Volume
7: No. 6, November 2010
Stephanie B. Coursey Bailey, MD, MS
Suggested citation for this article: Bailey SBC. Focusing on solid
partnerships across multiple sectors for population health improvement. Prev
Chronic Dis 2010;7(6):A115.
http://www.cdc.gov/pcd/issues/2010/nov/10_0126.htm.
Accessed [date].
Introduction
Partnerships create a way forward when no clear solution exists and no single
entity can claim the necessary expertise, authority, or resources to bring about
change. Cross-sectoral partnerships are needed to mobilize community action and
improve population health.
The Mobilizing Action Toward Community Health (MATCH) articles in this issue
of Preventing Chronic Disease reveal compelling themes, issues, and
recommendations for improving population health. These include many challenges, such as how to scale up successful partnership efforts (1,2),
determine if and how partnership activity can be correlated with changing health
metrics (1-5), expand the use of incentives for improvement (1,3,4,6), and strengthen groups’ distributive leadership and governance (1,2,4-6).
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Building Blocks for Effective Multisectoral
Partnerships
The MATCH articles identify characteristics that are needed to build and sustain
successful partnerships: 1) social value, 2) common goals, 3) rewards and incentives, and
4)
comprehensive and coordinated approaches.
According to Wei-Skillern, the driving force of social entrepreneurship is
the creation of social value rather than personal or shareholder wealth (1). She
describes a form of networking that leverages organizational resources and
expertise to achieve greater social impact. The network approach does not
necessarily require more resources; rather, the goal is to make the best use of
existing resources.
Fawcett et al assert that systems require interconnectedness to support effective
and sustained efforts to change conditions (7). Having common goals helps create
a unified sense of mission and encourages collective engagement to improve
community health. This is best realized if a comprehensive and coordinated
framework is adopted, such as the 2002 Institute of Medicine (IOM) framework for
collaborative public health action in communities (8). The IOM
framework outlines 12 collaborative processes that can facilitate change and
improvement in population-level outcomes.
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Lessons from the Healthy Communities movement
Pittman discusses some consistent patterns and themes of the
Healthy Communities movement: strong distributed leadership and governance,
existence of a health status improvement focus that distributes the
broad-focused community intervention into its various and targeted parts,
metrics to help guide the local efforts, accountable leadership, well-supported
infrastructure, and an investment in data systems that integrate across efforts
(2). This movement lays the foundation for what the European Union has adopted
as health in all policies, which shifts the emphasis from individual lifestyles
and single diseases to societal factors and actions that shape our everyday
living environments. This approach serves as a motivator for all available
measures in all policy fields.
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The call to build a new generation of intersectoral partnerships
Mays asserts that large-scale implementation partnerships affecting
communities most at risk remain rare in practice (4). The paucity of
this type of partnership may be because of the nature and constraints of
public and private funding mechanisms. Funds are usually allocated for a limited
time and come with many regulations. There is often not enough money
to go beyond the pilot. Pilot projects too often remain just that. Moving to implementation requires broad support, proven value, and additional
resources.
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Incentives for the business community
Workforce health, the community’s health, and metrics that are appropriate
for businesses can foster business sector engagement in population
health. We
may be at the cusp of a paradigm shift as business leaders become aware of the
cost savings associated with a healthy workforce. If business leaders understand
the close relationship between employee health and community environments, the
decision to be involved in population health improvement is an easy one. Many
examples exist of businesses participating in initiatives to strengthen
community health and developing internal workplace initiatives on their own. As
Webber and Mercure acknowledge, people operating from a business mindset may not internalize
the value or relevance of typical population health measures (5). However, metrics
(such as the burden of disease) can influence business decisions, such as where
to locate a business.
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Leadership, governance, and standards
Partnerships can and should be viewed as social networks in which breadth,
density, and organizational centrality are features that influence performance.
Other characteristics include clear goals, effective leaders who see beyond the
boundaries of their organizations, accountability, and a well-supported
infrastructure.
There is a potential economic basis for governance that promotes well-being
in a country or region. Fox suggests that governance could be strengthened by
creating and according political protection to public organizations (3).
Performance and accreditation standards for government public health agencies
represent opportunities for strengthening incentives for partnerships.
For 3 years, 2005-2007, approximately 750 communities used Mobilizing for
Action through Planning and Partnerships to
conduct community assessments and develop partnerships (9). Additional promising models should be developed and tested, such
as the state of Vermont’s Community Based Payment Reform (6).
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The Difficulty of Determining Direct Correlation or
Causation
From a research perspective, isolating the effects of partnerships on
community-level health behaviors remains a challenge. Better systems are needed for
measuring and reporting what happens in a community. Communities and
programs evolve over time, including changes in leadership, participants, levels
of participation, and environmental contexts. These complex and dynamic
variables and circumstances limit the degree to which rigorous evaluation may be
applied to partnership structure, function, and achievement. The value of
metrics in guiding local efforts, providing a form of accountability and
transparency, and creating a constituency for local political support and policy
change is not lost on communities. An integrative data system would help
researchers to measure the effect and effectiveness of multisectoral policies
and intervention.
Ultimately, health outcomes should be the measure on which any health
intervention is judged. However, the patience and commitment required to improve
population health outcomes over the long term
run counter to our strong cultural desire for instant answers and immediate
gratification. Such a system, based only on short-term change, is incompatible
with the provision of meaningful incentives for population health improvement.
Going forward, systems must be developed and institutionalized to reward the
longer term upstream solutions.
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Conclusion
This group of articles provides diverse perspectives on
partnerships for population health improvement. In considering them,
the following recommendations emerge for research and practice:
- Invest in data systems that can better integrate the multiple sources of
data affecting population health.
- Develop incentives for policy actions and leadership while blunting
disincentives for participation.
- Adopt a network mindset to overcome the seemingly intractable barriers to
achieving population health. This involves creating social value and having
common goals.
- Create opportunities for cross-sector networking and collaboration to
build relationships between and among leaders.
- Develop and advocate for sustained funding mechanisms as opposed to
short-term grants.
- Establish metrics to inform and motivate cross-sectoral action — with
emphasis on including partnerships with the business community.
Partnerships for population health improvement help us make better use of
existing resources, and they expand the dialogue to businesses, faith-based
organizations, education, commerce, public safety, housing, transportation,
decision makers, and community members. However, in the context of this
young discipline of population health, many questions on partnerships require
further exploration. These include questions that relate to organizational
partnerships, costs, leadership characteristics, and community dynamics.
Implementing the recommendations would likely have unintended consequences.
Recognizing health in all policies could lead, for example, to increased
competition for finite resources across sectors. However, potential benefits for
community health justify both the risk and the effort.
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Acknowledgments
This manuscript was developed as part of the Mobilizing Action Toward
Community Health (MATCH) project funded by the Robert Wood Johnson Foundation.
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Author Information
Stephanie B. Coursey Bailey, MD, MS, Office of the Chief of Public Health
Practice, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta,
GA 30333. Telephone: (404) 446-5726. E-mail:
stephanie.coursey@comcast.net.
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References
- Wei-Skillern J. Networks as a type of social entrepreneurship to advance
population health. Prev Chronic Dis 2010;7(6).
http://www.cdc.gov/pcd/issues/2010/nov/10_0082.htm.
- Pittman MA. Multisectoral lessons from Healthy Communities. Prev Chronic Dis 2010;7(6).
http://www.cdc.gov/pcd/issues/2010/nov/10_0085.htm.
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http://www.cdc.gov/pcd/issues/2010/nov/10_0027.htm.
- Mays GP. Improving public health system performance through
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