A huge part of what we do at ReThink Health is “place-based work”—meaning, we collaborate with leaders of multi-stakeholder partnerships around the country, “catalyzing changemakers” as we like to say, and help them to reimagine and transform health in their communities. Over the past decade, we have worked with nearly a hundred partnerships of varying size, scope, and history. Each is incredibly unique. And yet, a broad term such as “multi-sector partnerships” is put forward, it’s easy to forget how distinct each of these partnerships is. It is tempting to make universal assumptions that might not be accurate.
ReThink Health’s 2nd biennial Pulse Check report, released last month, highlights those differences as well as similarities. With responses from more than 230 multi-sector partnerships for health, the Pulse Check paints a more comprehensive picture of the state of the field. By looking broadly at what partnerships are doing, we can identify how many are narrowly focused on a single issue—and what the most common issues are—as compared to how many are taking a broader view. We can pinpoint their locations and identify national trends. We can see whether they are working in a local jurisdiction or more widely across a county or multiple counties. And we can get more specific about the sectors that are involved in the work.
1. Partnership formation is on the rise and many are at the beginning of their development. While some multi-sector partnerships have existed for decades, many more have formed only recently. The vast majority of respondents said their partnerships began after 2009. In fact, over 80 percent more partnerships formed between 2010 and 2015 than in the 24 years prior . While the survey does not reveal how many partnerships there are across the country, it is clear that their formation is a growing trend. For this reason, many are likely contending with a specific set of challenges common to new organizations.
2. Partnerships work primarily at the county or multi-county level. We received responses from partnerships in 42 states, as well as Washington, D.C., and the Virgin Islands. A large majority of those partnerships—49 percent—operate at the county or multi-county level, followed by state (16%) and city (9%). Because the provision of health care, public health, and social services in the United States in highly localized, this doesn’t come as a big surprise. For example, a fundamental activity of many county health departments is the undertaking of community health assessment and planning, and these are often led by multi-sector partnerships.
3. Partnerships approach their work in many different ways. Multi-sector partnerships carry out activities spanning four major areas: health care access, quality, and/ or cost; health behaviors and risk factors; social, economic, and educational conditions; and physical environments. A little more than one-third of partnerships (34%) devote a majority of their time to a single dominant focus; slightly more (36%) are addressing a mix of just two or three; and just less than a third (29%) have a comprehensive portfolio that encompasses all four areas.
4. The sectors involved are numerous and varied. To get a sense of how cross-cutting partnerships actually are, and how well they represent the institutional diversity of a community, the Pulse Check survey proposed a large range of sectors from which partnerships could select to indicate their participants. This list included not only the usual suspects from the health world, but also research and academia, housing and economic development, business, law enforcement, and many others. About half of all responding partnerships indicated active participation from 10 or more sectors, suggesting that many groups involve a diverse range of actors in their work. Public health and health care organizations most often play leadership roles. The least engaged sectors are unions, media, law enforcement, faith-based institutions, and health insurers. So while many groups have successfully engaged an impressive range of sectors in their work, there is significant potential to more deeply involve others.
5. Partnerships get their authority to lead from numerous sources. Because multi-sector partnerships are addressing challenges that cut across many sectors and organizations, they need to be able to influence change in many spheres—with individuals and families, across and within institutions, and at various levels of government. This requires groups to have legitimacy, or what we refer to as “authority to lead,” with many stakeholders in a community. Most partnerships indicate they have multiple sources of authority, including being champions of a widely shared vision, receiving recognition from leaders central to their cause, and being a trusted source of information. Notably, broad-based grassroots support was the least reported source of authority. Since we know that grassroots engagement is essential when working to improve a health in a community, this finding highlights an opportunity for partnerships to more meaningfully engage both community-based organizations and residents in their work.
6. Infrastructure and financing are often the greatest challenges. Most partnerships struggle with fragile infrastructure, which can include limited staff capacity or strained capabilities for cross-cutting functions such as learning and evaluation, communications, operations, and strategic financial management. Additionally, nearly all partnerships named long-term financial planning as a chief challenge. Most groups do not have dependable resources and tend to use financing structures that are short-term in nature, such as grants. Strained infrastructure is a common barrier for all partnerships, especially those that are just starting out. Being attentive early on to building staff capacity, establishing essential operational—or “backbone”—functions, and setting expectations for resource-sharing across participating organizations can help to set a partnership up for sustained success down the road.
As the movement for health transformation continues to expand beyond what any individual organization can accomplish alone, the Pulse Check findings illustrate that multi-sector partnerships are playing an increasingly important role. Those of us who work in this field can clearly see how rapidly the “partnering” space is growing, and data from the Pulse Check confirm this trend. But the findings also highlight how challenging and fragile the work of collaborating can be.
If you see yourself in these findings—or if you don’t—share your own experience in the comments below. And sign up here to be sure you are included in our next Pulse Check survey!