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Intersectoral Action and the
Social Determinants of
Health:
What’s the evidence?
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What’s the evidence?
 National Collaborating Centre for Determinants of
Health. (2012). Assessing the impact and effectiveness
of intersectoral action on the social determinants of
health: An expedited systematic review. Antigonish,
NS: National Collaborating Centre for Determinants
of Health, St. Francis Xavier University.
 ENGLISH - http://nccdh.ca/resources/entry/assessing-
the-impact-and-effectiveness-of-intersectoral-action-on-
the-SDOH
 FRENCH - http://nccdh.ca/fr/resources/entry/assessing-
the-impact-and-effectiveness-of-intersectoral-action-on-
the-SDOH

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This webinar has been made possible with support from the
Canadian Institutes of Health Research
Welcome!
Intersectoral Action
and the Social
Determinants of
Health:
What’s the evidence?

The Health Evidence Team
Kara DeCorby Heather Husson
Administrative Director Project Manager
Maureen Dobbins
Scientific Director
Tel: 905 525-9140 ext 22481
E-mail: dobbinsm@mcmaster.ca
Lori Greco Robyn Traynor Lyndsey McRae
Knowledge Broker Research Coordinator Research Assistant

What is www.health-evidence.ca?
Evidence
inform
Decision Making

Why use www.health-evidence.ca?
1. Saves you time
2. Relevant & current evidence
3. Transparent process
4. Supports for EIDM available
5. Easy to use

Knowledge Translation
Supplement Project
CIHR-funded KTB-112487

Review
 National Collaborating Centre for Determinants of
Health. (2012). Assessing the impact and effectiveness
of intersectoral action on the social determinants of
health: An expedited systematic review. Antigonish,
NS: National Collaborating Centre for Determinants
of Health, St. Francis Xavier University.

Evaluation
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survey link after the webinar.
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please e-mail Jennifer McGugan at
mcgugj@mcmaster.ca
to be sent the survey

Questions?

National Collaborating Centre for
Determinants of Health
Sume Ndumbe-Eyoh Hannah Moffatt
seyoh@stfx.ca hmoffatt@stfx.ca
Knowledge Translation Specialists

About the National Collaborating Centre
for Determinants of Health
• Our focus
– Social determinants of health (SDH) & health equity
• Our audience
– All organizations that make up the public health sector in
Canada
– The practitioners, decision makers and researchers who
work within public health
• Our work
– Translate and share evidence to influence interrelated
determinants and advance health equity
Visit us at www.nccdh.ca

Pan-Canadian

Visit us at www.nccdh.ca
• Resource Library
• Health Equity Clicks: Community
• Health Equity Clicks: Organizations
• Networking events & workshops

Summary Statement:
NCCDH(2012)
P General population
I Any population health intervention, involving an intersectoral
relationship, related to the social determinants of health (SDOH
and health equity
C Health equity
O Health Outcomes: measures of morbidity/mortality, quality o
life, adherence to healthcare, etc. SDOH Outcomes:
income/income distribution, employment, housing, etc. Policy
Outcomes: societal-level legislative changes, and organizational
level policies/programs
Quality Rating: 8 (strong)

Summary of Included
Studies
 Included articles met several relevance criteria:
• Any design/population health intervention re: SDOH & health equity
• Explicit mention of intersectoral relationship
• Outcomes : health, SDOH, or policy
• Published in English or French between Jan 2001-Jan 2012
• Set in one of: Norway, Finland, Denmark, Sweden, Australia, New
Zealand (NZ), Canada, the United States (US), or the United
Kingdom (UK)
 Total of17 articles included: 1 systematic review, 14 quantitative studies
& 2 qualitative studies

Overall Considerations
 Evidence of effectiveness for some upstream, midstream, and
downstream interventions
 Role of the public health sector was not always clearly
described in the primary studies, however intervention
descriptions can be accessed in Table 2 of the review.
 Interventions targeted very specific populations so findings may
not be generalizable to a different population and/or setting.
 Long-term effectiveness remains unclear.
 Public health decision makers should advocate for development
and funding of research assessing impact of intersectoral
collaborations, particularly those focused on upstream
interventions.

General Implications
Public health SHOULD consider:
 Intervening in early childhood, given positive effect for kids,
especially for early literacy among children of low-income mothers
 Upstream interventions to improve housing and employment
conditions, evidence of impact for other SDH is limited
 Midstream interventions to improve employment/working
conditions, child literacy, dental health, housing, and organizational
change
 Downstream interventions to increase access to oral health
services, immunization rates, appropriate use of primary health
care services, and referrals from school readiness checks.

What’s the evidence?
Upstream Interventions
 Employment/working conditions: interagency
agreements in multiple US states led to a 25% yearly
increase in supported employment over 5 years in
adults with disabilities
 Housing: national legislation to improve housing
conditions among Australian indigenous communities
led to slight improvements of infrastructure
components but no impact on hygienic conditions

Implications: Practice & policy
Upstream Interventions
 consider implementing upstream interventions
that appear effective, knowing the current
evidence-base is limited
so cautioning that
 advocating for additional, long-term impact
assessment of upstream interventions is needed

What’s the evidence?
Midstream Interventions
 Employment/working conditions (2 studies) –
improvements in employment (76.7% of participants
obtaining employment) and improved working
conditions with 5 workplace changes
 Childhood Literacy (1 study) – improved early
literacy behaviours, increased parents reporting
showing books to their infants daily (53.67% in 2001,
69.44% in 2003), reading aloud to children daily (33% in
2001, 53.70% in 2003), and participation in the Raising
a Reader program (4.3% in 2001 and 16.7% in 2003).

Midstream Interventions,
cont.
 Housing(1 study) – all households received helpful housing
modifications, with decreased hospital admissions for those up to 34
years old, decreased housing-related, preventable hospital
admissions.
 Social & Physical Environments (3 studies) -
 Eight projects resulting from a collaborative demonstrated organizational change and
advocacy projects at multiple levels, but had no impact on program integration or policy
 School-based break time snacking reduced indicators of childhood dental disease (DMFT
changed from 1.13, CI [0.85, 1.40] in year 1 to 1.58, CI [1.28, 1.89] in year 2) and
increased number of filled permanent teeth in lower SES schools over time: mean 0.49,
CI [0.20, 0.77] Year 1 and 1.05, CI [0.69, 1.14] Year 2.
 Chronic disease coalition did not report health outcomes but initiated a
number of programs, policies, and practices with outcomes not yet available

Implications: Practice & policy
Midstream Interventions
 implement school-based break-time snack initiatives as an
avenue to address childhood dental disease
 consider interventions that address employment/working
conditions and childhood literacy, dental health and
housing
 explore collaboratives for community-based and school-
based organizational change, and potential to advocate at
multiple levels
 consider that it is unclear as to whether improvements
lasted long-term

What’s the evidence?
Downstream Interventions
 Oral health: school- and home visit-based oral health education
program led to 32% of children being cavity-free at three years, as
opposed to 8% at study-onset (n=58), with more children having a
primary dental health practitioner and/or receiving preventive care
 Mental health: school-based mental health service led to a
decrease in peer problems and hyperactivity within the intervention
group, but number of problems were still higher compared to the
control group
 Immunization: study involving 23 organizations targeting those
< 5 years of age saw an overall increase in immunization rates of
46% to 80.5%

Downstream Interventions,
cont.
 Case coordination & case management, with
community-based health education and physical activity for youths
and seniors showed 45% of participants established a primary care
provider, with 40% fewer ER visits (p < .05), and decreased patients
with poor diabetic control from 78% to 48% (p < .05).
 School readiness checks in a rural, economically-
disadvantaged community (e.g. oral and vision screening, behavioural
assessment) from trained healthcare professionals maintained a 50%
referral rate over 10 months
 School-based asthma education intervention showed
no impact on urgent health services or school attendance in low-
income ethnic minority families.

Implications: Practice & policy
Downstream Interventions
 implement interventions that improve access to
education and preventive/restorative dental care through
school- or community-based screening and/or referrals
for oral health and access to care
 consider that individual studies demonstrate downstream
interventions improve some aspects of mental health of
refugee children, immunization coverage, chronic disease
management, and school readiness
 No evidence to support school-based asthma education
for low-income, ethnic minority families at this time

General Implications
Public health SHOULD promote / support / implement:
 Intervening in early childhood
 Upstream interventions to improve housing and
employment conditions
 Midstream interventions to improve employment/
working conditions, child literacy, dental health, housing,
and organizational change
 Downstream interventions to increase access to oral
health services, immunization rates, appropriate use of
primary health care services, and referrals from school
readiness checks

Questions?
Contact us: Sume Ndumbe-Eyoh seyoh@stfx.ca

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