Promoting Intersectoral Collaboration Through the Evaluations of Public Health Interventions: Insights From Key Informants in 6 European Countries

Document Type: Original Article

Authors

1 Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway

2 Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway

3 Research Council of Norway, Oslo, Norway

Abstract

Background
Intersectoral collaboration is critical to the successful implementation of many public health interventions (PHIs). Little attention has been paid to whether and how processes at the stage of evaluation can promote intersectoral collaboration. The objective of this study was to examine European experiences and views on whether and how the evaluation of PHIs promote intersectoral collaboration.

 
Methods
A qualitative study design was used. We conducted semi-structured interviews with 15 individuals centrally involved in the evaluation of PHIs in 6 European countries (Austria, Denmark, England, Germany, Norway, and Switzerland). Questions pertained to current processes for evaluating PHIs in the country and current and potential strategies for promoting intersectoral collaboration. Transcripts were analyzed using thematic analysis to identify key themes responding to our primary objective.

 
Results
Experiences with promoting intersectoral collaboration through the evaluation of PHIs could be summarized in 4 themes: (1) Early involvement of non-health sectors in the evaluative process and inclusion of non-health benefits can promote intersectoral collaboration, but should be combined with greater influence of these sectors in shaping PHIs; (2) Harmonization of methodological approaches may enable comparison of results and facilitate intersectoral collaboration, but should not be an overriding goal; (3) Involvement in health impact assessments (HIAs) can promote intersectoral collaboration, but needs to be incentivized and be conducted without putting overwhelming demands on non-health sectors; (4) A designated body for evaluating PHIs may promote intersectoral collaboration, but its design needs to take account of realities of policy-making.

 
Conclusion
The full potential for promoting intersectoral collaboration through the evaluation of PHIs appears currently unrealized in the settings we studied. To further promote intersectoral collaboration, evaluators and decisionmakers may consider the full range of strategies characterized in this study. This may be most effective if the strategies are deployed so that they reinforce each other, value outcomes beyond health, and are tailored to maximize political priority for PHIs across sectors.

Highlights

Supplementary File 1 (Download)

Supplementary File 2 (Download)

Supplementary File 3 (Download)

Keywords


  1. Orton LC, Lloyd-Williams F, Taylor-Robinson DC, Moonan M, O'Flaherty M, Capewell S. Prioritising public health: a qualitative study of decision making to reduce health inequalities. BMC Public Health. 2011;11:821. doi:10.1186/1471-2458-11-821
  2. Masters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Community Health. 2017;71(8):827-834. doi:10.1136/jech-2016-208141
  3. Coe G, de Beyer J. The imperative for health promotion in universal health coverage. Glob Health Sci Pract. 2014;2(1):10-22. doi:10.9745/ghsp-d-13-00164
  4. Watson MC, Forshaw M. Prioritising prevention and health promotion. BMJ. 2016;352:i1333. doi:10.1136/bmj.i1333
  5. Fineberg HV. The paradox of disease prevention: celebrated in principle, resisted in practice. JAMA. 2013;310(1):85-90. doi:10.1001/jama.2013.7518
  6. Drummond M, Weatherly H, Ferguson B. Economic evaluation of health interventions. BMJ. 2008;337:a1204. doi:10.1136/bmj.a1204
  7. Weatherly H, Drummond M, Claxton K, et al. Methods for assessing the cost-effectiveness of public health interventions: key challenges and recommendations. Health Policy. 2009;93(2-3):85-92. doi:10.1016/j.healthpol.2009.07.012
  8. Tangcharoensathien V, Srisookwatana O, Pinprateep P, Posayanonda T, Patcharanarumol W. Multisectoral actions for health: challenges and opportunities in complex policy environments. Int J Health Policy Manag. 2017;6(7):359-363. doi:10.15171/ijhpm.2017.61
  9. Ndumbe-Eyoh S, Moffatt H. Intersectoral action for health equity: a rapid systematic review. BMC Public Health. 2013;13:1056. doi:10.1186/1471-2458-13-1056
  10. Corbin JH. Health promotion, partnership and intersectoral action. Health Promot Int. 2017;32(6):923-929. doi:10.1093/heapro/dax084
  11. Armstrong R, Doyle J, Lamb C, Waters E. Multi-sectoral health promotion and public health: the role of evidence. J Public Health (Oxf). 2006;28(2):168-172. doi:10.1093/pubmed/fdl013
  12. Lawless A, Baum F, Delany-Crowe T, et al. Developing a framework for a program theory-based approach to evaluating policy processes and outcomes: Health in All Policies in South Australia. Int J Health Policy Manag. 2018;7(6):510-521. doi:10.15171/ijhpm.2017.121
  13. Pinto AD, Molnar A, Shankardass K, O'Campo PJ, Bayoumi AM. Economic considerations and health in all policies initiatives: evidence from interviews with key informants in Sweden, Quebec and South Australia. BMC Public Health. 2015;15:171. doi:10.1186/s12889-015-1350-0
  14. Rasanathan K, Atkins V, Mwansambo C, Soucat A, Bennett S. Governing multisectoral action for health in low-income and middle-income countries: an agenda for the way forward. BMJ Glob Health. 2018;3(Suppl 4):e000890. doi:10.1136/bmjgh-2018-000890
  15. Owusu-Addo E, Edusah SE, Sarfo-Mensah P. The utility of stakeholder involvement in the evaluation of community-based health promotion programmes. Int J Health Promot Educ. 2015;53(6):291-302. doi:10.1080/14635240.2015.1030033
  16. Gilliam A, Davis D, Barrington T, Lacson R, Uhl G, Phoenix U. The value of engaging stakeholders in planning and implementing evaluations. AIDS Educ Prev. 2002;14(3 Suppl A):5-17. doi:10.1521/aeap.14.4.5.23878
  17. Leviton LC, Melichar L. Balancing stakeholder needs in the evaluation of healthcare quality improvement. BMJ Qual Saf. 2016;25(10):803-807. doi:10.1136/bmjqs-2015-004814
  18. Kang E, Park HJ, Kim JE. Health impact assessment as a strategy for intersectoral collaboration. J Prev Med Public Health. 2011;44(5):201-209. doi:10.3961/jpmph.2011.44.5.201
  19. Mindell J, Bowen C, Herriot N, Findlay G, Atkinson S. Institutionalizing health impact assessment in London as a public health tool for increasing synergy between policies in other areas. Public Health. 2010;124(2):107-114. doi:10.1016/j.puhe.2010.01.007
  20. Lavinghouze SR, Snyder K. Developing your evaluation plans: a critical component of public health program infrastructure. Am J Health Educ. 2013;44(4):237-243. doi:10.1080/19325037.2013.798216
  21. Judd J, Frankish CJ, Moulton G. Setting standards in the evaluation of community-based health promotion programmes--a unifying approach. Health Promot Int. 2001;16(4):367-380. doi:10.1093/heapro/16.4.367
  22. Smith RD, Petticrew M. Public health evaluation in the twenty-first century: time to see the wood as well as the trees. J Public Health (Oxf). 2010;32(1):2-7. doi:10.1093/pubmed/fdp122
  23. Bennett S, Glandon D, Rasanathan K. Governing multisectoral action for health in low-income and middle-income countries: unpacking the problem and rising to the challenge. BMJ Glob Health. 2018;3(Suppl 4):e000880. doi:10.1136/bmjgh-2018-000880
  24. Pinto AD, Molnar A, Shankardass K, O'Campo PJ, Bayoumi AM. Economic considerations and health in all policies initiatives: evidence from interviews with key informants in Sweden, Quebec and South Australia. BMC Public Health. 2015;15:171. doi:10.1186/s12889-015-1350-0
  25. Rantala R, Bortz M, Armada F. Intersectoral action: local governments promoting health. Health Promot Int. 2014;29(suppl 1):i92–i102. doi:10.1093/heapro/dau047
  26. Howard R, Gunther S. Health in All Policies: An EU literature review 2006–2011 and interview with key stakeholders. Equity Action; 2012.
  27. de Leeuw E, Green G, Dyakova M, Spanswick L, Palmer N. European Healthy Cities evaluation: conceptual framework and methodology. Health Promot Int. 2015;30 Suppl 1:i8-i17. doi:10.1093/heapro/dav036
  28. Duran A, Kutzin J. Financing of public health services and programs: Time to look into the black box. Implementing Health Financing Reform; 2010:247-269.
  29. Rychetnik L, Frommer M, Hawe P, Shiell A. Criteria for evaluating evidence on public health interventions. J Epidemiol Community Health. 2002;56(2):119-127. doi:10.1136/jech.56.2.119
  30. Golden SD, Earp JA. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav. 2012;39(3):364-372. doi:10.1177/1090198111418634
  31. Rose G. The Strategy of Preventive Medicine. New York: Oxford University Press; 1994.
  32. Frohlich KL. Commentary: What is a population-based intervention? Returning to Geoffrey Rose. Int J Epidemiol. 2014;43(4):1292-1293. doi:10.1093/ije/dyu111
  33. Baum F, Lawless A, Delany T, et al. Evaluation of Health in All Policies: concept, theory and application. Health Promot Int. 2014;29 Suppl 1:i130-142. doi:10.1093/heapro/dau032
  34. Rychetnik L, Hawe P, Waters E, Barratt A, Frommer M. A glossary for evidence based public health. J Epidemiol Community Health. 2004;58(7):538-545. doi:10.1136/jech.2003.011585
  35. Ringard A, Sagan A, Sperre Saunes I, Lindahl AK. Norway: health system review. Health Syst Transit. 2013;15(8):1-162.
  36. Olejaz M, Juul Nielsen A, Rudkjøbing A, Okkels Birk H, Krasnik A, Hernández-Quevedo C. Denmark: health system review. Health Syst Transit. 2012;14(2):1-192.
  37. Hofmarcher MM, Quentin W. Austria: health system review. Health Syst Transit. 2013;15(7):1-292.
  38. De Pietro C, Camenzind P, Sturny I, et al. Switzerland: health system review. Health Syst Transit. 2015;17(4):1-288.
  39. Cylus J, Richardson E, Findley L, Longley M, O'Neill C, Steel D. United Kingdom: United Kingdom: health system review. Health Syst Transit. 2015;17(5):1-126.
  40. Busse R, Blumel M. Germany: health system review. Health Syst Transit. 2014;16(2):1-296.
  41. Bryman A. Social Research Methods. 2nd ed. Oxford, New York: Oxford University Press; 2004.
  42. Yin RK. Qualitative Research from Start to Finish. New York: Guilford Press; 2011.
  43. Patton M. Purposeful sampling. In: Qualitative Evaluation and Research Methods. Beverly Hills, CA: Sage Publications; 1990.
  44. Suri H. Purposeful sampling in qualitative research synthesis. Qual Res J. 2011;11(2):63-75. doi:10.3316/QRJ1102063
  45. King N. Using templates in the thematic analysis of text. In: Cassell C, Symon G, eds. Essential Guide to Qualitative Methods in Organizational Research. London: Sage; 2004.
  46. Crabtree B, Miller W. Using codes and code manuals: a template organizing style of interpretation. In: Crabtree BF, Miller WL, eds. Doing Qualitative Research. 2nd ed. Thousand Oaks, CA: Sage Publications; 1999:163-177.
  47. St-Pierre L HH, St-Pierre GHL. Governance Tools and Framework for Health in all Policies. Montreal, Paris, Brussels: National Collaborating Centre for Healthy Public Policy, International Union for Health Promotion and Education, European Observatory on Health Systems and Policies; 2008.
  48. Johansson P, Tillgren P. Financing intersectoral health promotion programmes: some reasons why collaborators are collaborating as indicated by cost-effectiveness analyses. Scand J Public Health. 2011;39(6 Suppl):26-32. doi:10.1177/1403494810393559
  49. Public Health Agency of Canada (PHAC). Crossing Sectors - Experiences in Intersectoral Action, Public Policy and Health. https://www.canada.ca/en/public-health/services/reports-publications/2007/crossing-sectors-experiences-intersectoral-action-public-policy-health.html. Published 2007.
  50. Lock K. Health impact assessment. BMJ. 2000;320(7246):1395-1398. doi:10.1136/bmj.320.7246.1395
  51. Krieger N, Northridge M, Gruskin S, et al. Assessing health impact assessment: multidisciplinary and international perspectives. J Epidemiol Community Health. 2003;57(9):659-662. doi:10.1136/jech.57.9.659
  52. Larsen M, Rantala R, Koudenburg OA, Gulis G. Intersectoral action for health: the experience of a Danish municipality. Scand J Public Health. 2014;42(7):649-657. doi:10.1177/1403494814544397
  53. Danaher A. Reducing Health Inequities: Enablers and Barriers to Inter-Sectoral Collaboration. Wellesley Institute; 2011.
  54. de Leeuw E. Engagement of sectors other than health in integrated health governance, policy, and action. Annu Rev Public Health. 2017;38:329-349. doi:10.1146/annurev-publhealth-031816-044309
  55. Peters BG. Managing horizontal government: the politics of co‐ordination. Public Adm. 1998;76(2):295-311. doi:10.1111/1467-9299.00102
  56. Lawless AP, Williams C, Hurley C, Wildgoose D, Sawford A, Kickbusch I. Health in All Policies: evaluating the South Australian approach to intersectoral action for health. Can J Public Health. 2012;103(7 Suppl 1):eS15-19.
  57. World Health Organization (WHO). The Economics of the Social Determinants of Health and Health Inequalities: A Resource Book. Geneva: WHO; 2013.
  58. World Health Organization (WHO). Contributing to social and economic development: sustainable action across sectors to improve health and health equity (‎follow up of the 8th Global Conference on Health Promotion)‎. WHO; 2015.
  59. Health Impact Assessment: Main Concepts and Suggested Approach. Copenhagen: WHO Regional Office for Europe: WHO European Centre for Health Policy; 1999.
  60. Bertram M, Koudenburg OA, Gulis G. Process evaluation of the development and implementation of an intersectoral health policy in Varde municipality, Denmark. World Health Organization; 2014:32.
  61. Gopinathan U, Watts N, Hougendobler D. Conceptual and institutional gaps: understanding how the WHO can become a more effective cross-sectoral collaborator. Global Health. 2015;11:46. doi:10.1186/s12992-015-0128-6
  62. Nutbeam D. Inter-sectoral action for health: making it work. Health Promot Int. 1994;9(3):143-144. doi:10.1093/heapro/9.3.143
  63. Ollila E. Health in All Policies: from rhetoric to action. Scand J Public Health. 2011;39(6 Suppl):11-18. doi:10.1177/1403494810379895
  64. Fafard P, Hoffman SJ. Rethinking knowledge translation for public health policy. Evid Policy. 2018. doi:10.1332/174426418X15212871808802
  65. Bernier NF, Clavier C. Public health policy research: making the case for a political science approach. Health Promot Int. 2011;26(1):109-116. doi:10.1093/heapro/daq079
  66. Oneka G, Vahid Shahidi F, Muntaner C, et al. A glossary of terms for understanding political aspects in the implementation of Health in All Policies (HiAP). J Epidemiol Community Health. 2017;71(8):835-838. doi:10.1136/jech-2017-208979
  67. Declaration of Alma-Ata. International Conference on Primary Health Care. Alma-Ata: World Health Organization; 1978.
  68. World Health Organization (WHO). The Ottawa Charter for Health Promotion. First International Conference on Health Promotion; 1986; Ottawa.
  69. Commission on Social Determinants of Health (CSDH). Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Geneva, Switzerland: https://www.who.int/social_determinants/thecommission/finalreport/en/. Updated April 25, 2017. Published 2008.
  70. World Health Organization (WHO). Rio Political Declaration on Social Determinants of Health. World Conference on Social Determinants of Health. https://www.who.int/sdhconference/declaration/en/.  Updated December 14, 2011. Published 2011.
  71. Fisher M, Baum FE, MacDougall C, Newman L, McDermott D, Phillips C. Intersectoral action on SDH and equity in Australian health policy. Health Promot Int. 2017;32(6):953-963. doi:10.1093/heapro/daw035
  72. Holt DH, Frohlich KL, Tjørnhøj-Thomsen T, Clavier C. Intersectoriality in Danish municipalities: corrupting the social determinants of health? Health Promot Int. 2017;32(5):881-890. doi:10.1093/heapro/daw020
  73. Rasanathan K, Bennett S, Atkins V, et al. Governing multisectoral action for health in low- and middle-income countries. PLoS Med. 2017;14(4):e1002285. doi:10.1371/journal.pmed.1002285
  74. Transforming our world: the 2030 Agenda for Sustainable Development. Sustainable Development Knowledge Platform website. https://sustainabledevelopment.un.org/post2015/transformingourworld. Published 2015.
  75. Buse K, Hawkes S. Health in the sustainable development goals: ready for a paradigm shift? Global Health. 2015;11:13. doi:10.1186/s12992-015-0098-8
  76. Rasanathan K, Damji N, Atsbeha T, et al. Ensuring multisectoral action on the determinants of reproductive, maternal, newborn, child, and adolescent health in the post-2015 era. BMJ. 2015;351:h4213. doi:10.1136/bmj.h4213
  77. Melkas T. Health in all policies as a priority in Finnish health policy: a case study on national health policy development. Scand J Public Health. 2013;41(11 Suppl):3-28. doi:10.1177/1403494812472296
  78. Shankardass K, Muntaner C, Kokkinen L, et al. The implementation of Health in All Policies initiatives: a systems framework for government action. Health Res Policy Syst. 2018;16(1):26. doi:10.1186/s12961-018-0295-z
  79. Lundgren B. Experiences from the Swedish determinants-based public health policy. Promot Educ. 2008;15(2):27-33. doi:10.1177/1025382308090345
  80. Baum F, Delany-Crowe T, MacDougall C, Lawless A, van Eyk H, Williams C. Ideas, actors and institutions: lessons from South Australian Health in All Policies on what encourages other sectors' involvement. BMC Public Health. 2017;17(1):811. doi:10.1186/s12889-017-4821-7
  81. Kemm J. Health impact assessment: a tool for healthy public policy. Health Promot Int. 2001;16(1):79-85. doi:10.1093/heapro/16.1.79
  82. O'Neill M, Lemieux V, Groleau G, Fortin JP, Lamarche PA. Coalition theory as a framework for understanding and implementing intersectoral health-related interventions. Health Promot Int. 1997;12(1):79-87. doi:10.1093/heapro/12.1.79
  83. Pettman TL, Armstrong R, Doyle J, et al. Strengthening evaluation to capture the breadth of public health practice: ideal vs. real. J Public Health (Oxf). 2012;34(1):151-155. doi:10.1093/pubmed/fds014
  84. Ottersen T, Schmidt H. Universal health coverage and public health: ensuring parity and complementarity. Am J Public Health. 2017;107(2):248-250. doi:10.2105/ajph.2016.303590
  85. Lorgelly PK, Lawson KD, Fenwick EA, Briggs AH. Outcome measurement in economic evaluations of public health interventions: a role for the capability approach? Int J Environ Res Public Health. 2010;7(5):2274-2289. doi:10.3390/ijerph7052274
  86. Prenger R, Pieterse ME, Braakman-Jansen LM, van der Palen J, Christenhusz LC, Seydel ER. Moving beyond a limited follow-up in cost-effectiveness analyses of behavioral interventions. Eur J Health Econ. 2013;14(2):297-306. doi:10.1007/s10198-011-0371-6
  87. Smith KE. Health inequalities in Scotland and England: the contrasting journeys of ideas from research into policy. Soc Sci Med. 2007;64(7):1438-1449. doi:10.1016/j.socscimed.2006.11.008
  88. Fafard P. Public health understandings of policy and power: lessons from INSITE. J Urban Health. 2012;89(6):905-914. doi:10.1007/s11524-012-9698-2
  89. Smith KE. The politics of ideas: the complex interplay of health inequalities research and policy. Sci Public Policy. 2013;41(5):561-574. doi:10.1093/scipol/sct085
  90. Gagnon F, Bergeron P, Clavier C, Fafard P, Martin E, Blouin C. Why and how political science can contribute to public health? Proposals for collaborative research avenues. Int J Health Policy Manag. 2017;6(9):495-499. doi:10.15171/ijhpm.2017.38
  91. Baker P, Friel S, Kay A, Baum F, Strazdins L, Mackean T. What enables and constrains the inclusion of the social determinants of health inequities in government policy agendas? A narrative review. Int J Health Policy Manag. 2018;7(2):101-111. doi:10.15171/ijhpm.2017.130
  92. Hauck K, Smith PC. The Politics of Priority Setting in Health: A Political Economy Perspective. Washington, DC: Center for Global Development; 2015.
  93. Smith K. Beyond Evidence-Based Policy in Public Health: The Interplay of Ideas. Basingstoke: Palgrave Macmillan; 2013.