Intersectoral collaboration

Factors impacting health

It has long been clear that confronting society's health challenges cannot be done by the health sector alone, as health is mainly determined by factors outside the health sector. Similarly the structure and functioning of health care systems is largely a result of decisions made at political levels and in various other sectors beyond that of health.

Fragmented responsibilities

Responsibilities for health outcomes have largely remained at local level while crucial decision-making on the determinants that influence health have been taken at EU or global level. Action must take place at local level, but where policies are defined at the regional, national and international level, action on HiAP needs to reach to these levels of decision-making. This is important in particular with respect to policies that may limit or restrict policy space for measures that could be taken, for example, for the control of the consumption of hazardous substances, changing dietary patterns, and to influence social determinants of health. 

Intersectoral collaboration has been among the weakest of strategic inputs that impede the success of primary health care. While new evidence on the feasibility and success of collaboration has been encouraging, collaborative strategies need to take account of the particular needs and circumstances of individual countries as well as the context and nature of policies that are of importance. 

Local level participation and focus bears little relevance to decisions if actual decisions concerning policies are made at a higher level, but can be very important where there is more policy space for co-operation or joint implementation in practice. It is thus important to understand what policies are in question and at which level of governance decisions on these are made.

Reaching out to other sectors

The health sector needs to be prepared to take a lead in intersectoral collaboration, with lessons and experience built up incrementally through pilot projects. When political mandate has already been achieved, the actual work of reaching out to and working with other sectors can begin in earnest.

Administrative co-operation

Intersectoral collaboration contributes to the health in all policies approach in the context of a focus on administrative co-operation. The aim of intersectoral collaboration is to identify those policy inputs that effect health and to decide what actions can be taken or avoided by those that have to implement the policy framework under negotiation so as to protect, maintain or improve the health of citizens. The task of health in all policies is to enable and support this as part of political decision-making, accountabilities and practice.