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UBC Theses and Dissertations

Primary care, public health and the intersectoral management of health determinants : a realist inquiry Clair, Veronic


Problem: International bodies such as the World Health Organization call on nation-states to more adequately address health determinants (HD) and strengthen primary healthcare through intersectoral action for health (IAH). Despite many leaders expressing the desire to strengthen IAH, in many countries, practitioners and policy-makers struggle to succeed. This study aims to deepen the understanding of how to maximize the impact on health and HD through collaborations between primary care providers (PCP), public health professionals (PHP), and representatives of sectors other than the health sector (ROS). Method: This research includes a supplementary analysis of a mixed-methods case study on Cuban IAH to clarify and compare the roles of the various actors of interest (PCP, PHP, ROS) in managing HD, including the contexts, mechanisms, and outcomes (CMO) in which IAH occurs in Cuba when involving those particular actors. This is followed by a knowledge synthesis of IAH interventions internationally, providing a variety of different contexts, which enables systematic comparison of the various CMO configurations extracted from those interventions, following a method inspired by realist synthesis. Data for the final CMO analysis and demi-regularity are drawn from both the Cuban case study and the other examples of IAH from around the world that involved PCP, PHP, and ROS. Conclusions: IAH involving PHP, PCP, and ROS can lead to significant, positive health outcomes through the management of HD. A key context in which significant improvement in HD and health outcome occurs is when the IAH are carefully planned based on prior evidence and best practices related to partnership building and public health. Key mechanisms of those interventions include: 1) systematic attention to infrastructures, and activities that successfully increase social capital; 2) which in turn supports the negotiation of complementary and synergistic roles between PCP, PHP and ROS, and 3) using cycles of adjustment based on best practices of quality improvement which enable cumulative and reinforcing synergies over time (years and decades), as projects unfold in complex changing policy and practice environments, and as the multiple actors increase their social capital and experience in dealing with health determinants.

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Attribution-NonCommercial-NoDerivs 2.5 Canada