Learning from intersectoral action beyond health: a meta-narrative review

Abstract

Intersectoral action (ISA) is considered pivotal for achieving health and societal goals but remains difficult to achieve as it requires complex efforts, resources and coordinated responses from multiple sectors and organizations. While ISA in health is often desired, its potential can be better informed by the advanced theory-building and empirical application in real-world contexts from political science, public administration and environmental sciences. Considering the importance and the associated challenges in achieving ISA, we have conducted a meta-narrative review, in the research domains of political science, public administration, environmental and health. The review aims to identify theory, theoretical concepts and empirical applications of ISA in these identified research traditions and draw learning for health. Using the multidisciplinary database of SCOPUS from 1996 to 2017, 5535 records were identified, 155 full-text articles were reviewed and 57 papers met our final inclusion criteria. In our findings, we trace the theoretical roots of ISA across all research domains, describing the main focus and motivation to pursue collaborative work. The literature synthesis is organized around the following: implementation instruments, formal mechanisms and informal networks, enabling institutional environments involving the interplay of hardware (i.e. resources, management systems, structures) and software (more specifically the realms of ideas, values, power); and the important role of leaders who can work across boundaries in promoting ISA, political mobilization and the essential role of hybrid accountability mechanisms. Overall, our review reaffirms affirms that ISA has both technical and political dimensions. In addition to technical concerns for strengthening capacities and providing support instruments and mechanisms, future research must carefully consider power and inter-organizational dynamics in order to develop a more fulsome understanding and improve the implementation of intersectoral initiatives, as well as to ensure their sustainability. This also shows the need for continued attention to emergent knowledge bases across different research domains including health.

Examining Intersectoral Action as an Approach to Implementing Multistakeholder Collaborations to Achieve the Sustainable Development Goals

“…Research turned towards new ways that different levels and sectors of government could cooperate with each other and collaborate with private and civil society actors. Mondal et al review models of collaboration developed outside of health promotion, finding that “theory-building on mechanisms of coordination, institutionalization processes and dimensions of culture, values and power has been primarily conducted in political science … and public administration” ([ 26 ] p. 2). They highlight that the environmental sciences, in contending with a topic that crosses many sectoral boundaries, have also contributed to processes of governing across sectors.…”

“…Mondal et al review the rise of “joined-up-government” and “whole-of-government” ideas, which emerged to address barriers to policy coherence and the silos of separate operating structures entrenched in the public sector. These approaches “focused on building a strong unified set of values and collaboration among public servants” and “the dynamics of interaction between institutions, and ensuring challenges related to control, coordination and accountability” ([ 26 ] p. 11). Governance research investigates these interactions.…”

“…They also use the term “sectors” to mean public, private and non-profit organizations. The dual lineage of notions of intersectoral action strengthen its application to governance processes, offering relevance for governments engaging collaboratively on the SDGs [ 24 , 26 ].…”

“…Intersectoral action research considers the fundamental principles, key skills, and necessary conditions for successful collaboration across sectors. The public administration sciences have emphasized macro-level institutional reform, investigating the role of coordination, accountability, and power [ 26 ]. Mondal et al find that an institutional cultural shift away from hierarchy towards “a learning culture with more tolerance for uncertainties … the creation of values and trust, promoting team-building, and establishing a cohesive work culture” (26 p. 13) is a top requirement for collaboration.…”

Tackling the politics of intersectoral action for the health of people and planet

“…Health (and illness) results from actions taken by individuals, communities, corporations, and governments within and, crucially, outside the health sector. The same logic applies to planetary health16 with health, business, and environment literature reporting similar barriers to, and facilitators of, intersectoral action 171819202122. We conducted a pragmatic review, grouping the wide variety of barriers and opportunities described into seven themes (box 3).…”