Identifying cross-sectoral cooperation for urban health

Abstract   Empirical evidence for collaborative health promotion practices is still limited. The Cross-Sectoral Cooperation Self-Assessment Tool (CroCo SA) presented here provides a tool for cities to assess their current commitment to promote urban health and well-being across sectors. The SA tool was validated by co-operating with 9 pilot cities and seven countries in the framework of the Healthy Boost project funded by Interreg Baltic Sea Region (2019-2022). Addressing the current complexity, interdependence and emerging challenges of health promotion requires cross-sectoral cooperation and tools to assess cross-sectoral processes and make their impact visible. A digitized CroCo SA tool was developed and validated. An SA evaluation matrix was created, including 162 cells of options for reflective and guiding responses according to 6 scale x 27 items used in the SA tool. After submission of the electronic form, respondents can view anonymized results in a digital form on the Healthy Boost platform. The feedback report summarizes the results for respondents and provides, both numerical and descriptive, verbal feedback on the state of the assessed city's capacity for cross-sectoral cooperation, based on each assessment. The steps the respondents could take in their respective cities to improve cross-sectoral cooperation are outlined. Recommendations are based on the evidence found to be the prerequisites for effective cross-sectoral work for health promotion. SA can be conducted in many languages offered by the Google translation programme. Guiding feedback of CroCo SA defines areas for improvement in strategies and actions, allowing respondents also to do benchmarking and learn from other cities and countries. Self-assessment itself is a learning process. Key messages • The CroCo SA tool offers a method for gathering information about the state of cross-sectoral cooperation for urban health promotion. • By identifying strengths and weaknesses in cooperation, the city can build capacity for cross-sectoral cooperation.


Background:
In both scale and impact, population ageing has far reaching implications for our planet, not least as a major driver of population growth and the ever-increasing human demands on natural resources and ecosystems. This fundamentally impacts sustainable development efforts to eradicate poverty, achieve food security, build inclusive and resilient communities, and ensure sustainable consumption. The overarching connections between global ageing and sustainability are clear: a focus on sustainable healthy ageing is fundamental to a healthy planet. Our responses to date have however largely been disconnected. To progress this dual agenda, our work aims to i) assess whether current national/international strategies addressing healthy ageing include a strategic focus on sustainability; ii) present the evidence for such alignments; and iii) develop a framework of sustainable actions and aligned policy.

Methods:
A mixed-methods approach using content and applied thematic analysis was utilised to examine strategy documents, and develop an analytical framework derived from relevant theory to guide quantitative and qualitative analysis of the resultant data. Evidence themes were developed iteratively during analytical phases. Findings informed the development of the framework.

Results:
We identified and analysed 36 strategies published from 2000 to 2021 containing over 600 wide-ranging policies. No strategies and only a minority of policies included a strategic sustainability focus. A larger subset made reference to links between ageing and sustainability or environmental elements yet these were largely theoretical and not carried through in the key strategic approaches or resulting polices.

Conclusions:
This work provides valuable insights into strategic approaches to foster sustainable healthy ageing and identifies levers for greater alignment and sustainable action. The recently declared 2021-30 UN Decade of Healthy Ageing provides an ideal platform for action.

Key messages:
While the evidence for strong alignment is unequivocal, global healthy ageing and sustainability agendas are largely disconnected. By strengthening the links between healthy ageing and sustainability agendas, stakeholders across sectors can reinforce and design approaches that meet human needs while protecting our planet. Empirical evidence for collaborative health promotion practices is still limited. The Cross-Sectoral Cooperation Self-Assessment Tool (CroCo SA) presented here provides a tool for cities to assess their current commitment to promote urban health and well-being across sectors. The SA tool was validated by co-operating with 9 pilot cities and seven countries in the framework of the Healthy Boost project funded by Interreg Baltic Sea Region (2019-2022). Addressing the current complexity, interdependence and emerging challenges of health promotion requires cross-sectoral cooperation and tools to assess cross-sectoral processes and make their impact visible. A digitized CroCo SA tool was developed and validated. An SA evaluation matrix was created, including 162 cells of options for reflective and guiding responses according to 6 scale x 27 items used in the SA tool. After submission of the electronic form, respondents can view anonymized results in a digital form on the Healthy Boost platform. The feedback report summarizes the results for respondents and provides, both numerical and descriptive, verbal feedback on the state of the assessed city's capacity for cross-sectoral cooperation, based on each assessment. The steps the respondents could take in their respective cities to improve cross-sectoral cooperation are outlined. Recommendations are based on the evidence found to be the prerequisites for effective cross-sectoral work for health promotion. SA can be conducted in many languages offered by the Google translation programme. Guiding feedback of CroCo SA defines areas for improvement in strategies and actions, allowing respondents also to do benchmarking and learn from other cities and countries. Self-assessment itself is a learning process. Key messages: The CroCo SA tool offers a method for gathering information about the state of cross-sectoral cooperation for urban health promotion. By identifying strengths and weaknesses in cooperation, the city can build capacity for cross-sectoral cooperation.