There is NoNo Role for Health Role for Health Regions in Non-Medical Regions in Non-Medical Determinants of HealthDeterminants of Health
What is the What is the Preferred FuturePreferred Future ffor or for Health Regions in Addressing for Health Regions in Addressing Non-Medical Determinants of HealthNon-Medical Determinants of Health
Research Questions
How are health regions working with key potential collaborators (i.e., NGOs, private sector, non-health ministries) to address the non-medical determinants of health?
What is the status of initiatives undertaken by health regions to
address the non-medical determinants of health in partnership with other sectors of government and/or society?
How do individual-specific, organizational & structural factors
limit or facilitate intersectoral collaboration by health regions on the non-medical determinants of health?
Project Overview Stratification Survey Instrument
Key Informant Interviews
Representatives of Regional HealthAuthoritiesRepresentatives of Partners
Document Review 107 surveys sent to ten provinces Response rate of 65%.
Response rates varied by province lowest - 36.7% (Que)& highest 100% (Alberta).
Current “Health-Sector” Action on Current “Health-Sector” Action on Health Canada’s Health Canada’s Non-MedicalNon-Medical Determinants Determinants
Determinant of Health Programs/Core Funding
No Action
Healthy Child Development 54% 12%
Personal Health Practices 48% 09%
Physical Environment 33% 16%
Social Support 31% 18%
Education 24% 26%
Social Environments 21% 27%
Culture 21% 27%
Employment/Work Conditions 18% 26%
Gender 18% 32%
Income & Social Status 17% 32%
Intersectoral Collaboration
“A recognized 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 … in a way that is more effective, efficient or sustainable than could be achieved by the health sector acting alone.”
WHO International Conference on Intersectoral Action for Health, 1997
Intersectoral Collaboration
Ministry of Health
Non-Health Ministries
Non-Government Organizations within the Health Sector
Private Sector – Health
Non-Government Organizations outside the Health Sector
Private Sector Organizations outside the Health Sector
Intersectoral Collaboration
Level DefinitionCurrently no involvement at all between our health organization &
otheragencies/groups for this determinant
Some (informal) contact between our health organization & otheragencies/groups for this determinant
A formal structure for collaboration has been developed between our
health organization & other agencies/groups for this determinant
Our health organization & other agencies/groups are developing or have
completed a plan of action for this determinant
Our health organization & other agencies/groups are developing orhave implemented programs to address this determinant
Intersectoral Collaboration
Both child development and personal health practices were receiving most attention from health regions.
Sixty-eight percent of regions reported a high-level of intersectoral activities (i.e., action plan or programs established) around child development, while only 3% reported no intersectoral activities for child development.
No intersectoral activities were reported by a larger number of regions around gender (38%), culture (27%), and employment/working conditions (26%).
Roles for Health Authorities
Collaborator/partner
Facilitator
Communicator/educator
Advocate
Initiator/leader
* the categorization of roles is not mutually exclusive
Factors Influencing Implementation of NMDH
Individual Factors
Organizational Factors
Systems/Environmental Factors
Fundamental Nature of the NMDH (Horizontal complexity: NMDH works across sectors (e.g., social, economic); Vertical complexity: NMDH aims for change at individual, community, organizational, and systems levels)
Summary of Challenges
Defining ‘Nonmedical’ Determinants of Health (NMDH) Values Underlying NMDH Complexity of Models of NMDH
Time Frames for Addressing NMDH Responsibility for Addressing NMDH
Impact Assessment of Addressing NMDHStructural Constraints around NMDH
Accountability for Addressing NMDH
Relations Between Health Sector & NMDHResources to Strengthen Action on NMDH
Sustainability of NMDH Initiatives
Next Steps ??? Facilitators & Barriers
Individual / Community Facilitators, Interpersonal Facilitators, Organizational Facilitators, Structural Facilitators
Individual / Community Barriers, Interpersonal Barriers, Organizational Barriers, Structural Barriers
In-Depth Case Studies
Study of Implementation of Vancouver’s Population Health Strategy
Possible Case Studies of Food Security, Housing, Early Child Development
Contact InformationContact Information Dr. Jim Frankish
Institute of Health Promotion Research
604-822-9205, 822-9210 [email protected]
jimfrankish.com
www.pchr.net
References Frankish J. Moulton G. Quantz D. Carson A. Casebeer A.
Eyles J. Labonte R. Evoy B. 2007. Addressing the non-medical determinants of health: a survey of Canada's health regions. Canadian Journal of Public Health. 98(1):41-7.
G. Moulton et al. 2007, Addressing the Non-Medical Determinants of Health: A Canadian Perspective of Regional Health Authorities & Partners - Part I: Setting Priorities - Developing Strategies – Adopting Roles.
G. Moulton et al. 2007, Addressing the Non-Medical Determinants of Health: A Canadian Perspective of Regional Health Authorities & Partners – Part II: Critical Factors Influencing RHA Actions targeting NMDH.
