Wednesday, June 20, 2012

[EQ] Assessing the impact and effectiveness of intersectoral action on the social determinants of health and health equity

Assessing the impact and effectiveness of intersectoral action on the social determinants of health and health equity:
An expedited systematic review

Antigonish, Nova Scotia Canada: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

ISBN: 978-1-926823-12-6 -  NCCDH_CCNDS  – June 2012

Available online PDF [64p.] at:

“……This expedited systematic review is part of ongoing work at the NCCDH that explores “what works” to improve health equity through action on the social determinants of health.

The focus of this review is the effectiveness of intersectoral action as a public health practice to advance health equity.

The review summarizes the best available research evidence to support evidence-informed public health.
Research evidence is one component of information needed to inform decision-making in public health. Other important forms of information include practice-based experience and program evaluation, as well as factors about the local environment, priorities, and available resources.

Strengthening our understanding of the impact of intersectoral action on health equity will help to clarify how public health works with other sectors and to identify the tools and strategies that support this work……….”


Intersectoral action for health equity

What we did

“…..Using streamlined systematic review methods we sought out evidence on the impact of intersectoral action on health equity. Over a period of three months, we screened over 10,000 articles, selected articles that met our review criteria, critically appraised the included studies, and synthesized the findings.

What we found

The review includes 17 studies which met our criteria.

o        Few of these studies reported on interventions which address structural determinants of health. Interventions which focused on access to care and service delivery were more common.

o        The impact of intersectoral action is mixed, revealing a moderate effect to no effect on the social determinants of health. The evidence on the impact of intersectoral action on health equity is limited.

o        A number of tools and strategies such as project committees, funding, dedicated staff, and clear expectations of outcomes for the population of interest supported the initiation and implementation of intersectoral initiatives.

What we learned

Our findings support what others have noted – much of the literature on the social determinants of health to advance health equity is descriptive and there is less of an emphasis on interventions. There are many examples of intersectoral initiatives from across Canada and around the world, yet outcomes related to health, the social determinants of health, or policy for health equity are often not reported. Applying the expedited systematic review method to the extremely complex and context-specific nature of social determinants of health interventions has emphasized the lack of available high quality, rigorously evaluated evidence.

This review has strengthened our understanding of the impact of intersectoral action on health equity and helps us to clarify how public health organizations work with other sectors……….” [au]



Background .

Research Question

Methods .

Literature Search .

Relevance .

Quality Assessment .

Data Extraction and Analysis

Findings .

Quality of Included Studies .

Systematic Review .

Primary Studies .

Population Health Approach to Reducing Health Inequities

Populations .

Intervention Settings .

How the Social Determinants of Health Are Addressed .

Relationships and Roles

Tools, Mechanisms, and Strategies for Initiation and Implementation



Conclusions .

Implications .

For Practice and Policy

For Research


Tables , Figure and Appendices .

Table 1 Quality Assessment Results .

Table 2 Characteristics of Included Studies .

Figure 1 Search Results .

Appendix 1 Search Strategy

Appendix 2 Grey Literature Search



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