Glossary and additional resources: The Intersectoral Action Fund

Glossary of terms

The terms below are listed in alphabetical order.

Community

A group of people who share something in common. A community can be formed from geographic location, identity factors, shared experiences, or other attributes that create a sense of belonging or interpersonal connection among its members.

Community resilience

A resilient community, whether defined by geography, interest, experience, or identity, is one that has the resources and capacity to help prevent, withstand, and recover from and adapt to challenging issues or disruptive situations that impact population health (for example, emergencies, pandemics, climate-related crises).

Gender-based Analysis Plus (GBA Plus)

Gender-based Analysis Plus (GBA Plus) is an analytical tool used to support the development of responsive and inclusive policies, programs, and other initiatives^{Footnote 1}. GBA Plus is a process for understanding who is impacted by the issue or opportunity being addressed by the initiative; identifying how the initiative could be tailored to meet diverse needs of the people most impacted; and anticipating and mitigating any barriers to accessing or benefitting from the initiative. GBA Plus is an intersectional analysis that goes beyond biological (sex) and socio-cultural (gender) differences to consider other factors, such as age, disability, education, ethnicity, economic status, geography (including rurality), language, race, religion, and sexual orientation. Applying SGBA Plus allows us to formulate responsive and inclusive initiatives to promote greater health equity. Part of this is ensuring effective communication by considering the different information needs, preferences and barriers of diverse population groups.

Health equity

Health equity means that all people have fair opportunities and resources to reach their fullest health potential regardless of their socioeconomic status, race, ethnicity, gender, age, sexual orientation, or other socially determined circumstances^{Footnote 2}. Health inequities refer to health inequalities (that is, differences in the health status of individuals or groups) that are unfair or unjust and modifiable. These are avoidable differences in health status or social determinants of health. Examples of health inequities include:

Canadians who live in remote or Northern regions have limited access to nutritious and affordable foods
Higher rates of diabetes amongst women and other racialized populations and Indigenous Peoples, especially for those living with lower income
Lower life expectancy for people living with lower incomes

A health equity approach seeks to reduce inequalities and increase access to opportunities and conditions conducive to health for all. Heightened efforts to address the needs of populations that are at higher risk for poorer quality social determinants of health or poorer health outcomes can help reduce health inequities between different population groups.

Intersectoral action

Intersectoral action (ISA), also called multisectoral action or intersectoral collaboration (ISC), refers to the ways that different groups and sectors of society such as health, agriculture, education, environment, transportation, government, amongst others, work together to improve the health and well-being of Canadians^{Footnote 3}. For example, the employment sector, health sector, and local government may work together to improve working conditions and job stability for individuals that are precariously employed, impacting health equity and well-being. A few examples ISA approaches include:

Health in All Policies is an approach to addressing social determinants of health at all levels of government, aiming to support decision-makers to integrate considerations of health, equity and well-being into all policies
Healthy Cities was a project designed to encourage cities to take a more holistic approach to addressing health issues by putting a greater emphasis on health at the municipal level through the implementation of intersectoral health plans and collaboration with other cities and networks
The One Health approach involves the intersection of the public health, veterinary, and environmental sectors. It encourages intersectoral action at all levels to optimize the health of people, animals, and environments

Knowledge mobilization

Knowledge mobilization includes the synthesis, adaptation, dissemination and active exchange of knowledge.

People with lived experience

People with lived experience are individuals who have personal knowledge and firsthand experience with everyday events. People with lived experience represent their own understanding and experience of issues, challenges, identity factors, health conditions, or other factors, rather than representations constructed by others. Examples of lived experience may include, people experiencing problematic substance use, people living in low-income, people living in communities without access to public transport, people who are precariously employed, people who identify as 2SLGBTQIA+, people who are members of racialized populations, among others.

Social determinants of health

Our health is mostly shaped by the conditions into which we are born, live, grow, work, age, and play – known as the social determinants of health (SDOH). These conditions are in turn shaped by even broader social, political, and economic influences, known as the structural determinants of health, which influence how resources, power and opportunities are distributed and how this supports or detracts from our ability to reach our full health potential. For example, people can occupy different positions on the social or economic hierarchy, based on how society treats them according to factors such as their perceived race, sexual orientation, ability, sex, gender, religion or age.

Social determinants of health include^{Footnote 4}^{Footnote 5}

Income and social status
Employment, precarious work and working conditions
Education and literacy
Healthy child development
Housing
Food security
Social environment (for example, access to leisure and recreation; community and public spaces, experience of belonging or violence; digital connectivity)
Physical environment (for example, land use, transportation)
Policing and criminal justice
Racism
Exclusion or discrimination (for example, on the basis of ability, sexual orientation, gender, sex, age, culture, or other factors; excluding racism)

SDOH are shaped by the distribution of wealth, power, and opportunities within and between populations. Experiences of discrimination, racism and historical trauma are important social determinants of health for certain groups such as Indigenous Peoples, 2SLGBTQIA+ and Black Canadians.

Upstream, midstream and downstream interventions

The terms “upstream” and “downstream,” in the context of public health interventions, comes from a story first told in the 1970s by Irving Zola, a medical sociologist. The story was a way of presenting guiding concepts for public health practice. The story is as follows^{Footnote 4}:

Imagine being on a shore of a swiftly flowing river and suddenly seeing someone drowning. You jump into the river, pull the person to shore and provide CPR. Just as this person begins to breathe, another cry for help is heard from the river, and once again you jump into the river to assist. Again and again, over and over, you jump into the river to save them. After pulling so many people out of the river, you realize how busy you are, so busy in fact, that you don’t have the time to see who or what is upstream pushing them in.

Though not mentioned in the original story, the metaphor has been expanded to include midstream interventions, the social safety net, and has been adapted to resonate with certain communities.

While interventions at all levels (upstream, midstream, and downstream) are necessary for a robust public health approach, the Intersectoral Action Fund prioritizes projects that promote health equity by taking an upstream approach to addressing the social determinants of health.

Upstream interventions

Upstream interventions target the social and structural determinants of health (that is, stopping people from falling into the river in the first place). This means targeting the policies and underlying inequities that shape both the conditions of people’s lives and their behaviours. Because these factors influence many other risk factors, addressing them can impact several health outcomes^{Footnote 4}. Following the upstream metaphor, an upstream intervention could include building a bridge so that everyone can cross the river safely. Example of upstream interventions include:

Engaging with a diverse group of stakeholders and people with lived experience to assess community needs and identify policies (for example, pay equity for communities impacted by precarious work; development of local/regional strategies on food systems) to address the root causes of food insecurity
Developing an action plan and meaningfully engage with Indigenous Peoples to preserve and revitalize Indigenous cultures, languages, and traditions to strengthen community identity, resilience, and mental well-being, all of which are critical for health
Collaborating across sectors to identify transportation policies that support the equitable and fair allocation of transportation funding and that promote adequate investment in public transit systems based on community needs

Midstream interventions

Midstream interventions are aimed at reducing group vulnerabilities and mitigating existing inequities (that is, helping people fare better in the current so they won’t drown). These vulnerabilities mainly manifest in the environmental and living conditions of people’s lives. Following the metaphor, a midstream intervention could include providing swimming lessons or life vests to all residents living near the river – while the environment is not changed, individuals would be better equipped to prevent drowning. Again, addressing these for affected groups can impact several health outcomes. Examples of midstream interventions include:

Establishing school lunch programs with no eligibility requirements to support families experiencing food insecurity without stigma
Developing training programs for healthcare providers that reduce bias and foster cultural sensitivity to the needs of Indigenous patients
Implementing subsidized transit programs or fare reductions for low-income individuals, making public transit more affordable and accessible

Downstream interventions

Downstream interventions support people who are already experiencing the health impacts (that is, helping people after they are caught in the current). These interventions are focused on changing individual behaviours that are strongly linked to poor health outcomes (for example, a poor diet or lack of physical activity), building skills, and/or treating the resulting health issue. Following the metaphor, a downstream intervention could include rescuing those who are drowning from in the river as it happens – although individuals may be saved, nothing prevents more individuals from being at risk of drowning. Examples of downstream interventions include:

Introducing community fridges in neighbourhoods where there are people who are experiencing food insecurity to support the immediate food access needs of individuals experiencing food insecurity without requiring registration or needs-testing
Providing resources in Indigenous languages or developing tailored communications to reach Indigenous populations
Implementing specialized transportation services in communities for seniors and individuals with disabilities who have specific mobility needs

Additional resources and links

Gender-Based Analysis Plus resources

Social determinants of health, intersectoral action and health equity resources

Upstream interventions

Footnote 1

Women and Gender Equality Canada (2023). “What is Gender-based Analysis Plus.” Accessed May 2, 2024. https://www.canada.ca/en/women-gender-equality/gender-based-analysis-plus/what-gender-based-analysis-plus.html

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Footnote 2

Public Health Agency of Canada (2024). “Integrating Health Equity into Funding Proposals: A Guide for Applicants.” Accessed on May 2, 2024. https://www.canada.ca/en/public-health/services/publications/health-system-services/integrating-health-equity-funding-proposals-guide-applicants.html

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Footnote 3

World Health Organization. (2023). “Working together for equity and healthier populations: sustainable multisectoral collaboration based on Health in All Policies approaches.” Accessed May 2, 2024. https://www.who.int/publications/i/item/9789240067530

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Footnote 4

Public Health Agency of Canada (2022). “A Vision to Transform Canada’s Public Health System.” Canada.ca. Accessed May 2, 2024. https://www.canada.ca/content/dam/phac-aspc/documents/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/state-public-health-canada-2021/cpho-report-eng.pdf.

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Footnote 5

Public Health Agency of Canada & Pan-Canadian Public Health Network (2018). “Key Health Inequalities in Canada: A National Portrait – Executive Summary. ”Government of Canada. Accessed May 2, 2024. https://www.canada.ca/en/public-health/services/publications/science-research-data/key-health-inequalities-canada-national-portrait-executive-summary.html

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Date modified:: 2024-06-18

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