Multisectoral Actions for Health: Challenges and Opportunities in Complex Policy Environments

Document Type : Editorial


1 International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand

2 National Health Commission Office, Nonthaburi, Thailand


Multisectoral actions for health, defined as actions undertaken by non-health sectors to protect the health of the population, are essential in the context of inter-linkages between three dimensions of sustainable development: economic, social, and environmental. These multisectoral actions can address the social and economic factors that influence the health of a population at the local, national, and global levels. This editorial identifies the challenges, opportunities and capacity development for effective multisectoral actions for health in a complex policy environment. The root causes of the challenges lie in poor governance such as entrenched political and administrative corruption, widespread clientelism, lack of citizen voice, weak social capital, lack of trust and lack of respect for human rights. This is further complicated by the lack of government effectiveness caused by poor capacity for strong public financial management and low levels of transparency and accountability which leads to corruption. The absence of or rapid changes in government policies, and low salary in relation to living standards result in migration out of qualified staff. Tobacco, alcohol and sugary drink industries are major risk factors for non-communicable diseases (NCDs) and had interfered with health policy through regulatory capture and potential law suits against the government. Opportunities still exist. Some World Health Assembly (WHA) and United Nations General Assembly (UNGA) resolutions are both considered as external driving forces for intersectoral actions for health. In addition, Thailand National Health Assembly under the National Health Act is another tool providing opportunity to form trust among stakeholders from different sectors.
Capacity development at individual, institutional and system level to generate evidence and ensure it is used by multisectoral agencies is as critical as strengthening the health literacy of people and the overall good governance of a country.


Main Subjects

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  1. United Nations General Assembly. “The future we want” A/RES/66/288” (Sixty-sixth session, New York, USA, September 11, 2012).  Accessed March 8, 2017.
  2. United Nations. Integrating the three dimensions of sustainable development: A framework and tools. Bangkok: UNESCAP; 2015.
  3. World Health Organization, Public Health Agency of Canada. Health equity through intersectoral action: an analysis of 18 country case studies. Geneva: World Health Organization; 2008.  Accessed March 10, 2017.
  4. Marano N, Arguin P, Pappaioanou M, King L. Role of multi-sector partnerships in controlling emerging zoonotic diseases. Emerg Infect Dis. 2005;11(12):1813-1814.
  5. Public Health Agency of Canada. Crossing Sectors – Experiences in Intersectoral Action, Public Policy and Health.  Published 2007.
  6. Rasanathan K. 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
  7. WHO. Scaling up action against noncommunicable diseases: how much will it cost?   Accessed March 10, 2017. Published 2011.
  8. Saloojee Y, Dagli E. Tobacco industry tactics for resisting public policy on health. Bull World Health Organ. 2000;78(7):902-910.
  9. Rosenberg J, Siegel M. Use of corporate sponsorship as a tobacco marketing tool: a review of tobacco industry sponsorship in the USA, 1995-99. Tob Control. 2001;10:239–246
  10. Tobacco industry challenges Thai government.   Accessed March 10, 2017.
  11. Tobacco companies file lawsuits against UK Government over plain packaging laws.   Accessed March 10, 2017.
  12. Smith C, Kraemer J, Johnson A, Mays D. Plain packaging of cigarettes: do we have sufficient evidence? Risk Manag Healthc Policy. 2015;8:21-30. doi:10.2147/RMHP.S63042
  13. McCambridge J, Hawkins B, Holden C. Industry Use of Evidence to Influence Alcohol Policy: A Case Study of Submissions to the 2008 Scottish Government Consultation. PLOS Med. 2013;10(4):e1001431. doi:10.1371/journal.pmed.1001431
  14. Pira E, Pelucchi C, Piolatto PG, Negri E, Bilei T, La Vecchia C. Mortality from cancer and other causes in the Balangero cohort of chrysotile asbestos miners. Occup Environ Med. 2009;66(12):805-809.
  15. Loomis D, Dement JM, Wolf SH, Richardson DB. Lung cancer mortality and fibre exposures among North Carolina asbestos textile workers. Occup Environ Med. 2009;66(8):535-542.
  16. World Health Organization. Elimination of Asbestos-Related Diseases. Geneva: WHO; 2006.
  17. International Labour Organization. Resolution concerning asbestos, 2006. The 95th Session of the International Labour Conference, June 2006.    Accessed September 8, 2014. Published 2006. 
  18. King Mongkut’s Institute of Technology Ladkrabang 2013 Analysis, review and recommendation on safe use of Chrysotile 2013 (Thai report).  Accessed March 10, 2017.
  19. Moskowitz H, Burns M, Fiorentino D, Smiley A, Zador P. Driver characteristics and impairment at various BAC. Washington DC: Southern California Research Institute, National Highways Traffic Safety Administration; 2000.
  20. Office of the Minister of Transport to the Chair Cabinet. Safer Journeys—lowering the legal alcohol limits for adult drivers.   Accessed March 10, 2017. Published 2013.
  21. Ministry of Social Development, New Zealand. What Works to Reduce Alcohol-Related Harm and why aren’t The Policies More Popular?   Accessed March 10, 2017.
  22. Andreuccetti G, Carvalho H, Cherpitel C, et al. Reducing the legal blood alcohol concentration limit for driving in developing countries: a time for change? Results and implications derived from a time–series analysis (2001–10) conducted in Brazil. Addiction. 2011;106;2124-2131. doi:10.1111/j.1360-0443.2011.03521.x
  23. Wasi P. ‘‘Triangle that moves the mountain’’ and health systems reform movement in Thailand. Human Resources for Health Development Journal. 2000;4:106-110.
  24. Rasanathan K, Posayanonda T, Birmingham M, Tangcharoensathien V. Innovation and participation for healthy public policy: the first National Health Assembly in Thailand. Health Expect. 2012;15(1):87-96. doi:10.1111/j.1369-7625.2010.00656.x
  25. OECD. Challenges of capacity development, working toward good practice. Paris: OECD; 2006.
  26. UNDP. Capacity development,  Management Development and Governance Division, Bureau for Policy Development, Technical Advisory Paper 2. New York: UNDP; 1997.
  27. European Commission, Capacity Building.  Accessed March 10, 2017.
  28. Wander N, Malone RE. Fiscal versus social responsibility: how Philip Morris shaped the public funds divestment debate. Tob Control. 2006;15(3):231-241. doi:10.1136/tc.2005.015321
  29. Vateesatokit P. Tailoring tobacco control efforts to the country: the example of Thailand. In: de Beyer J, Brigden L, eds. Tobacco Control Policy: Strategies, Successes & Setbacks. Washington DC: World Bank; 2003.
  30. United Nations. The United Nations Convention Against Corruption. Available at  Accessed March 10, 2017. Published 2004.
  31. Bennett S, Corluka A, Doherty J, et al. Influencing policy change: the experience of health think tanks in low- and middle-income countries. Health Policy Plan.2012;27(3):194-203. doi:10.1093/heapol/czr035
  32. Bennett S, Corluka  A, Doherty J, Tangcharoensathien V. Approaches to developing the capacity of health policy analysis institutes: a comparative case study. Health Res Policy Syst. 2012;10:7. doi:10.1186/1478-4505-10-7
  33. Pitayarangsarit S, Tangcharoensathien V. Sustaining capacity in health policy and systems research in Thailand. Bull World Health Organ. 2009; 87:72-74.
  34. Bustreo F, Harding A, Axelsson H. Can developing countries achieve adequate improvements in child health outcomes without engaging the private sector? Bull World Health Organ. 2003;81(12):886-895.
  35. Hellman J, Kaufmann D. Confronting the Challenge of State Capture in Transition Economies. Finance and Development. 2001;38(3).
  36. Senge P. The Fifth Discipline: The Art & Practice of the Learning Organization. USA: Doubleday Publisher; 2006.