Civil Society leaders who coordinate efforts to improve their communities can see where barriers to good health lie and work together to find solutions. They are present across numerous sectors, and are competent to build powerful collaborations to address the many factors that create health. For that reason, they are well positioned to call to action funders, partners, agency constituents, congregants, and community members and inform them about the existing evidence, which can help identify the underlying causes of health problems and work to create solutions.




Community conditions, or community determinants, further translate into unequal opportunities, choices, and access to resources that would allow people to pursue healthy, thriving lives. Focusing on community determinants enables communities to alter the way that structural drivers affect daily living conditions, thus providing the opportunity to improve health and safety and reduce inequities.

In many cases, specific sectors have played historical and/or current roles in the production of health inequities. Cross-sector engagement and collaboration becomes a powerful tool to catalyze and sustain change across the social determinants of health. A critical component in engaging multiple sectors is to better understand key information about each sector by:

  • identifying the roles and contributions of multiple sectors, their similarities and differences; and
  • analyzing how joint efforts across two or more sectors could enhance social determinants of health. 


Fostering shared priorities across sectors includes:

  • identifying the root causes and community conditions that drive illness and injury within a community/region;
  • developing a structured process by which other sectors can help shape priority strategies;
  • and identifying messages that effectively communicate priorities.

More broadly, there is a need for training and capacity building across sectors to foster collaboration with each other, advance comprehensive approaches, actively engage in multi-sector systems to improve social determinants of health, and apply a health equity lens. This is not only about skill-building but about shifting organizational cultures and norms within and across sectors in communities.

Possible challenges for communities to address health equity and reach the SDGs:

  • The determinants of health are interrelated and interconnected. It’s difficult to disentangle any one determinant from one or more others in regards to health equity; they are connected through policies, practices, systems, and sectors, as well as in their impact on communities.
    • A lack of public safety inhibits economic development in communities, which impacts employment, income and wealth.
    • Educational outcomes, income and wealth, and employment are all associated with an increased or decreased risk of violence (public safety), as is the socio-cultural and physical/built environment.
  • Health inequities have been produced through policies and laws, practices, and procedures – some deliberate, some inadvertent, some historical, some current day – that have contributed to health inequities across racial/ethnic and socio-economic lines. In environments where multiple determinants interact to the detriment of health, the production of inequity may be accelerated and compounded across multiple generations. Multiple sectors have a role to play in reversing the production of inequities and in supporting community transformation and health equity.



  • Collaboration Multiplier tool provides an interactive framework for developing deeper understanding across different sectors and can be used to inform ongoing and new collaborations.
  • The THRIVE tool was created to answer the question, “What can communities do to improve health and safety and reduce inequities?” Community leaders can utilize THRIVE to engage community members in identifying priority improvements to the social, physical and economic environment to achieve better health and safety outcomes. Moving from Understanding to Action on Health Equity: Social Determinants of Health Frameworks and THRIVE provides an overview of the development of THRIVE, and reviews its purposes and uses.
    • Working as a thought-partner with the Robert Wood Johnson Foundation, PI conducted an analysis to determine the sectors and systems to engage for achieving health equity, and pinpointing the actions to accomplish to achieve equitable outcomes. The analysis resulted in Countering the Production of Inequities: A Framework of Emerging Systems to Achieve an Equitable Culture of Health. The framework underscores how historical and current policies and laws, practices and procedures produce inequities in health outcomes to inform a concrete understanding of how to begin to reverse or ameliorate the inequities and support communities in transforming to achieve an equitable culture of health. This current work with RWJF builds on our collaborative work last year to produce Measuring What Works to Achieve Health Equity: Metrics for the Determinants of Health, a set of disparity metrics for measuring the determinants of health that must be improved to achieve health equity – including structural drivers, community determinants, and healthcare.
  • A Time of Opportunity: Local Solutions to Reduce Inequities in Health and Safety, prepared for the Institute of Medicine Roundtable on Health Disparities, identifies state and community solutions for addressing inequities and poor health outcomes in our communities and within the healthcare.
  • A Practitioner’s Guide for Advancing Health Equity, released by the Centers for Disease Control and Prevention (CDC), and developed with the assistance of Prevention Institute, focuses on policy, systems, and environmental change, to improve access to healthy food and opportunities for physical activity, as well as to reduce exposure and access to tobacco products.
  • Links Between Violence and Health Equity explains the significant impacts of violence on health and equity.
  • Good Health Counts: A 21st Century Approach to Health and Community for California, makes the connection between factors in the environment—including equitable opportunities, strong social ties, the ability to buy healthful foods, perceptions of safety, and affordable, quality medical services—and their impact on health.
  • Health Equity and Prevention Primer is a web-based training series and curriculum for public health practitioners and advocates interested in policy advocacy, community change, and multi-sector engagement to integrate a health equity lens into their initiatives in pursuit of overall health and safety.
  • Communities Taking Action is a collection of profiles, which showcase successful community initiatives in the United States to improve health equity, and demonstrates key steps for creating healthy, equitable environments to inspire similar action in other communities and locales.
  • Building on Collaboration Multiplier, we created a comprehensive guidebook, Multi-Sector Partnerships for Preventing Violence that details roles and contributions for multiple sectors in preventing violence, provides examples from what’s working around the country, and informs effective collaboration across key sectors. A Multi-Sector Approach to Preventing Violence is a companion overview document, which outlines the approach.


Additional resources

  • The Community Tool Box is an online resource to help people — locally and globally — work together to change conditions that affect their lives and build healthier communities. Established in 1994 as a public service by the University of Kansas and collaborating organizations, the Community Tool Box promotes community health and development by connecting people, ideas and resources. Informed by disciplines including applied behavior analysis, public health, and community psychology, the Community Tool Box is widely used in teaching, training, and technical support; it is available in English, Spanish, and Arabic.
  • Developed by PolicyLink, Getting Equity Advocacy Results (GEAR) builds upon the wisdom and experience of seasoned advocates and action researchers; it offers proven benchmarks, frameworks, and tools for measuring progress in equity-focused policy change across multiple issues. This online tool covers the major elements involved in undertaking advocacy for equity, associated benchmarks and links to additional tools and resources to help advocates increase their effectiveness, identify opportunities to drive change, and demonstrate results.