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The importance of the built environment as a critical influence on public health is receiving increasing attention from researchers, planners and health professionals. While it seems impossible to identify specific causal influences and their impacts, there is a convincing need for action. The multifaceted, interconnected character of both influences and impacts suggests the need for collaborative, multi-sectoral approaches. Drawing from a recent study of multi-sectoral collaboratives in Ontario that are focused on improving health through changes to the built environment, this paper briefly discusses some of the lessons that were learned by collaborative participants. Each lesson is described in the context of a different collaborative. While not presented as the definitive lessons, they were all identified as important to effective multi-sectoral collaboration. For example, "Just try it!" and "Honour the process of the community"--illustrated using the communities of Haliburton County and Timiskaming District-offerconstructive suggestions for collaboratives entering into this type of work. Several "truths", which provide a cautionary note, are also described. "It takes time" and "Context is critical" are nearing platitudes, yet are valuable enough to bear repeating. The general conclusion is that multi-sectoral collaborative efforts make an important contribution to addressing the challenges and that such collaboratives benefit from the involvement of health professionals, planners, citizens and politicians.
Les chercheurs, les planificateurs et les professionnels de la sante s'interessent de plus en plus a I'influence essentielle de I'environnement bati sur la sante publique. Bien qu'il semble impossible de degager des influences determinantes et leurs consequences, il est neanmoins essentiel d'agir a cet egard. Le fait que les influences et leurs consequences presentent plusieurs volets et soient inter-reliees donnent a penser qu'il y a lieu d'adopter des approches collaboratives et multisectorielles. Se fondant sur une etude recente de collaborations multi-sectorielles en Ontario axees sur ('amelioration de la sante par I'intermediaire de modifications apportees a I'environnement bati les auteurs du present article examinent certaines des lecons transmises par les participants a ces collaborations. Chaque lecon est decrite dans le contexte d'un projet de collaboration different. Bien qu'elles ne soient pas presentees comme des lecons definitives, toutes ont ete jugees importantes a regard de collaborations multisectorielles efficaces. Par exemple, Just try it! (Essayez pour voir!) et Honour the process of the community (Honorer le processus de la collectivite), illustres en se servant des collectivites de Haliburton County et de Timiskaming District, offrent des suggestions constructives pour des collaborations qui entreprennent ce type de travail. On y decrit egalement plusieurs [much less than]verites[much greater than] qui fournissent une certaine mise en garde. It takes time (Cela prend du temps) et Context is critical (Le contexte est essentiel) sont des avertissements bien connus, qu'il vaut tout de meme la peine de repeter. En conclusion generale, les initiatives de collaboration multisectorielle contribuent de maniere importante a la resolution des enjeux et profitent de la participation des professionnels de la sante, des planificateurs, des citoyens et des hommes politiques.
Keywords:
Multi-sectoral collaboration, best/promising practices, health, built environment
Introduction
As noted in the introduction to this theme issue, the linkage between health and the built environment is being given increasing attention. While there is no exacting understanding of the linkages--nor any expectation that there will be, given the complexities involved--there is sufficient evidence to suggest a need for change. Given that influences and impacts are multifaceted and that relevant knowledge is to be found across disciplines, successful interventions are likely to be collaborative and multi-sectoral in nature. In particular, campaigns and programs might best involve planning, health and environmental experts and organizations. Support for such approaches can be found in several recent reports--and in observing the diversity of associations publishing them: Ontario College of Family Physicians (Abelson et al. 2005), Ontario Professional Planners Institute (2007), Canadian Mental Health Association, Ontario (2008) and others.
The Ontario Healthy Communities Coalition (OHCC), given their mandate and their awareness of this type of health impacts, successfully sought funding for a project linking healthy communities and the built environment (OHCC 2008). One part of the project was to explore the best/promising practices of multi-sectoral collaboratives focused on improving public health through the built environment. This paper draws on the final report (Tucs and Dempster 2008), which featured seven multi-sectoral collaboratives in Ontario (Figure 1). The report spoke to experiences, insights, lessons and knowledge of collaborative participants. The study also sketched some of the successes, challenges and opportunities the collaboratives faced and also included brief descriptions of the organizational structures and resources of the collaboratives--as well as their social, cultural and political contexts. The studies were based on brief conversations with and/ or written contributions from members of the collaboratives.
[FIGURE 1 OMITTED]
What follows are a few lessons from the multi-sectoral collaboratives that were featured in the report--key elements of success that we all might learn from. We present seven stories, where each illuminates one of seven lessons. The case studies were not exhaustive, nor was there a comprehensive review, analysis or assessment of practices and principles. Our intention was to share practices that each collaborative identified as important and then to provide details enabling others to grasp the reasons for their emergence and the "realities" surrounding them. As a further distillation of the report, the discussion here is presented in even more general terms. For additional details please refer to the report or use the contact information for each collaborative included in the report to find out more.
Seven stories, seven lessons
From our perspective, there are many more than seven lessons to be learned from the efforts of the multi-sectoral collaboratives we studied. For this paper, we selected lessons that had been emphasized by participants, that seemed poignant to us and that could be readily illustrated in a shorter paper. In each of the following seven examples, we provide a very brief description of a collaborative and a lesson relevant to multi-sectoral collaboration that arises from their work.
Just Try It!:
Active Transportation Planning in Haliburton County
The Communities in Action (CIA) Committee is an informal organization operating under the Haliburton County Community Cooperative (HCCC), which is an umbrella not-for-profit organization that provides support to small organizations that lack capacity and resources. The CIA Committee benefited from HCCC's support while promoting active transportation and active transportation planning in Haliburton County. As in other rural communities, the distances between home, work, school, recreation and commercial areas have led to a strong car culture. Not surprisingly, encouraging active transportation such as walking and cycling is seen as one way to improve the health of rural residents.
Organizationally, the CIA committee has a chair, a project coordinator and someone to manage the budget. Aside from the responsibilities assigned to these roles, all members share an equal voice at the table. The committee also has a number of partnerships with other groups and organizations. In all, there is participation and support from health units, townships, the County, a research centre and community health, trail and cycling groups. Members and partners acknowledge their flat committee structure can be challenging and suggest their success is a consequence of the experience and capacity of group members, each of whom has been involved in many community initiatives.
In spite of this knowledge and experience, a central challenge for the collaborative was the lack of know how and experience around Active Transportation (AT) planning in a rural context--including a lack of knowledge and experience in other communities. One of their key lessons: Just try it!
The collaborative began by bringing together representatives from appropriate sectors--people and groups who knew how to get things done at a community and political level. The multiple skills and perspectives enabled a more comprehensive and well-informed approach and helped bridge specialized disciplines and ways of doing things. Working together through common goals and objectives led to increased social capital within and among the group and its partners.
The Committee--in collaboration with community residents--took AT ideas that were known to work in urban settings and wove them together with their understanding of their own communities. This led to a workplan of priorities and activities they thought could work in a rural context. The workplan functioned as a guide "but [we] were flexible on its implementation and involved the community in the planning and design process". The group also recognized that continuous monitoring and the workup of data were critical for project evolution. It allowed the group to take advantage of opportunities and adapt to challenges that arose along the way.
The "call to be 'innovators' in rural AT planning" was identified as both "a challenge and an opportunity" by the CIA Committee. The project demanded that the committee 'think outside the box' and think about and listen to the community, perhaps in ways beyond the familiar. They have since become experts in rural AT planning and have been asked to present their work to other communities.
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