Table 1.
Examples of intersectoral action programmes and how they are facilitated*
| Example | Description | Facilitation |
|---|---|---|
| Global | ||
| Global action plan for healthy lives and well being for all (GAP) Initiative23 | The GAP initiative brings together 13 multilateral health, development, and humanitarian agencies to better support countries to accelerate progress towards the health related sustainable development goals (SDGs). GAP serves as a platform for intersectoral action by better aligning their ways of working to reduce inefficiencies and provide more streamlined support to countries | • The mandate for the GAP initiative came from three heads of state with the backing of the UN secretary general • It involves multilateral health, development, and humanitarian member organisations (such as WHO, GAVI, World Bank) working to support countries to accelerate progress against SDG 3 targets • Executive heads of member organisations constitute the principals of the GAP and are accountable for its success: they set strategic direction, evaluate progress, and report annually, providing leadership and support from the top • Day-to-day functioning is vested in focal points—staff appointed by the heads of agency. They develop, discuss, and agree the overall GAP workplan, the monitoring framework, and monitor progress. Importantly, they coordinate relevant actions within their own agencies to further the joint plan • The intersectoral work is undertaken in thematic working groups—eg, on financing, research, determinants, and meaningful engagement of civil society. Teams of GAP members support countries with the various offerings of the working groups to help countries implement programmes addressing the health related SDG targets. The GAP is supported by a small secretariat to provide glue to the initiative • Accountability is ensured by regular reports as well as a planned independent external evaluation |
| The United Nations Joint Program on AIDS (UNAIDS)24 | A joint programme of 11 UN agencies with a mandate to lead the global AIDS response. Each agency has specific mandates ranging from gender equality to decent work to education, all of which are relevant to a robust AIDS response. UNAIDS was established to provide intersectoral action across the various determinants of HIV, and provides an example of civil representatives mobilising to achieve intersectoral action | • UNAIDS structure involves a board made up of representatives from UN agencies, governments, and affected civil society organisations. • Executive leadership is exercised by representation of chair at ministerial or ambassadorial level and among the co-sponsors by heads of agency • A formal division of labour among UN agencies, a pooled budget, shared accountability framework, and dedicated secretariat all facilitate intersectoral action. At the technical level, formal and informal working groups facilitate collaboration across agencies • The board meets twice a year to report on progress towards shared goals, providing accountability • One barrier to negotiate is the fact each of the UN agencies has its own mandate. This inevitably means the level of engagement and support of activities in the shared plan depends on the extent to which their boards demand it of them |
| Montreal Protocol on Substances that Deplete the Ozone Layer | A global agreement to protect the Earth’s ozone layer by phasing out the chemicals that deplete it. It is an example of science mobilising intersectoral action efforts | Research showing the damage to ozone layer from chloroflurocarbons provided the basis for action25-27
• In 1985 the Vienna Convention for the Protection of the Ozone Layer was created28 • The Montreal protocol followed two years later, establishing a shared action plan and accountability framework; it provides a set of practical, actionable tasks agreed to in 1987 and achieved universal participation with confirmation by every country on 16 September 2009,29 • The parties to the protocol meet annually to make decisions, including adjustments or amendments aimed at ensuring the successful implementation of the agreement. One such meeting led to the Kigali amendment in 2016 to cut production and consumption of hydrofluorocarbon30 |
| Country | ||
| Thailand’s National Health Act 31 | Thailand implemented a National Health Act in 2007. The act “secured participation as the basic orienting principle and practice in health policy making in Thailand” | • The National Health Act established the National Health Commission (NHC) chaired by the prime minister and made up in equal parts of the “triangle that moves the mountain”: the knowledge sector (technical knowledge, health professionals), the government sector (politicians, local services), and the people sector (civil society, media, private sector). Importantly, 50% of the membership must come from outside the healthcare sector • The National Health Commission convenes an annual national health assembly which brings the three sides of the triangle together to discuss health policy and reports to the Cabinet. • The annual assembly process addresses power imbalances through equal representation of each sector, with equal speaking rights; varying points of view are welcomed, and every attempt is made to put all sides on an equal footing (through capacity building, awareness raising work, etc). If a consensus cannot be reached on a particular point, the agenda item will be deferred to allow for more consultation time. • Involving all key actors in the national health assembly process provides accountability and shared learning |
| Voices for Healthy Kids in the US32 | A multisectoral collaboration that “‘seeks public policy changes to improve food and physical activity environments to promote healthy weight for all children and adolescents in the United States” | • Provides grant funding to not-for-profit organisations to launch campaigns that engage, organise, and mobilise advocates to improve the food and physical activity environment at state or local levels • The multisectoral collaboration model adopted enabled over 140 stakeholder organisations to align resources • Robust accountability mechanisms with third party evaluations were established to collect, evaluate, and provide feedback to ensure continual improvement |
| One Health in Ghana and India33 | Intersectoral collaborations for “One Health” (through data on rabies prevention and control, avian flu, and flood risk management) | • Executive leadership, strong political will, and financial resources (donor support or clear economic incentives) facilitated implementation at scale • There is shared leadership for development of joint cross sectoral goals, workplans, and coordination arrangements |
| Local or municipal | ||
| Nature based approaches in local municipalities, Sweden34 | Nature based approaches recognise that human societies and their development are dependent on natural systems. These approaches were implemented into the daily planning practices and associated governance of Swedish municipalities | • Municipal staff and individual champions overcame multiple constraints (institutional and organisational; policy and legal; financial and human resources; knowledge and capacity) by employing targeted stakeholder collaboration, strategic citizen involvement, alteration of internal cooperation structures, outsourcing, and concealed integration of science and policy • Civic support was mobilised at the planning phase through diverse activities aimed at increasing public awareness and avoiding protest, such as planning walks, planning games, digital dialogues, and targeted media • Robust accountability mechanisms included changes to internal cooperation, working structures, and capacities to ensure integration; shifting from working in silos towards more intersectoral work; and improving communication by breaking down formalities • Concealed science-policy integration progressively mainstreams scientific considerations into informal and formal planning regulations and tools through incremental, and thus little noticed, changes |
| City Blueprint Approach in Ahmedabad, India35 | The City Blueprint Approach provides a framework for governance, sharing knowledge and facilitating integration between the scientific and policy communities working on urban water management | • An assessment of Ahmedabad’s water governance using the City Blueprint Approach identified areas for improvement, which would in turn improve the city’s ability to address water challenges • Executive leadership was evidenced by visionary agents within the government who used their authority to set ambitious goals for all five water related challenges. However, insufficient statutory compliance and the inadequate use of policy instruments limited the attainment of these goals, while monitoring and policy evaluation were insufficient to improve implementation • Connecting science and policy was seen as key to resolving water governance challenges, including reliable information, stakeholder engagement, and implementing capacity • The study showed that capacity to address one of the five challenges (urban heat islands) was high. A plan included steps that would address identified water governance issues overall (ie, learning, stakeholder engagement, and implementing capacity). This set an example of how Ahmedabad may be able to address the other four challenges |
| Inherit; promoting healthier, sustainable lifestyles in EU cities 36 | Inherit is a project funded under the EU Horizon 2020 research programme that aims to identify, investigate, and promote effective intersectoral policies, interventions, and innovations that enable and encourage healthier, more sustainable, and equitable behaviours and lifestyles | • Shared goals and cooperation agreements were notable; participating partners saw the necessity and mutual benefits of both • Other facilitating factors included being acknowledged by the outside world and by important stakeholders as well as having an open attitude and long term vision, flexibility, and people feeling they could trust and rely on one another • Participants saw the motivation and competence of partners as vital facilitators of cooperation and they seemed intrinsically motivated to make the initiative successful |
| A greener and smarter city, Korea, Seoul37 | Seoul metropolitan government (SMG) declared a sustainable policy initiative along with action plans for environmental management, creative economic development, and improvement of social equity, focused on creating decent jobs for residents through public-private partnerships | • Executive leadership as well as shared, cross-sectoral goals and coordination are reflected in the collaboration of SMG with communities and local industry on every urban regeneration project in Seoul, to sustain economic activities and promote new opportunities. Project success is measured by economic development as well as physical improvement • The administration established an information disclosure policy division aimed at disclosing administrative information and creating new economic and social values through information sharing • Under the residents’ participation budget system residents are able to decide how around $45m should be used each year • Policy workshops are held frequently to gather the opinions of experts and residents on SMG policies, and to reflect those views in future policies to maintain the cities competitive edge and residents’ quality of life |
*
Studies identified by using Google Scholar to search for articles published between 2011 and 2021 using the search terms “political” OR “politics” OR “environment” OR “environmental”+“cross sector” OR “multi sector” OR “intersectoral” and selecting those that indicated an examination of political factors in intersectoral action of either health or environmental spaces. Additional cases were identified through a Delphi process based on the authors’ expertise and experience.