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Rural Health Information Hub

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 and homelessness)
  • Transportation (for example: local transportation authority, Medicaid non-emergency transportation organizations)
  • Justice (for example: law enforcement, juvenile justice systems)
  • Faith-based organizations
  • Public health departments
  • Other community-based organizations serving communities that experience inequities (for example: the Cooperative Extension System, Rotary Clubs, Lions Clubs, Kiwanis Clubs)
  • Tribal agencies

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 health.
  • 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, called Project 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.” These 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 system.
  • The Allendale 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.

Implementation Considerations

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 exclusion.

Health Equity and Access in Rural Regions (HEARR) uses an equitable 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 groups)?
  • 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 experience inequities?
  • 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
Date: 2016

Cross-Sector 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)
Date: 4/2020

Cross-Sector 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 (PHNCI)
Date: 7/2019

Going 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
Date: 5/2018

Working 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
Date: 9/2018