Health Equity Through Intersectoral Action

"This case study synthesis is a product of a larger collaborative undertaking of the World Health Organization (WHO) and the Public Health Agency of Canada (PHAC) and was contracted and funded by PHAC"--Page i.

Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Social justice has always been a core value driving public health. Today, much of the etiology of avoidable disease is rooted in inequitable social conditions brought on by disparities in wealth and power and reproduced through ongoing forms of oppression, exploitation, and marginalization. Tackling Health Inequities raises questions and provides a starting point for health practitioners ready to reorient public health practice to address the fundamental causes of health inequities. This reorientation involves restructuring the organization, culture and daily work of public health. Tackling Health Inequities is meant to inspire readers to imagine or envision public health practice and their role in ways that question contemporary thinking and assumptions, as emerging trends, social conditions, and policies generate increasing inequities in health.

This document provides practical advice for implementing multisectoral collaboration for healthy public policies. Health in All Policies (HiAP) approaches have typically played an important role in advocating for, and fostering action on, the social determinants of health (SDH) to advance health equity. This document summarizes key related WHO literature with a focus on providing an overview of core HiAP concepts and concrete advice on fostering collaborative relationships between different parts of government for healthy public policies. It provides practical examples on four topics (“the four pillars of HiAP”): 1) Governance and accountability; 2) Leadership at all levels; 3) Ways of working; and 4) Resources, financing and capabilities. The content is targeted to public health professionals who are advocating for policy action on SDH or who are dealing with specific policy initiatives requiring cross-government collaboration.