Intersectoral Collaboration on Non-Medical Determinants of Health: The Role of Health Regions in Canada Dr. James Frankish Institute of Health Promotion Research, College for Interdisciplinary Studies, UBC Every sin is the result of collaboration" (S. Crane 1871)

Research Team  J. Frankish, Institute of Health Promotion Research, UBC  G. Moulton, Institute of Health Promotion Research UBC  D. Quantz, Vancouver Coastal Health  A. Carson, Centre on Aging, University of Victoria  A. Casebeer, Community Health Sciences, U of Calgary  J. Eyles, Geography & Earth Sciences, McMaster University  R. Labonte, Community Medicine, U of Ottawa  B. Evoy, Vancouver Coastal Health  J. Gerbrandt, Institute of Health Promotion Research, UBC  Cathy Pryce, Calgary Health Authority  Susan Tirone, Dalhousie University

Current & Recent Projects  Training Program in Community Partnership Research  Homelessness & Poverty-Related Research  Health Literacy, & Literacy & Health Research  Health-System Reform & Marginalized Groups  Measuring the Health of Communities

Non-Medical Determinants of Health  Income & Social Status  Social Support Networks  Education  Employment & Working Conditions  Social Environments  Physical Environment  Personal Health Practices  Healthy Child Development  Culture  Gender (From Health Canada – Excludes Health Services & Biology /Genetics)

Rationale - A Continuum of Absurdities Health Regions are Totally Responsible for Non-Medical Determinants of Health There is No Role for Health Regions in Non-Medical Determinants of Health What is the Preferred Future f or for Health Regions in Addressing Non- Medical Determinants of Health

Research Questions  How are health regions working with key potential collaborators (i.e., NGOs, private sector, non-health ministries) to address the non-medical determinants of health?  What is the status of initiatives undertaken by health regions to address the non-medical determinants of health in partnership with other sectors of government and/or society?  How do individual-specific, organizational & structural factors limit or facilitate intersectoral collaboration by health regions on the non-medical determinants of health?

Project Overview  Stratification Survey Instrument  Key Informant Interviews Representatives of Regional Health Authorities Representatives of Partners  Document Review  107 surveys sent to ten provinces  Response rate of 65%.  Response rates varied by province lowest % (Que) & highest 100% (Alberta).

Current “Health-Sector” Action on Health Canada’s Non-Medical Determinants Determinant of HealthPrograms/Core FundingNo Action Healthy Child Development54%12% Personal Health Practices48%09% Physical Environment33%16% Social Support31%18% Education24%26% Social Environments21%27% Culture21%27% Employment/Work Conditions18%26% Gender18%32% Income & Social Status17%32%

Intersectoral Collaboration “A recognized relationship between part or parts of the health sector with part or parts of another sector which has been formed to take action on an issue to achieve health outcomes … in a way that is more effective, efficient or sustainable than could be achieved by the health sector acting alone.” WHO International Conference on Intersectoral Action for Health, 1997

Intersectoral Collaboration  Ministry of Health  Non-Health Ministries  Non-Government Organizations within the Health Sector  Private Sector – Health  Non-Government Organizations outside the Health Sector  Private Sector Organizations outside the Health Sector

Intersectoral Collaboration Level Definition Currently no involvement at all between our health organization & other agencies/groups for this determinant Some (informal) contact between our health organization & other agencies/groups for this determinant A formal structure for collaboration has been developed between our health organization & other agencies/groups for this determinant Our health organization & other agencies/groups are developing or have completed a plan of action for this determinant Our health organization & other agencies/groups are developing or have implemented programs to address this determinant

Intersectoral Collaboration  Both child development and personal health practices were receiving most attention from health regions.  Sixty-eight percent of regions reported a high-level of intersectoral activities (i.e., action plan or programs established) around child development, while only 3% reported no intersectoral activities for child development.  No intersectoral activities were reported by a larger number of regions around gender (38%), culture (27%), and employment/working conditions (26%).

Roles for Health Authorities  Collaborator/partner  Facilitator  Communicator/educator  Advocate  Initiator/leader * the categorization of roles is not mutually exclusive

Factors Influencing Implementation of NMDH  Individual Factors  Organizational Factors  Systems/Environmental Factors  Fundamental Nature of the NMDH ( Horizontal complexity: NMDH works across sectors (e.g., social, economic); Vertical complexity: NMDH aims for change at individual, community, organizational, and systems levels)

Summary of Challenges  Defining ‘Nonmedical’ Determinants of Health (NMDH)  Values Underlying NMDH  Complexity of Models of NMDH  Time Frames for Addressing NMDH  Responsibility for Addressing NMDH  Impact Assessment of Addressing NMDH Structural Constraints around NMDH  Accountability for Addressing NMDH  Relations Between Health Sector & NMDH Resources to Strengthen Action on NMDH  Sustainability of NMDH Initiatives

Next Steps ???  Facilitators & Barriers Individual / Community Facilitators, Interpersonal Facilitators, Organizational Facilitators, Structural Facilitators Individual / Community Barriers, Interpersonal Barriers, Organizational Barriers, Structural Barriers  In-Depth Case Studies Study of Implementation of Vancouver’s Population Health Strategy Possible Case Studies of Food Security, Housing, Early Child Development

Contact Information  Dr. Jim Frankish Institute of Health Promotion Research  ,  jimfrankish.com 

References  Frankish J. Moulton G. Quantz D. Carson A. Casebeer A. Eyles J. Labonte R. Evoy B Addressing the non- medical determinants of health: a survey of Canada's health regions. Canadian Journal of Public Health. 98(1):41-7.  G. Moulton et al. 2007, Addressing the Non-Medical Determinants of Health: A Canadian Perspective of Regional Health Authorities & Partners - Part I: Setting Priorities - Developing Strategies – Adopting Roles.  G. Moulton et al. 2007, Addressing the Non-Medical Determinants of Health: A Canadian Perspective of Regional Health Authorities & Partners – Part II: Critical Factors Influencing RHA Actions targeting NMDH.