An Environmental Scan of Recent Initiatives Incorporating Social Determinants in Public Health
CROSS-SECTOR COLLABORATION TO IMPROVE PUBLIC HEALTH
The foundational importance of social, environmental, and economic factors as determinants of health has long been recognized (NCCHS, 1967; Institute of Medicine, 1988; Evans, Barer, and Marmor, 1994; Wilkinson and Marmot, 2003; Mokdad et al, 2004). Until recently, this recognition had resulted in few sustained, organized efforts to positively influence these determinants to foster health at the community level. In recent years, however, numerous efforts have arisen across the United States that explicitly seek to improve the public’s health by catalyzing collaboration across multiple societal sectors, with the goal of leveraging policy, systems, and environmental changes to drive sustained improvements in the public’s health. Many are using concepts such as “Health in All Policies” (WHO, 2013; Rudolph et al., 2013) and collective impact (Kania and Kramer, 2011) to structure their efforts. These initiatives vary in scope and scale, and they address the challenge of multisector approaches to the social determinants in a variety of ways, often innovating as they evolve.
The foundational importance of social, environmental, and economic factors as determinants of health has long been recognized (NCCHS, 1967; Institute of Medicine, 1988; Evans, Barer, and Marmor, 1994; Wilkinson and Marmot, 2003; Mokdad et al, 2004). Until recently, this recognition had resulted in few sustained, organized efforts to positively influence these determinants to foster health at the community level. In recent years, however, numerous efforts have arisen across the United States that explicitly seek to improve the public’s health by catalyzing collaboration across multiple societal sectors, with the goal of leveraging policy, systems, and environmental changes to drive sustained improvements in the public’s health. Many are using concepts such as “Health in All Policies” (WHO, 2013; Rudolph et al., 2013) and collective impact (Kania and Kramer, 2011) to structure their efforts. These initiatives vary in scope and scale, and they address the challenge of multisector approaches to the social determinants in a variety of ways, often innovating as they evolve.
These pioneering efforts face several challenges. First, they are generally not guided by any national strategy or coherent plan to promote such cross-sector partnerships or to leverage resources across these initiatives. Second, many community efforts are developing in relative isolation, with little opportunity to learn from the successes and failures of similar undertakings in other communities. Third, the accelerated pace at which broad, health-oriented community collaboratives are being launched makes it difficult to maintain awareness of the many opportunities, toolkits, and frameworks that already exist.
These efforts are laudable and offer much to adapt and apply in communities across the country. To begin to systematize such cross-sector, expansive approaches to community health, in this article we identify, categorize, and describe an array of multisector initiatives and collaborations currently under way across the United States that explicitly include attention to social, economic, and environmental factors to foster community health and well-being.