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Intersectoral work for health: Mirage or oasis?

Patricio V. Marquez's picture

It is common to hear officials from countries and international agencies talk about the multiple challenges that impede intersectoral work for health. The concern is valid: while ministries of health and related institutions are organized and funded to improve the “health” of the population, other ministries do not have such a mandate. In most cases, this has led to a certain paralysis characterized by lofty aspirations in the health sector about the potential benefits of intersectoral action, but with little collaboration and action involving other sectors.

Should we accept the status quo or proactively find entry points to engage other sectors in advancing the global health agenda?

In this context, it was gratifying to see high-level officials from ministries of finance, trade, health, and customs from 14 Southern African countries gather together at an African regional forum on tobacco control held earlier this month in Gaborone, Botswana, organized by the World Bank and the Bloomberg Philanthropies, with support from the Gates Foundation and the World Health Organization.

The forum proved to be a good example of an effective entry point to begin sensitizing non health officials on the importance of adopting government-wide policies to prevent and control the negative health impact of tobacco consumption in a society.

Experts spoke on the nature of the tobacco challenge, explaining how tobacco taxation might be used to achieve public health goals. Discussion also centered on illicit trade and how it might be overcome to prevent it from undermining the effectiveness of high excise taxes on tobacco products that make them less affordable, drawing on international perspectives from a range of countries--Brazil, China, India, Kenya, South Africa, the United Kingdom and the United States.

Representatives from various countries emphasized that in resource-poor countries (e.g., Malawi, Zimbabwe) where tobacco cultivation is part of the farming system of large number of smallholder producers and is the only cash crop, there is need to support agricultural diversification to help farmers move away from tobacco dependence.

It was evident that sharing knowledge and country experiences is key to dispelling myths and misconceptions in favor of evidence, establishing common understanding across sectors about the social and economic determinants that influence health, and identifying interventions to open doors for intersectoral collaboration.


Also, the opportunity for peer-to-peer learning, and both Kenya’s and Mauritius’s willingness to share their expertise in tobacco control with other countries, showed that cooperation between African countries, along with international assistance, could help carry intersectoral work forward.

I left Gaborone convinced that reaching out to other sectors is not only possible but actually critical if we aree going to advance the global health agenda. Perhaps now that the forum has helped establish an intersectoral connection, international partners could support the Southern African countries as they develop multisectoral policies and actions to overcome the many hurdles they face in implementing effective tobacco control measures.


In doing so, we should not forget the eloquent words of the Minister of Health of Botswana, the Hon. Rev. Dr. John Seakgosin, who advised us to keep in mind that “tobacco causes sickness, pain, grief and misery, and that its impact is impossible to measure in only monetary terms.”


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Comments

Submitted by Hana Ross on
It is encouraging to see the emerging collaboration between different government sectors in Africa and Asia, and among large agencies with global reach (such as the World Bank, the International Monetary Fund and regional developmental banks). The two recent high level meetings (in Gaborone and in Manila this June) are a great example of how to further promote such collaboration that could result in better health outcomes, and economic growth.

Submitted by Anonymous on
Your observation is important. In the reshaping of the global health agenda, it is critical to recognize, advocate and faciliate the engagement on non-health sector actors, both at the national and international levels. An arsenal of multisectoral interventions has the potential to significantly contribute to the improvement of the health status and the well being of the population. --Patricio

Submitted by Anonymous on
While the author makes several important points on multisectoral factors in health that I agree with, the central role of Ministries of Health in addressing health issues should not be downplayed. Focusing on other sectors sometimes serves to justify the failure of health sector interventions. Immunization program efforts, other maternal and child health interventions, routine health service delivery, disease surveillance, NCD information communiation, etc. can be main contributors to overall burden of disease reduction, if implemented effectively. Perhaps the World Bank's HNP sector is trying to avoid accountability for failure to achieve better results by pointing to other sectors??

Submitted by Anonymous on
Your observation is valid, but intersectoral action for health does not imply that the role of health sector institutions such as a the Ministry of Health is to be downplayed. The contribution of health services, as you mention, is critical to prevent disease (e.g., immunization programs) or to treat diseases in a health facility once they develop (e.g. cancer) or to deal with emergency situations that require medical care (e.g., hemorrhage during child delivery or trauma after a car crash). So public health and medical care are integral parts of the intersectoral action for improving health conditions. Having said that, the public health arsenal will be enriched and good outcomes generated if other sectoral interventions are mobilized: e.g., excise taxation to make cigarrete consumption unaffordable, or police action to enforce laws to prevent drinking and driving. --Patricio

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