Integrated territorial development for health equity : what elements are crucial?

Complex problems such as health inequities and neighborhood revitalization are increasingly addressed through local intersectoral partnerships, causing a multiplicity of venues in which actors can be involved, and... [ view full abstract ]

Complex problems such as health inequities and neighborhood revitalization are increasingly addressed through local intersectoral partnerships, causing a multiplicity of venues in which actors can be involved, and consequently, « hyper-consultation ». To overcome this problem and improve action, communities started to convene actors from local networks in order to implement integrated territorial development approaches. As part of a wider research on the subject of integrated territorial development practices, a postdoctoral intership was carried out. The objective of this component of the research was to enhance participants' understanding of three local networks and support reflection on optimizing collaborative practices. The trainee developed an innovate research method based on a collaborative model for emerging initiatives that assured sharing and use of knowledge, as outlined by the knowledge-based enlightement strategy. A summary of the data highlighted a number of elements to improve common to the three initiatives studied: the need to clarify and assert a clear leadership in order to carry out actions that promote equity; the importance of resources, particularly financing; diversification of sectors represented by partners; level of trust between partners; clarification of roles, particularly elected institutions and managers; and finally, recognition of the approach by local decision makers. In addition, contextual factors specific to the socio-political climate seem to have been critical during the observed period. Indeed, repositioning of the State according to a logic of individual responsibility and phasing of investment in communities in favor of centralization and privatization, destabilized local networks, still being rebuilt. The results will provide a better understanding of local practices and nourish the larger study that will end in 2017, thereby enhancing new ways to deal with complex problems in communities, such as health inequities and adverse living conditions.