Cross-Sector Collaborations in Public Health for Promoting Physical Activity, Advancing Health Equity, and Reducing the Prevalence of Chronic Disease in the U.S.

Abstract

Rates of chronic diseases such as obesity and diabetes are on the rise in the U.S. disproportionately impacting the Hispanic population. At the local level, public health services research has been focused on the impact of local health department (LHD) performance on improving population health outcomes. State health departments (SHDs) also engage in promoting health equity and reducing chronic disease disparities through cross-sector collaborations, but gaps in the literature exist regarding factors that promote the effectiveness and sustainability of such efforts. Yet, health department engagement could affect performance in and the sustainability of cross-sectoral public health initiatives. This dissertation aimed to explore how the current public health infrastructure within the U.S. can support the engagement and sustainability of cross-sectoral collaborations for promoting physical activity, advancing health equity, and reducing the prevalence of chronic disease. To add to the existing literature, we utilized the Cross-Sector Alignment Theory of Change and the Chronic Disease Prevention/Healthy Living Promotion (CDP/HLP) Framework to design a multi-method research study for examining cross-sectoral collaborations. We examined formal, written strategies (FWS) in association with LHD engagement in cross-sectoral collaborations for obesity prevention. We conducted a quantitative analysis to determine relationships between a FWS for obesity prevention and the level of LHD engagement in cross-sector collaborations targeting health promotion. Then, LHDs identified as either highly or moderately engaged in obesity prevention efforts were purposively sampled for a qualitative analysis to identify factors within LHDs that assist in maintaining engaged and sustainable cross-sector collaborations that promote PA, particularly for the Hispanic community. Finally, an additional qualitative analysis aimed to (1) explore specific characteristics of existing collaborations between SHD and external organizations that promote the engagement and sustainability of health equity initiatives and (2) identify organizational strategies that SHD staff and partners perceive to be successful in addressing chronic disease disparities through cross-sectoral collaborations. The studies described here utilized frameworks to evaluate the impact of health department engagement on outcomes and organizational strategies to support the engagement and sustainability of cross-sectoral partnerships. In each study, findings support the need for resource and capacity building, particularly in smaller health departments that serve rural areas. For LHDs prioritizing marginalized populations, there is a need to integrate the social determinants of health (SDOH) into culturally appropriate interventions through partnerships with community-based organizations. When examining state-level organizational strategies for ensuring engagement and the sustainability of cross-sectoral collaborations, public-private partnerships (PPPs) were key to increasing organizational capacity to develop and maintain health equity initiatives that strive to reduce chronic disease disparities.