Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
J Eval Clin Pract. 2013 Dec;19(6):1095-100. doi: 10.1111/jep.12069. Epub 2013 Jun 27.
Intersectoral action (ISA) has been at the forefront of public health policy discussions since the 1970s. ISA incorporates a broader perspective of public health issues and coordinates efforts to address the social, political, economic and environmental contexts from which health determinants operate and are created. Despite being forwarded as a useful way to address and treat complex or 'wicked' problems, such policy issues are still often addressed within, rather than across, disciplinary silos and ISA has been documented to fail more often than it succeeds.
This paper contributes to an understanding of ISA by outlining and applying critical systems heuristics (CSH) theory and methods.
CSH theory and methods are described and discussed before applying them to the example of addressing climate change and health equity through public health practice.
CSH thinking provides useful tools to engage stakeholders, question relations of power that may exist between collaborating partners, and move beyond power inequalities that guide ISA initiatives.
CSH is a compelling framing that can improve an understanding of the collaborative relationships that are a prerequisite for engaging in ISA to address complex or 'wicked' policy problems such as climate change.
自 20 世纪 70 年代以来,跨部门行动(ISA)一直处于公共卫生政策讨论的前沿。ISA 采用了更广泛的公共卫生问题视角,并协调努力,解决健康决定因素运作和产生的社会、政治、经济和环境背景。尽管被认为是解决和治疗复杂或“棘手”问题的一种有用方法,但此类政策问题仍然经常在学科筒仓内解决,而不是跨学科解决,ISA 的失败案例多于成功案例。
本文通过概述和应用关键系统启发式(CSH)理论和方法,为理解 ISA 做出了贡献。
在将 CSH 理论和方法应用于通过公共卫生实践解决气候变化和健康公平问题的示例之前,对其进行了描述和讨论。
CSH 思维为参与利益相关者提供了有用的工具,质疑合作伙伴之间可能存在的权力关系,并超越指导 ISA 举措的权力不平等。
CSH 是一种引人注目的框架,可以更好地理解合作关系,这是参与 ISA 以解决复杂或“棘手”政策问题(如气候变化)的先决条件。