Fostering Multi-Sector Collaboration to Advance Health Equity
Multi-sector collaborations can help advance health
equity by bringing together partners that can address multiple factors that drive health disparities, including
the social determinants of health. Rural communities should consider convening
partners from various sectors to help target upstream factors that affect health. Many rural communities are
already convening coalitions and partnerships to advance health; for example, as part of an effort to develop
and implement a Community Health Assessment and a Community Health Improvement Plan or through community
advisory councils. Rural communities can explore strategies to promote equitable practices in existing
partnerships and consider whether additional partnerships are needed to advance health equity.
Potential partners for multi-sector
collaboration will depend on several factors but may include representatives from the following sectors:
Education (for example: pre-K, K-12 schools, job training programs, colleges and universities)
Economic (for example: community development institutions, small businesses, agriculture, Federal Reserve)
Social Services (for example: child welfare organizations; Women, Infants, and Children (WIC) programs)
Housing (for example: local housing authorities, community-based organizations focused on housing insecurity
Transportation (for example: local transportation authority, Medicaid non-emergency transportation
Justice (for example: law enforcement, juvenile justice systems)
Public health departments
Other community-based organizations serving communities that experience inequities (for example: the
Cooperative Extension System, Rotary Clubs, Lions Clubs, Kiwanis Clubs)
The Build Healthy Places Network offers a Primer for Multi-Sector Health
Partnerships in Rural Areas and Small Cities that discusses different models and levels of complexity
for partnerships between community development organizations and healthcare systems.
A key consideration for creating multi-sector collaborations is how to engage communities that experience
inequities. These communities are in the best position to inform policies and programs that affect their
community members. There may be organizations, coalitions, and other groups in rural communities that are
already organizing but might not have a seat at the table. By collaborating with existing organizations and
groups, rural communities can amplify their work and begin to address mistrust that may result from historic
exclusion and abuse. Engaging
Community Members Affected by Health Inequities provides additional information about authentically
engaging the community in multi-sector collaborations.
Examples of Rural Multi-Sector Collaborations
Marshall Browning Hospital and
Pinckneyville Hospital is establishing a multi-sector collaboration to address a community mental
health crisis. In addition to hospital staff, the collaboration includes representatives from county
schools, local libraries, businesses (such as local restaurant and hotel owners), emergency medical
services, law enforcement, the local health department, the local housing authority, and counseling centers.
The coalition is also planning to host community forums to help create an agenda for addressing mental
Adventist Health Clear
Lake, a Critical Access Hospital in rural Lake County, California, helped organize a cross-sector
collaboration to meet the needs of people who were high utilizers of healthcare and emergency medical
services, many of whom were without housing. The collaboration was organized around a model of authentic
healing relationships, shared aims, patient-centeredness, and community engagement. The collaboration,
Restoration, mobilized to open a transitional housing facility. The clients of the facility are
enrolled in Project Restoration, which also includes representatives from local government, law enforcement,
first responders, and community agencies.
The Williamson Health and Wellness
Center's Healthy in the Hills Network includes members of communities that experience inequities in
Mingo County, West Virginia. All members of the network have decision-making ability as all
strategies are decided by vote. In addition to the Williamson Health and Wellness Center, other network
members include Mingo County Schools, Williamson Parks and Recreation, local sports leagues and gyms,
West Virginia University Extension Service, local businesses, Mingo County Development Authority, Mingo
County Family Resource Network, and the Williamson Farmers Market, among others.
Community ownership is the cornerstone of the 11 coalitions that participate in the Georgia Health Initiative (formerly the Healthcare Georgia Foundation) Two
Georgias Initiative and is part of the long-term sustainability strategy for the Initiative. When
communities lead their own coalitions, they are more invested in the continued success of the partnerships.
The coalitions received guidance from Georgia Health Decisions, a technical assistance provider focused on
community and coalition building.
Rhode Island's novel Health
Equity Zone (HEZ) initiative is a prevention-focused community-based approach to advancing health
equity. Each HEZ is led by a community collaborative with an administrative “backbone organization.”
collaboratives conduct a community assessment to describe assets and priority inequities to address, engage
community members and other partners to join the effort, and develop an action plan to address the
inequities identified in the community assessment. Collaboratives then move into implementation, updating
their action plan each year to include lessons learned. For example, Healthy Bodies, Healthy Minds
Washington County is working on transforming behavioral health by focusing on priority issues of
culture change, self-determination and inclusion, parity and treatment, and addressing gaps in the crisis
Broadband Pilot Project brought together a cross-sector collaborative with partners from state and
local government, school districts, and corporate entities. The pilot helped increase access to broadband
infrastructure in rural Allendale County, South Carolina. Key projects included establishing public Wi-Fi
hubs at community locations and residential Wi-Fi access in approximately 1,000 homes. The broadband access
will help rural students access distance learning opportunities.
Engaging in equitable multi-sector collaborations can be challenging. Partners may have differing priorities,
levels of commitment, and experience with group collaboration. Rural communities may also be required to
consider opportunities to share power and decision-making abilities with other community members who experience
inequities. Many rural communities have sought technical assistance and engaged in training to receive guidance
on building effective and sustainable coalitions and collaborations.
External coaches and consultants can help rural communities gain skills in meeting facilitation, consensus
building, and co-creation of strategies. External facilitators can also guide collaborations as they have
complex conversations about the root causes of health inequities, like racism, discrimination, and historical
Health Equity and Access in Rural Regions (HEARR) uses an
collaboration framework to help communities address priority issues related to health and environmental justice.
The framework is trauma-informed and promotes
inclusion of people who may have been historically excluded from decision-making in their communities. The
California Accountable Community for Health Initiative sites received training in the Art of Hosting method of group facilitation.
Maintaining multi-sector collaborations over time is critical to avoid eroding trust with communities that
experience inequities. However, sustaining these collaborations remains a key challenge for many rural
communities. Module 6: Funding and Sustainability
for Rural Health Equity Programs provides strategies for thinking about sustainability from the onset of
program planning for health equity initiatives.
Questions for Consideration
Are we engaging organizations and groups that serve communities that experience inequities?
Are we recognizing different kinds of groups (for example: sports leagues, local businesses, faith-based
What are the power dynamics among members of the collaboration? How can the collaboration be intentional
about addressing power imbalances?
How are decisions made through cross-sector collaborations? Who has a say in resource allocation?
How are partners holding themselves accountable?
Are there opportunities for the multi-sector collaboration to develop rural leaders among communities that
What plans are in place to sustain the collaboration over time?
Program Clearinghouse Examples
Resources to Learn More
Community-Clinical Linkages for the
Prevention and Control of Chronic Diseases
Provides key considerations and action steps for public health practitioners seeking to foster relationships
between communities and clinical sectors to advance population health.
Organization(s): Centers for Disease Control and Prevention
Collaboration for Improving the Health of Communities: You Can't Do It Alone
Discusses the Readiness Matrix for Cross-Sector Collaboration to help partners assess commonalities and
potential barriers when working together. Describes the Community Population Health Expansion Matrix to help
partners consider opportunities to move from the status quo to collaborating on the need for change.
Author(s): Bialek, R. & Moran, J. W.
Organization(s): Public Health Foundation (PHF)
Innovation Initiative: Environmental Scan Full Report
Highlights results of an environmental scan exploring models, roles, key resources, and best practices for
cross-sector collaborations. Discusses evidence about the impact of these partnerships to address the social
determinants of health and improve health equity.
Organization(s): Center for Sharing Public Health Services, Public Health National Center for Innovations
All In to Improve Health Through Multi-Sector Collaboration and Systematic Data Sharing
Discusses promising practices to improve health, advance health equity, and address social determinants of
health through multi-sector collaborative data sharing and linking of information systems. Describes potential
barriers to multi-sector collaborations and how to effectively address them.
Organization(s): Data Across Sectors for Health (DASH), County Health Rankings and Roadmaps
Together: A Guide to Collaboration in Rural Revitalization
Provides recommendations for and examples of cross-sector collaboration for the purpose of rural revitalization.
Focuses on three key components for success: coming together, staying together, and growing together.
Author(s): Savage, A., Brune, S., Hovis, M., et al.
Organization(s): North Carolina State University Extension