Multi-sector community health partnerships are critical for building local capacity to address upstream determinants of health. This is a key takeaway from CALPHO’s exploration of local-level Health in All Policies. Moving upstream requires long-term planning, systems thinking, sustained funding, and political support – areas that challenge many partnerships and may limit their scope to addressing specific outcomes. I am not suggesting that more narrowly-focused partnerships are a waste of resources. There are certainly benefits to focusing on proximal health causes that participants feel empowered to address, and a history of successful collaboration and the resulting collective efficacy are powerful glues. But collective efficacy is just one of the necessary ingredients for moving a partnership upstream toward effecting local, systems-changing policies. What are the others?
A recent study published in Health Affairs helps to answer this question. Noting a lack of objective data on multi-sector partnerships, the authors designed a thorough study to identify facilitating characteristics for a partnership to engage in “regional health system transformation.” They developed a four-part conceptual framework to evaluate a partnership’s readiness for this kind of engagement: stewardship, strategy, financing, and environment (meaning health system market and policy environment). Within this framework, they set a list of readiness expectations adapted from a body of collaboration literature and past partnership assessments by ReThink Health. Finally, they compared these expectations to analyses from an extensive interview and site visit process. This resulted in a list of the most mature partnerships (which included the North Colorado Health Alliance), and a snapshot of how most partnerships compare to their expectations. Perhaps not surprisingly, most did not meet those expectations. (if you are interested in learning more about the expectations and maturity lists, email me)
This framework and its embedded expectations are valuable assessment tools, and when combined with operational knowledge of local context, can help guide partnerships' strategic direction. But the authors' vision for systems change, while extensive, is not comprehensive. From the outset, it limits the concept of "multi-sector" to sectors with power – power often originating from and sustained by inequitable systems. Under this framework, a mature partnership includes governmental public health, health care entities, business interests, elected leaders, and economic development entities. It does not account for groups whose power must grow – and whose voice must be heard – in order for the entire system to change equitably. In other words, this framework may help community partnerships develop relationships with the powerful, which is necessary, but it misses the critical importance of engaging affected populations and sharing leadership with community members. This absence limits the contribution that more grass-roots organizations like Lake County Build A Generation can add to our understanding of community health partnerships, and especially how they can help foster understanding and unity between groups at different ends of the power spectrum.
ReThink Health’s most recent Pulse Check on Multi-Sector Partnerships does a better job of including this factor in its analysis, noting that “less than half report that their authority comes from broad-based grassroots support.” ReThink also noted the lack of engagement of sectors like media, faith, and health insurers. Some of Colorado’s partnerships offer rich examples of why these sectors are important. For example, Healthy Mesa’s overarching focus on community connectedness places family, faith, the arts, and local recreation at the center of Mesa’s health ecosystem (as opposed putting efficient health care provision in the center). This aligns the partnership with the values of its community and may increase its clout with local leaders.
CALPHO will continue to support LPHA’s partnership efforts, especially opportunities to learn from each other. Along with CDPHE’s Office of Planning, Partnerships and Improvement, Trailhead Institute, the Rocky Mountain Public Health Training Center, and County Health Rankings & Roadmaps, CALPHO is developing a workshop on partnerships for the community health assessment/improvement plan process, and we hope to extend learning opportunities on that topic. If you have suggestions for this workshop or other ways we can help, please email us.