Multisector interagency collaboration is necessary to implement the complex multi-level evidence-based health policies, environmental interventions, and systems approaches that address social determinants of health for the major chronic diseases that have become a core focus for public health [1, 2]. Governmental public health departments have increasingly collaborated with other health organizations such as clinics and hospitals, with calls for increased partnerships with a broader array of organizations . In recent decades, the Department of Health and Human Services (DHHS) through the Healthy People objectives, along with the Institute of Medicine (IOM, now the National Academy of Medicine), have continuously advocated for stronger collaborations between public health departments and multisector organizations. For example, core Healthy People agenda items starting from the turn of the century have called for state health departments (SHDs) to take a leadership role in collaborating with diverse partners to facilitate the implementation of community health improvement plans . In the same timeframe, IOM recommendations from annual reports have called for collaborative partnerships as a key mechanism for involving organizations with a stake in community health .
Despite this, the extent of widespread public health department collaboration with multisector organizations remains unclear, with some evidence suggesting multisector partnerships are beneficial for community health, but that public health departments still collaborate primarily with organizations within the health sector [4, 6, 7]. Participants in Canada’s Multi-Sector Partnerships Initiative in public health reported increased resources, including increased access to people with different skills and expertise [8, 9]. Additionally, most studies in the area of public health collaborations have focused on primarily characterizing smaller-scale partnerships between local level health departments and agencies . Less is known relatively on how mid to higher level public health agencies such as SHDs collaborate with organizations outside of the health sector. Evidence at the local level shows benefits of multisector community partnerships. For example, a national study by Tabak et al. (2018) found that for local health departments, collaboration with other multisector organizations in the community was critical for the provision of evidence-based interventions related to obesity and diabetes prevention, as few interventions were delivered only directly by the local health department itself . In the area of cardiovascular disease, a local multisector initiative resulted in increased percentages of healthcare system hypertensive patients with controlled blood pressure, compared to baseline . Multisector cancer collaborations have shown increased use of evidence-based approaches to facilitate cancer screening [12, 13] and increased cancer screening rates . While hospitals are required to work with community-based organizations to inform their community health needs assessments and plans, such collaborations are often not sustained through implementation .
While evidence in local-level partnerships is promising, key differences exist in the roles and collaborative and partnership forming processes of state-level health departments versus local level health agencies. For example, compared to local health departments, SHDs are expected to take on a more central leadership role, to be involved in higher-level activities such as informing state-wide health policy creation, and to manage relationships with diverse partner organizations and many different local health departments that may have competing priorities [5, 16].
Additionally, SHDs increasingly focus on health equity at a systems level and can serve as a bridging hub to foster both state and local level multisector collaborations to address health equity and social determinants of health. Because social determinants of health are impacted by a diverse array of service sectors outside of health-focused organizations like hospitals and clinics (e.g. housing, transportation, schools, city planning), SHDs are often in a position to facilitate partnerships between organizations belonging to different sectors . In the context of community health equity, evidence suggests that in state-level public health practice, a positive association exists between higher quality, more diverse partnerships and commitment to health equity work . A recent systematic review on public health strategies to reduce health inequalities additionally identified multisector collaborations by public health agencies as a core component for successful interventions and programs .
The Association of State and Territorial Health Officials (ASTHO) report on multisector collaboration among state health agencies provides the best picture of U.S. state-level health agency collaboration in the literature . This is a valuable and critical source of information on health agency collaborations at the state level, but the ASTHO survey assesses collaboration with a broad lens and does not break down multisector collaborations by chronic disease program area or work unit within each SHD. This is a gap, as SHDs are not monolithic entities and may contain numerous program area work units focused on different infectious and chronic diseases. Depending on the specific chronic disease area, these different work units will be engaged in different types of health-promoting activities, thereby necessitating different types of organizational partners and collaborators. For example, a public health work unit focused on reducing childhood obesity may be more likely to collaborate with the parks and recreation department (to promote outdoor physical activity) compared to a work unit in the tobacco control program area.
This paper aims to provide a snapshot of the types of organizations SHDs collaborate with for chronic disease prevention, the degree to which collaborating organizations lie in the health sector versus other sectors, and if/how collaborations differ depending on specific chronic disease program areas. Therefore, this study adds to the growing body of literature on multisector collaboration in that most existing research has focused on local level health department partnerships, studies that are on a state level are primarily focused on the SHD collaborations within a single state, and studies on SHDs nationally have yet to characterize collaborations within specific chronic disease program areas.