State agency staff members and leaders of nonprofit social service organizations report multiple advantages to using a cross-sector approach to address health inequities—preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are caused by social, economic, and environmental factors. Addressing these complex problems requires collaboration among state agencies—such as departments of health, environment, transportation, and social services—and community partners.
The potential benefits of these joint efforts are clear. When state agencies work closely with community-based organizations, they can further their reach and impact, promote equity, involve stakeholders and local residents in decision making, and better meet community and social needs. These efforts can diminish longstanding silos—in work, processes, and focus—resulting from narrow funding streams and complicated bureaucratic structures. Concentrating shared attention on problems can lead to solutions that better align resources and improve systems and health outcomes. Once the critical infrastructure and relationships have been established, such collaboration can be applied to other issues, in health equity and beyond.
However, developing effective cross-sector partnerships can be difficult. Staff turnover, for example, can blunt momentum by disrupting the relationships and institutional knowledge that are key to progress. In addition, bureaucratic silos can deter improvements. And other priorities, such as responding to the COVID-19 pandemic, can derail efforts to address critical public health problems.
The Health Impact Project, a collaboration between the Robert Wood Johnson Foundation and The Pew Charitable Trusts, has enabled and supported cross-sector efforts to reduce health disparities and inequities in maternal and infant health in nine states and the District of Columbia. Below, staff members from four state agencies that took part in the Calling All Sectors: State Agencies Joined for Health initiative describe some of the benefits and challenges of working in these teams.
Answers have been edited for clarity.
Q: How did this cross-sector initiative impact your work, organization, partners, or target population?
Dr. C. Anneta Arno, Ph.D., MPH, director of the Office of Health Equity at the D.C. Department of Health: “Our office aligned priorities pertaining to perinatal health, housing insecurity, and homelessness to implement an equity-informed, multisectoral solution. D.C. residents with the lived experience of concurrent homelessness and pregnancy were engaged and invited to share their stories. Key district agencies collaborated on system-level changes that will address barriers to safe and stable housing for all pregnant individuals.”
Kelsee Torrez, behavioral health consultant for the Kansas Department for Health and Environment: “Calling All Sectors allowed for contacts and connections to be established across state agencies. This contributed to improved alignment, collaboration, and consistency. It also established a precedent for partnership with individuals with lived experience, which we can continue in future initiatives.”
Amanda Brunson, special projects officer for child welfare at the Louisiana Department of Children and Family Services: “This initiative allowed multiple state agencies to work with a community partner from the ground up. The team learned together, made decisions together, and carried out work together. This is a very different model than what has happened in the past.”
Paul Throne, director of Washington State WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children) at the Washington State Department of Health: “Our project can serve as an example of community engagement and empowerment, and it demonstrates that government-run programs can be open to participant input and guidance.”
Q: What challenged you or your partner organization’s ability to achieve its objectives?
Arno: “At the beginning of the initiative, the agencies’ and community’s active interest in the project’s priority population created a supportive environment. Buy-in from core partners and warm handoffs when staff turnover occurred were key to maintaining collaboration and momentum. The COVID-19 pandemic did shift priorities and may have temporarily delayed progress, but the Office of Health Equity leveraged the extended support and timeline to engage more deeply with partners and meet our goals.”
Torrez: “Most significantly, turnover in key personnel impacted progress in achieving desired outcomes. This resulted in a loss of momentum and vision, and it required a new focus on relationship-building and regular modifications to the work plan.”
Brunson: “COVID-19 had a major impact on this project. There is immense value to meeting in person, which was lost. We also experienced turnover with several of the initial team members, but when we were able to replace some of them, we gained unique perspectives and renewed energy.”
Throne: “COVID-19 had a significant impact on our scope and timeline. All state staff and community partners were forced to adjust to completely new ways of working and connecting. In addition, the project team went through a major change when the decision was made to shift focus to WIC as a driver of outcomes for Black birthing families. This required additional data—and the time and expertise to interpret it. This time was well spent, however, as it led to a solid decision regarding the geographic area of focus for this work.”