International Journal of Health Policy and Management

International Journal of Health Policy and Management

Intersectoral Collaboration and Complex Health Emergencies: Insights From a Comparative Analysis of Public Space Regulation During COVID-19 in Four Canadian Provinces

Articles in Press

Document Type : Original Article

Authors
Veena Sriram 1, 2
Leah Shipton 3
Sara Allin 4
Lara Gautier 5
Katherine Fierlbeck 6
Alessia Montecalvo 2
Susan Usher 7
Peter Berman 1
1 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
2 School of Public Policy and Global Affairs, University of British Columbia, Vancouver, BC, Canada
3 School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
5 Department of Health Management, Policy and Evaluation, School of Public Health, Université de Montréal, Montréal, QC, Canada
6 Department of Political Science, Dalhousie University, Halifax, NS, Canada
7 Department of Equity, Ethics and Policy, McGill University, Montréal, QC, Canada
Abstract
Background
This paper contrasts and examines the perceptions of policy communities on the dynamics and factors shaping intersectoral collaboration in governance of health emergencies, drawing on the example of public space regulation during COVID-19 in four Canadian provinces, with the goal of exploring variation and perceived quality of policy responses.

Methods
We compared public space regulation in four Canadian provinces—British Columbia (BC), Nova Scotia (NS), Ontario (ON) and Québec (QC)—during COVID-19 from 2020 to 2022. The study was designed as a comparative, qualitative, and explanatory case study, utilizing in-depth interviews and documents. We conducted 103 interviews with a diverse range of stakeholders, including senior government and non-government leaders, reviewed selected policy documents, and media reports. We utilized multisite qualitative analysis to analyze our data and develop within- and cross-case themes.

Results
Respondents reported vastly different provincial approaches to intersectoral collaboration within government and with non-governmental stakeholders in the management of public spaces, ranging from higher (BC, NS) to lower (ON, QC) levels of collaboration in governance, as reflected in the access of government and non-government stakeholders to key decision-makers and decision-making forums and processes, the transparency of those processes, and responsiveness to their input. Institutional frameworks, political factors and organizational culture and capacity were the major distinguishing factors between these provincial approaches to collaboration. Disparities in access to decisionmakers were reported, with business interests and certain civil society organizations experiencing easier access compared to other public interest groups.

Conclusion
Public health challenges are increasingly complex and intersectoral. Research on intersectoral collaboration must examine collaboration dynamics within and outside government holistically, rather than exploring these dynamics in siloes. Stakeholder engagement which combines institutional structures and inclusive stakeholder engagement within and outside government is crucial to managing complex policy processes during crisis and beyond.
Keywords
Canada
COVID-19
Health Governance
Intersectoral Collaboration
Interest Groups

  1. Weible CM, Nohrstedt D, Cairney P, et al. COVID-19 and the policy sciences: initial reactions and perspectives. Policy Sci. 2020;53(2):225-241. doi:10.1007/s11077-020-09381-4 

  2. Chiang YA, Pacca L, Vable A, Carton T, Pletcher MJ, Hamad R. Trajectories and patterns of US counties’ policy responses to the COVID-19 pandemic: a sequence analysis approach. SSM Popul Health. 2025;29:101734. doi:10.1016/j.ssmph.2024.101734  

  3. Agyapon-Ntra K, McSharry PE. A global analysis of the effectiveness of policy responses to COVID-19. Sci Rep. 2023;13(1):5629. doi:10.1038/s41598-023-31709-2 

  4. Greer SL, King EJ, da Fonseca EM, Peralta-Santos A. The comparative politics of COVID-19: The need to understand government responses. Global Public Health. 2020;15(9):1413-1416. doi:10.1080/17441692.2020.1783340 

  5. Fierlbeck K, Gautier L, Usher S, Allin S, Sriram V, Berman P. Testing “the science”: A comparative analysis of COVID-19 testing policy across four Canadian provinces. Soc Sci Med. 2025;371:117880. doi:10.1016/j.socscimed.2025.117880  

  6. Brubacher LJ, Hasan MdZ, Sriram V, et al. Investigating the influence of institutions, politics, organizations, and governance on the COVID-19 response in British Columbia, Canada: a jurisdictional case study protocol. Health Res Policy Syst. 2022;20(1):74. doi:10.1186/s12961-022-00868-5 

  7. Christensen T, Lægreid P. Balancing governance capacity and legitimacy: how the Norwegian government handled the COVID-19 crisis as a high performer. Public Adm Rev. 2020;80(5):774-779. doi:10.1111/puar.13241 

  8. Kork AA, Paananen H, Kihlström L, Tynkkynen LK. Frames of cooperation: interactional dynamics of pandemic governance networks. Public Manag Rev. 2025;1-33. doi:10.1080/14719037.2025.2557860 

  9. Buse K, Tomson G, Kuruvilla S, et al. Tackling the politics of intersectoral action for the health of people and planet. BMJ. 2022;376:e068124. doi:10.1136/bmj-2021-068124 

  10. Barbazza E, Tello JE. A review of health governance: definitions, dimensions and tools to govern. Health Policy. 2014;116(1):1-11. doi:10.1016/j.healthpol.2014.01.007  

  11. Christensen T, Ma L. Comparing SARS and COVID-19: challenges of governance capacity and legitimacy. Public Organization Review. 2021;21(4):629-645. doi:10.1007/s11115-021-00510-y 

  12. Torfing J. Governance Networks. In: Levi-Faur D, ed. The Oxford Handbook of Governance. Oxford University Press; 2012. doi:10.1093/oxfordhb/9780199560530.013.0007  

  13. Binderkrantz A. Different groups, different strategies: how interest groups pursue their political ambitions. Scan Polit Stud. 2008;31(2):173-200. doi:10.1111/j.1467-9477.2008.00201.x 

  14. Bubela T, Flood CM, McGrail K, Straus SE, Mishra S. How Canada’s decentralised COVID-19 response affected public health data and decision making. BMJ. 2023;382:e075665. doi:10.1136/bmj-2023-075665 

  15. Steytler N. Federalism Under Pressure: Federal ‘Health’ Factors and ‘Co-morbidities.’ In: Comparative Federalism and COVID-19: Combating the Pandemic. Routledge; 2022.

  16. Lynch J, Gollust SE. Introduction to “Subnational COVID-19 Politics and Policy.” J Health Polit Policy Law. 2021;46(6):925-928. doi:10.1215/03616878-9349086  

  17. Jüptner P, Klimovský D. Vertical and horizontal intergovernmental relations during the first wave of the COVID-19 crisis: experience from the extremely fragmented CEE countries. Local Gov Stud. 2022;48(2):232-350. doi:10.1080/03003930.2021.1944858 

  18. Kuhlmann S, Franzke J. Multi-level responses to COVID-19: crisis coordination in Germany from an intergovernmental perspective. Local Gov Stud. 2022;48(2):312-334. doi:10.1080/03003930.2021.1904398 

  19. Carlitz R, Yamanis T, Mollel H. Coping with denialism: how street-level bureaucrats adapted and responded to COVID-19 in Tanzania. J Health Polit Policy Law. 2021;46(6):989-1017. doi:10.1215/03616878-9349128 

  20. Crepaz M, Junk WM, Hanegraaff M, Berkhout J. Viral Lobbying: Strategies, Access and Influence During the COVID-19 Pandemic. 1st ed. Vol. 3. Berlin/Boston: De Gruyter; 2022.  doi:10.1515/9783110783148 

  21. Junk WM, Crepaz M, Hanegraaff M, Berkhout J, Aizenberg E. Changes in interest group access in times of crisis: no pain, no (lobby) gain. J Eur Public Policy. 2022;29(9):1374-1394. doi:10.1080/13501763.2021.1968936 

  22. Li B, Qian J, Xu J, Li Y. Collaborative governance in emergencies: Community food supply in COVID-19 in Wuhan, China. Urban Governance. 2022;2(1):188-196. doi:10.1016/j.ugj.2022.03.002 

  23. Jeong BG, Kim SJ. The government and civil society collaboration against COVID-19 in South Korea: a single or multiple actor play? Nonprofit Policy Forum. 2021;12(1):165-187. doi:10.1515/npf-2020-0051 

  24. Such E, Smith K, Woods HB, Meier P. Governance of intersectoral collaborations for population health and to reduce health inequalities in high-income countries: a complexity-informed systematic  review. Int J Health Policy Manag. 2022;11(12):2780-2792. doi:10.34172/ijhpm.2022.6550  

  25. Wanna J. Collaborative Government: Meanings, Dimensions, Drivers and Outcomes. In: Collaborative Governance: A new era of public policy in Australia. Canberra, Australia: ANU ePress; 2008. doi:10.22459/CG.12.2008.01 

  26. Leeson PT, Thompson HA. Chapter 23: COVID-19 and the interest group approach to government. In: Handbook on the Political Economy of Health Systems. Cheltenham, UK: Edward Elgar Publishing; 2023:397-411.  doi:10.4337/9781800885066.00032 

  27. Beyers J, Braun C. Ties that count: explaining interest group access to policymakers. J Public Policy. 2014;34(1):93-121. doi:10.1017/S0143814X13000263 

  28. Klijn EH, Koppenjan JFM.  Governance network theory: past, present and future. Policy Polit. 2012;40(4):187-206. 

  29. Carroll BJ, Brummel L, Toshkov D, Yesilkagit K. Multilevel governance and responses to the COVID-19 pandemic: a systematic literature review. Reg Fed Stud. 2025;35(2):305-326. doi:10.1080/13597566.2023.2292997 

  30. Cameron-Blake E, Breton C, Sim P. Variation in the Canadian provincial and territorial responses to COVID-19 [BSG-WP-2021/039]. 2021. (BSG Working Paper Series). https://www.bsg.ox.ac.uk/sites/default/files/2021-03/BSG-WP-2021-039.pdf. 

  31. Honey-Rosés J, Anguelovski I, Chireh V, et al. The impact of COVID-19 on public space: an early review of the emerging questions – design, perceptions and inequities. Cities Health. 2020;5:1-17. doi:10.1080/23748834.2020.1780074 

  32. Berman P, Cameron MA, Gaurav S, et al. Improving the response to future pandemics requires an improved understanding of the role played by institutions, politics, organization, and governance. PLOS Glob Public Health. 2023;3(1):e0001501. doi:10.1371/journal.pgph.0001501

  33. Ansell C, Gash A. Collaborative governance in theory and practice. J Public Adm Res Theory. 2008;18(4):543-571. doi:10.1093/jopart/mum032 

  34. Sørensen E, Torfing J. Theoretical approaches to governance network dynamics. In: Sørensen E, Torfing J, eds. Theories of Democratic Network Governance. London: Palgrave Macmillan UK; 2007:25-42. doi:10.1057/9780230625006_2  

  35. Emerson K, Nabatchi T, Balogh S. An integrative framework for collaborative governance. J Public Adm Res Theory. 2012;22(1):1-29. doi:10.1093/jopart/mur011 

  36. Yin R. Case Study Research Design and Methods. 5th ed. SAGE Publications; 2014.

  37. Cassola A, Fafard P, Nagi R, Hoffman SJ. Tensions and opportunities in the roles of senior public health officials in Canada: a qualitative study. Health Policy. 2022;126(10):988-995. doi:10.1016/j.healthpol.2022.07.009 

  38. Dalglish SL, Khalid H, McMahon SA. Document analysis in health policy research: the READ approach. Health Policy Plan. 2020;35(10):1424-1431. doi:10.1093/heapol/czaa064 

  39. Abfalter D, Mueller-Seeger J, Raich M. Translation decisions in qualitative research: a systematic framework. Int J Soc Res Methodol. 2021;24(4):469-486. doi:10.1080/13645579.2020.1805549 

  40. Brubacher LJ, Hasan MZ, Sriram V, et al. Investigating the influence of institutions, politics, organizations, and governance on the COVID-19 response in British Columbia, Canada: a jurisdictional case study protocol. Health Res Policy Syst. 2022;20(1):74. doi:10.1186/s12961-022-00868-5

  41. Jenkins EK, Slemon A, Haines-Saah RJ, Oliffe J. A guide to multisite qualitative analysis. Qual Health Res. 2018;28(12):1969-1977. doi:10.1177/1049732318786703  

  42. DeCuir-Gunby J, Marshall P, Mcculloch A. Developing and using a codebook for the analysis of interview data: an example from a professional development research project. Field methods. 2011;23:136-155. doi:10.1177/1525822X10388468 

  43. Gilson L, Hanson K, Sheikh K, Agyepong IA, Ssengooba F, Bennett S. Building the field of health policy and systems research: social science matters. PLoS Med. 2011;8(8):e1001079. doi:10.1371/journal.pmed.1001079 

  44. Mays N, Pope C. Qualitative research in health care. Assessing quality in qualitative research. BMJ. 2000;320(7226):50-52. doi:10.1136/bmj.320.7226.50 

  45. Sandelowski M. Sample size in qualitative research. Res Nurs Health. 1995;18(2):179-183. doi:10.1002/nur.4770180211 

  46. Gouvernement du Québec,. Montreal’s 2022 point-in-time count of people experiencing homelessness - Indigenous Populations. 2024.  https://santepubliquemontreal.ca/sites/drsp/files/media/document/DRSP_Pub_2025_02_04_Fascicule7_PopulationsAutochtones_EN.pdf. 

  47. SFU Morris J. Wosk Centre for Dialogue. Faith and Spiritual Leaders Dialogue Series. 2021. https://www.sfu.ca/content/dam/sfu/dialogue/ImagesAndFiles/SharedLearningPage/EventReports/PDFs/Faith%20and%20Spiritual%20Leaders%20Dialogue%20Series-%20Internal%20Report.pdf. 

  48. Office of the Provincial Health Officer. Restaurants, Coffee Shops, Cafes, Cafeterias and Licensed Premises, Including Pubs, Bars, Lounges, Nightclubs and Tasting Rooms. 2020. https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/covid-19/archived-docs/pho_order_nightclubs_food_drink_july_31_2020.pdf. 

  49. Office of the Provincial Health Officer. Variance of the Gatherings and Events Order of the Provincial Health Officer to Permit Inside Worship Services – June 15, 2021. 2021. https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/covid-19/archived-docs/covid-19-variance-indoor-worship-june-15-2021.pdf. 

  50. Office of the Provincial Health Officer. Variance of the Gatherings and Events Order of the Provincial Health Officer to Permit Inside Worship Services – May 26, 2021. 2021. https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/covid-19/archived-docs/covid-19-variance-outdoor-worship-may-26-2021.pdf. 

  51. Fierlbeck K. Public health and collaborative governance. Can Public Adm. 2010;53(1):1–19. doi:10.1111/j.1754-7121.2010.00110.x 

  52. Baum F, Musolino C, Freeman T, et al. Thinking politically about intersectoral action: ideas, interests and institutions shaping political dimensions of governing during COVID-19. Health Policy Plan. 2024;39(Suppl 2):i75-i92. doi:10.1093/heapol/czae047 

  53. Migone AR. Trust, but customize: federalism’s impact on the Canadian COVID-19 response. Policy Soc. 2020;39(3):382-402. doi:10.1080/14494035.2020.1783788 

  54. Atkinson M, Béland D, Marchildon G, Mcnutt K, Phillips P, Rasmussen K. Governance and Public Policy in Canada: A View from the Provinces. University of Toronto Press; 2013.

  55. Eady G, Rasmussen A. The unequal effects of the COVID-19 pandemic on political interest representation. Polit Behav. 2022;1-25. doi:10.1007/s11109-022-09842-x  

  56. Turner S, Segura C, Niño N. Implementing COVID-19 surveillance through inter-organizational coordination: a qualitative study of three cities in Colombia. Health Policy Plan. 2022;37(2):232-242. doi:10.1093/heapol/czab145 

  57. Thow AM, Harris P, Lencucha R. Vision, relationships, patience … and power: A qualitative analysis of how policy agents scale up cross-sectoral policy for nutrition. Soc Sci Med. 2025;372:117939. doi:10.1016/j.socscimed.2025.117939 

  58. Beaujoin C, Gautier L, Gagnon-Dufresne MC, et al. “It felt like building a plane while in flight”: the consideration of social inequalities in the design and planning of a contact-tracing intervention for COVID-19 in Montreal, Quebec. Can J Public Health. 2023;114(3):346-357. doi:10.17269/s41997-023-00759-4 

  59. Lacy-Nichols J, Williams O. “Part of the solution”: Food corporation strategies for regulatory capture and legitimacy. Int J Health Policy Manag. 2021;10(12):845-856. doi:10.34172/ijhpm.2021.111  

  60. Perlis RH, Ognyanova K, Uslu A, et al. Trust in physicians and hospitals during the COVID-19 pandemic in a 50-state survey of US adults. JAMA Netw Open. 2024;7(7):e2424984. doi:10.1001/jamanetworkopen.2024.24984 

  61. SteelFisher GK, Findling MG, Caporello HL, et al. Trust in US federal, state, and local public health agencies during COVID-19: responses and policy implications. Health Aff (Millwood). 2023;42(3):328-337. doi:10.1377/hlthaff.2022.01204 

  62. World Health Organization (WHO). Working together for equity and healthier populations: sustainable multisectoral collaboration based on Health in All Policies approaches. Geneva, Switzerland: WHO; 2023.

International Journal of Health Policy and Management

Articles in Press, Accepted Manuscript
Available Online from 06 September 2026

  • Received Date 14 November 2025
  • Revised Date 05 August 2026
  • Accepted Date 24 August 2026
  • First Published Date 06 September 2026
  • Published Date 06 September 2026