Integrated Governance and Healthy Public Policy: Two Canadian Examples

Healthy public policy is by nature intersectoral because those in the health sector are seeking to affect policy in other sectors. Intersectoral work is required, in particular, to address the determinants of health and to reduce health inequalities. There is a growing body of study on multi-sectoral approaches, or integrated governance approaches, as we have named them. To contribute to this body of study, and within this context, we present two examples of initiatives with healthy public policy goals recently implemented in Canada. The initiatives are designed to better coordinate public policies in multiple sectors of government activity so as to improve health outcomes. In this paper, we explore the initiatives as examples of integrated governance, describing their conceptual frameworks and implementation strategies, and noting their potential and limitations as identified in our review of the literature on integrated governance initiatives.

The two examples referred to are the strategies surrounding section 54 of Québec's Public Health Act and ActNow BC. We have chosen to focus on these examples for two reasons. First, they have received a certain amount of coverage in the public health world and are therefore relatively well known. This makes them useful reference points for discussion. Second, the two examples differ in their contexts, their conceptual frameworks and their implementation strategies. These differences provide an interesting set of factors to consider.

We emphasize that our paper does not seek to evaluate the effectiveness of the initiatives, nor to identify the “better” initiative. It intends rather to present a reflection that can further inform the conceptualization and implementation of these types of initiatives.

The paper is divided into four sections. First, we situate the concept of healthy public policies within the wider field of related integrated governance approaches (horizontal or vertical management, intersectoral action, intersectoral or interministerial cooperation, whole-of-government, network government, etc.). Second, we provide a description of the two example initiatives. Third, we present some proposals from the scientific and grey literature about success factors for integrated governance initiatives and use our initatives to exemplify these factors where present. Finally, in conclusion, we propose a few avenues for reflection about such initiatives.

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