For more info on the author, Taufique Joarder, click here.
In our medical curriculum in Bangladesh there is a subject called ‘Community Medicine’, which is an abridged version of Public Health. Our aspiring future doctors, occupied with the overly optimistic dream of becoming accomplished clinicians in the near future, often neglect this subject as this is only distantly related to their aspirations. Discouraging the tendency of delving into Community Medicine text books by some students, our senior colleagues used to say: ‘Just memorize the chapter on Primary Health Care (PHC) and the Alma Ata Declaration. Teachers never fail a student in Community Medicine, and if someone accidentally tends to fall into the ditch, they (the teachers) as a lifeline ask the definition of PHC, its eight components, and a few principles of the Alma Ata Declaration.’
When I hence embarked on ‘memorizing’ the chapter on PHC, desperate to avoid failing in Community Medicine, I came across the concept of Intersectoral Action for Health (IAH), as one of the principles of PHC. According to the report of the International Conference on Intersectoral Action for Health, which was held in 1997 in Halifax, Canada, IAH can be defined as: ‘…a recognized relationship between part or parts of the health sector with part or parts of another sector, which has been formed to take action on an issue to achieve health outcomes… in a way that is more effective, efficient or sustainable than could be achieved by the health sector acting alone.’
Many years went by and then I heard the term again when starting to conduct Key Informant interviews for a research project on Comprehensive Primary Health Care (CPHC). My key informant, being a district health officer in Bangladesh, tried to express how appreciative he was of IAH. He told stories about how different sectors contributed to accomplishing health related projects and activities within his purview, and illustrated this by the example of the National Immunization Day (NID), an event in which different government sectors, including education, administration, and police, all worked together to turn the day into a real success. He also referred to the issue of mental health, which is largely related to the security of people and in turn maintained by the police department.
Throughout several other interviews I found that all Key Informants were convinced about the necessity and importance of IAH. There was even encouragement and guidance from higher authorities, although there are no clear policy guidelines about who will collaborate with whom, to what extent, under whose leadership, and what will happen if a sector refuses to collaborate.
Later, when I continued my work at the school of public health (where I am still working), I realized that IAH is also important in the academic arena. For example, one professor of political science came to my rescue when I was trying to integrate a component on community empowerment in my proposed model of CPHC, while teachers in public administration enlightened me on the concept of devolution. My boss, who is an anthropologist, also trained me in the use of qualitative data collection, which I implemented during my CPHC research. These examples, as well as those that are mentioned in my recently published editorial in the journal Global Health Promotion, demonstrate how input from non-health disciplines can substantially contribute to the development of health research.
To me, intersectoral action is synonymous with health itself. The inclusive definition of health warrants complete physical, mental, and social wellbeing, which is unattainable without collaboration of sectors other than the health sector. But contrary to our own proposition of intersectoralism, we often neglect the contribution of other sectors towards the improvement of health indicators. For example, when we see an intervention in the health sector we naturally tend to evaluate whether the putative intervention is achieving expected improvements in health. Likewise, when we see improvements in health, we tend to attribute it to one or several interventions in the health sector itself. We often forget, however, that there are many interventions outside the health sector whose primary objective may not be health, but which are silently, yet successfully, achieving promising health improvements.
In our editorial we discussed how the BRAC Microfinance Program (which is a part of BRAC Development Program), BRAC Primary Schools (part of BRAC Education Program), Kishori Kendras or Adolescent Girls’ Clubs (a collaboration between the Adolescent Development Program of BRAC, the Ministry of Women and Children Affairs, and the Ministry of Youth and Sports of Bangladesh), and the Water and Sanitation Program (part of BRAC’s Environmental Sustainability Program), despite all being non-health programs, significantly contribute towards population health.
In addition, given the current focus on the social determinants of health and its accompanying need for intersectoral action, I strongly believe that the time has come to leave our disciplinary silos, and extend the warmth of acknowledgment towards any other sector that is contributing to population health. My contribution to the current issue of Global Health Promotion sheds light on this collaboration between health and non-health sectors, and presents some detailed examples from development interventions in Bangladesh which do just that.