In This Article Expand or collapse the "in this article" section Intersectoral Action

  • Introduction
  • The Launch of Intersectorality
  • History and Development
  • Outside-Health Contributions
  • Health Sector Conceptualizations

Public Health Intersectoral Action
Evelyne de Leeuw
  • LAST MODIFIED: 25 August 2021
  • DOI: 10.1093/obo/9780199756797-0203


Intersectoral collaboration has become an essential dimension of public health practice and policy since the mid-1970s. This article reviews the origins, theories, alternate views, and evidence, as well as guidance and training documents pertinent to this field. Although there were some antecedents of intersectoral thinking in the 1970s—for example, World Health Organization, National Environmental Health Programmes: Their Planning, Organization, and Administration; Report of a WHO Expert Committee (Meeting Held in Geneva from 3 to 11 June 1969), World Health Organization Technical Report 439 (Geneva, Switzerland: World Health Organization, 1970)—the heyday of conceptual and rhetorical development fell in the 1980s. The World Health Organization convened expert meetings—for example, Morris Schaefer, Intersectoral Cooperation and Health in Environmental Management: An Examination of National Experience (Geneva, Switzerland: World Health Organization, 1981)—and issued authoritative inventories of the success of intersectoral action—for example, World Health Organization, Intersectoral Action for Health: The Role of Intersectoral Cooperation in National Strategies for Health for All (Geneva, Switzerland: World Health Organization, 1986). This experience, and subsequent calls for further action and policymaking, culminated in a standard of setting conferences where key principles and dimensions of intersectoral action were affirmed; for example, W. Kreisel and Y. von Schirnding, “Intersectoral Action for Health: A Cornerstone for Health for All in the 21st Century,” World Health Statistics Quarterly / Rapport trimestriel de statistiques sanitaires mondiales 51.1 (1998): 75–78. Here, we combine insights from public health, political science, sociology, and public administration to comprehensively map the current body of knowledge.

The Launch of Intersectorality

The term “intersectoral action” has particular importance in the universe of statements and beliefs of the World Health Organization. It came to prominence as a result of the Primary Health Care conference in the Soviet republic of Kazakhstan in 1978, where the influential Alma Ata Declaration was developed and adopted. The concept of “intersectoral action” was neither defined nor codified substantially for a long time. It was an article of faith in the Alma Ata Declaration and was assumed self-explanatory for at least a decade after that pivotal moment. “Intersectoral action” is almost exclusively appropriated by the health (care) sector and its institutions (including scholarly writing). Collaborative efforts for joint gain do happen in other spheres of human endeavor but go under different monikers. A first more or less systematic perspective was offered in 1986. The case-based inventory identified a number of critical examples of intersectoral work in national health environments around the world. An Australian perspective, Harris, et al. 1995, identifies intersectoral action as “A recognized relationship between part or parts of the health sector and part or parts of another sector, that has been formed to take action on an issue or to achieve health outcomes (or intermediate health outcomes) in a way which is more effective, efficient or sustainable than could be achieved by the health sector working alone” (p. 5). This definition subsequently was adopted by an international WHO conference (Kreisel & Von Schirnding 1998). The conventional term is “intersectoral action.” There are, however, diversions from this term that have been included in this article. They include inter(sectoral), multi(sectoral), and sometimes trans(sectoral). We have chosen to ignore swanky word play, treat them all the same, and, for the sake of readability, use intersectoral or intersectorality. There is a question whether intersectoral action is equivalent to intersectoral policy and even intersectoral governance. There is great fuzziness in more-colloquial publications, but in scholarly terms a clear differentiation exists (e.g., de Leeuw 2015, de Leeuw 2017). Intersectorality is not owned by health scholarship and practice; a review of the health-driven descriptions, however, might suggest it is. Fields such as organizational science and psychology, public management, administrative science and industrial relations, and sociology seem generally absent from intersectorality arguments in health. Public management guru B. G. Peters (Peters 1998) has long been arguing that policy integration is the holy grail of any level of government. Approaches are called “joined-up government,” “whole of government” (WOG), “integrated policy,” or “horizontal policy” (see Trein Meyer and Maggetti 2019—none of which seems to have influenced health intersectorality much, judging from the analysis in Degeling 1995, which in its problematization sounds as fresh in the 2020s as it was decades ago.

  • de Leeuw, E. 2015. Intersectoral action, policy and governance in European Healthy Cities. Public Health Panorama 1.2: 175–182.

    Argues from empirical research in European Healthy Cities that it is useful to make a conceptual and theoretical distinction between intersectoral action (the operational intervention and act of collaborating), intersectoral policy (the deliberate joint resolution to solve a social problem), and intersectoral governance (the systems that drive integration and collaboration).

  • de Leeuw, E. 2017. Engagement of sectors other than health in integrated health governance, policy, and action. Annual Review of Public Health 38:329–349.

    DOI: 10.1146/annurev-publhealth-031816-044309

    Narrative review about the pervasive nature of all public and private policies in society influencing population health, how various disciplinary and jurisdictional perspectives have shown a need for better collaboration and integration, and how dogmatic, empirical, and conceptual forms of evidence join to form a community-driven spectrum of collaborative opportunities for health.

  • Degeling, P. 1995. The significance of “sectors” in calls for urban public health intersectoralism: An Australian perspective. Policy & Politics 23.4: 289–301.

    DOI: 10.1332/030557395782200518

    Challenges the notion of “sectors” as isolated silos and claims that sociology and political science can identify an opportunity to break through structural and belief system barriers for better integration.

  • Harris, E., M. Wise, P. Hawe, P. Finlay, and D. Nutbeam. 1995. Working together: Intersectoral action for health. Canberra: Australian Government Publishing Service.

    First systematic overview of determinants of efficacious intersectoral action—identifies a number of steps in the process of working together, and offers examples of how system outcomes are improved because of collaboration.

  • Kreisel, W., and Y. von Schirnding. 1998. Intersectoral action for health: A cornerstone for health for all in the 21st century. World Health Statistics Quarterly / Rapport trimestriel de statistiques sanitaires mondiales 51.1: 75–78.

    WHO conference report that outlines rationale and outcomes of the first WHO conference on intersectoral action for health. Adopts the vision and evidence base accumulated by WHO work on Primary Health, Health for All by the Year 2000, and, significantly, Harris, et al. 1995.

  • Peters, B. G. 1998. Managing horizontal government: The politics of coordination. Canadian Centre for Management Development, Research Paper 21. Ottawa, ON: Minister of Supply and Services.

    One of many papers by the administrative science guru Peters about policy integration and its barriers and determinants. In this government-commissioned report, he speaks a bit more freely than in other peer-reviewed articles. Unique in identifying the political nature of fragmentation and integration. Does not specifically focus on health. Takes a political view of the policy process rather than the action/interventionist one.

  • Trein, P., I. Meyer, and M. Maggetti. 2019. The integration and coordination of public policies: A systematic comparative review. Journal of Comparative Policy Analysis: Research and Practice 21.4: 332–349.

    A systematic review of political and administrative science concepts in integrated, horizontal, joined-up, whole-of-government, public policy (in the health fields of “Healthy Public Policy” or “Health in All Policy”). Authors find a separation between disciplines and theories across sectors (“integration” looks at environment and climate policy, “JUG/WOG” at social, health, and education policy), and welfare states. Useful for understanding intersectoral policy and governance.

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