The Need for Cross-Sector Collaboration in Addressing Social Determinants of Health

Illustrated by Eugenia Yoh

No single, individual, organization, or sector can change the course of America’s health.” (Robert Wood Johnson Foundation)

The field of public health works to protect and improve the health of people and their communities and can provide the knowledge needed to support the forces and systems that shape the conditions of daily life, most commonly known as social determinants of health (SDH). However, public health cannot address SDH alone. Therefore, a combination of partnerships whether as individuals, institutions or communities to cultivate creative solutions to protect and promote health is required. These types of relationships allow people to understand how their work affects the health and well-being of people.

In a 2018 study exploring the experiences of nurses who fostered cross-sector collaborations aimed at promoting health, successful collaborations included community and institutional involvement (1). The Robert Wood Johnson Foundation (RWJF) commission stated, “creating healthy communities will require a broad range of players—urban planning, education, housing, transportation, public health, health care, nutrition and others—to work together routinely and understand each other’s goals and skills.” Therefore, health promotion by addressing SDH on different levels of community development is necessary. In an effort to improve community health, unions between community development and health sectors have increased (3). Factors promoting cross-sector collaboration include the popularity and quality of successful partnerships, sustained investment in teamwork and policies that support joint efforts such as health in all policies, which take health into consideration in the development of policies across sectors (4).

In a 2013 study, Executive Director of Wilder Research Paul Mattessich and Senior Advisor for RWJF Interdisciplinary Research Leaders Program Ela Rausch assessed the status of collaborations between health and community development sectors. The researchers examined these partnerships through an email survey sent to 2,600 members of 12 networks known to have an interest in improving health such as the Federal Reserve Bank, Association for Community Health Improvement, NeighborWorks America and more. These 12 networks addressed issues including housing, transit, healthy food, opportunities for physical activity, early childcare and healthcare. Their collaborative initiative included direct service, promotion of policy change, infrastructure development as well as education and awareness. Of the 661 survey respondents, 297 reported that their cross-sector initiatives had been successful (3)

In the study, community development financial institutions played an integral role in the success of collaborative initiatives addressing SDH through their financing. About 81 percent of individuals involved in the partnerships stated that inadequate funding and resources served as a prominent barrier to their success. Through investigating the partnerships, researchers Mattessich and Rausch discovered that financial institutions were able to assist in financing healthcare clinics, dental clinics, pharmacies, corner groceries, farmer markets, community gardens, child care centers and affordable and healthy housing (3)

For example, in the study, a joint effort sparked investment in a low-income community that had not experienced major development in over 30 years in Coatesville, PA. This project involved  coordinated efforts of a health foundation, community health center, non-profit, community economic development department, state housing finance agency and federal home loan bank. The alliance resulted in a health and housing center that provided health and human services like dental, medical and mental health services for families and local school districts, affordable housing for seniors, a community meeting space and children’s library (3)

The importance of cross-sector collaboration motivated the formation of The National Alliance to Impact the Social Determinants of Health (NASDOH), which seeks to improve health through multi-sector partnerships. An example of their contribution towards fulfilling their mission can be seen in their involvement with the Healthy Homes Des Moines (HHDSM) initiative through the BUILD Health Challenge in 2018. The initiative consisted of a joint effort of 15 partners from community organizations, hospitals, school districts, the local health department and a housing trust fund. These entities worked on reducing pediatric asthma-related hospital visits through improving social, economic and environmental factors that impacted asthma. Their approach involved improving housing, health education, indoor air quality and the promotion of self-care and lifestyle changes and achieved 6.2 asthma free days per month for children of 62 families in Des Moines, IA (5)

In May, I had the opportunity to interview Dr. Diana C. Parra Perez about health inequities in St. Louis for a book I wrote titled, St. Louis Perspectives: Interviews on Inequity. Dr. Parra Perez’s research focuses on developing evidence-based recommendations for physical activity, nutrition and mindfulness-based programs at the community level and the impact of these interventions on the health and well-being of immigrant populations in the United States. During the interview she affirmed that “health comes from all places and from all sites.” Therefore, “when we have teams made up of people that are coming from all different areas, our results are going to be much better and much more effective. So, finding some sort of intersection of some of those initiatives and programs that are taking place will work better if we have support from all fronts in an intersectoral perspective” (6)

Dr. Parra Perez provided an example she witnessed in her hometown Bogota, Colombia. She spoke of a community-wide policy lobbied for by a coalition of citizens where every Sunday and during holidays the streets are closed for all automotive vehicles. This initiative is not linked to the healthcare system, but it was health promotive by increasing physical activity and improving air quality. Dr. Parra Perez mentioned how initiatives like this are able to benefit the physical, emotional and social health of people (6)

Health is a product of multiple determinants. Upstream SDH, which consists of non-medical influences on health and health systems, such as food access and nutrition, transportation, housing, incarceration, employment, safety, education and other conditions represent opportunities for improving health and reducing health disparities. Addressing SDH is fundamental in achieving health equity. With this in mind, health policy makers and other stakeholders should be actively working on ways to build relationships across sectors in order to achieve healthy communities. There is no one-size-fits-all model to address healthcare issues. It calls for an all-hands-on-deck approach to allow experts to diversify the perspectives assigned to meet the complexity of challenges these health-related issues produce (7)

Edited by: Anhthi Luong
Illustrated by: Eugenia Yoh

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