The Center for Sharing Public Health Services (CSPHS) and the Public Health National Center for Innovations (PHNCI) are co-leading the Cross-sector Innovation Initiative (CSII), a three-year endeavor to identify and support public health, healthcare, social services, and community organizations striving to build stronger, sustainable connections and systems that can more effectively address the needs of communities and ultimately improve health equity. Often, cross-sector collaborative efforts are temporary due to funding constraints or block funding, lack of incentives, and structures that do not lend themselves to more permanent relationships. By implementing systems alignment strategies, collaboratives work towards sustainability and ensure joint efforts are built to last and offer greater impact.

The CSII is comprised of ten cross-sector projects working towards specific population health goals through systems alignment efforts as outlined in the Framework for Aligning Sectors. The wide range of population health and equity issues being addressed by CSII grantees include:

• Birth outcomes
• Breastfeeding
• COVID-19
• Family violence
• Food security
• Housing
• Mental health
• Physical activity
• Substance use disorder
• Social connectedness
• Structural racism
• Tobacco prevention
• Trauma-informed care

Collaboratives rooted in a set of shared priorities based on community goals and needs can improve how organizations operate internally and with each other, as well as make sustainable progress toward disproportionately affected populations most at risk of inequities. To achieve this, systems alignment requires that sectors and leaders honor community voices, strengthen trust, and examine and shift power to share a purpose and a set of priority outcomes; create and use a shared data and measurement system; establish sustainable financing with incentives and accountability; and have strong governance infrastructure with leadership, appropriate roles, and defined relationships.

After a year of engagement with CSPHS and PHNCI, the CSII partnerships have shared learnings, and further underscored the unique challenges and opportunities that cross-sector partners face as they work together to improve population health, wellbeing, and equity for all.

Impact of COVID-19 and Racial Justice & Health Equity Movement

CSII grantees have adapted their work in response to the COVID-19 pandemic and national attention to racial justice. Across all core components of the Framework for Aligning Sectors, CSII grantees described the pandemic as deepening competing priorities, time pressures, delays and changes implementing existing project plans, and challenges in fully engaging partners and community members in conversations and decision making through virtual platforms. While multiple CSII grantees were focused on addressing structural racism prior to 2020, they shared that there was an influx of new partners and deepened investment from existing partners due to the events of the past year.

• Partners like governmental agencies, elected officials, and community organizations were newly willing to engage with ongoing efforts to address structural racism.
• Existing partnerships were strengthened through increased involvement in partner capacity-building opportunities, like anti-racism trainings, and were increasingly interested in taking action on the results of previous equity assessments.
• Resources were pooled to fund partners engaging in addressing structural racism
• New racial equity workgroups were formed.

When addressing the core components of the Framework for Aligning Sectors, there were slight differences in how current events impacted the planned work for grantees. For example, in discussing shared vision and priority outcomes, as well as governance, some CSII grantees shared the need to pivot focus to understanding immediate and emerging needs of community. On the other hand, progress on a shared data and measurement system was affected quite differently, where CSII grantees shared that staff with technical expertise – mostly from the public health sector – were redirected and heavily focused on immediate COVID-19 response efforts, thus pushing timelines for longer term, strategic efforts. Additionally, progress on sustainable financing towards aligning systems was hindered due to the climate of financial uncertainty created by COVID-19, and the need for funding to be redirected to more urgent needs.

Bright Spots

Despite the ongoing focus on urgent needs over the past year, CSII grantees noted that trusting relationships, partner commitments to cross-sector work, and the inclusion of community voice and broad community participation helped advance progress toward meeting the core components of the Framework for Aligning Sectors. Specifically, CSII grantees shared that partner leadership’s commitment to the collaborative, even with increased challenges, was essential to progress. Additionally, CSII grantees observed increased momentum towards addressing structural racism and inequities, the need for appropriate human resources and complementary funding sources, and strong collaborative and authentic processes to engage partners and community members, which produced many champions for cross-sector activities.

A common theme highlighted across the CSII grantees was how the events of the past year led more partners and communities to declare racism a public health crisis. For some, this was brought about by disparities in COVID-19 infections and deaths in their communities. Moving forward, these declarations will enable CSII grantees and their partners to focus on racial equity when considering current and future policies targeted at addressing population health, in addition to building a larger network of public and private partners willing to engage in efforts to address structural racism. 

Public health, healthcare, social service, and community organizations must have the capacity and urgency to improve how they work within their organizations, together, and with community members. By working toward a set of shared priorities based on community goals and needs, cross-sector collaboratives will make sustainable progress toward improving health and wellbeing in their communities. 

Interested in learning more? Stay tuned for the release of four topical briefs and an executive summary during the week of April 19th that dive deeper into community and partner engagement strategies, health equity and population health goals, alignment efforts, and innovations related to cross-sector alignment.