Challenges and Opportunities for Population Health Partnerships

The Mobilizing Action Toward Community Health (MATCH) articles in this issue of Preventing Chronic Disease discuss ideas, policies, and practices that can be used to produce a healthier population in the United States and globally. The articles pose the following questions: 1) How do we best measure long-term wellness at the population level?, 2) How do we provide incentives to organizations to accomplish better population health?, and 3) How can effective cross-sector partnerships be formed and implemented to help accomplish the task? The articles in this issue have done a good job, for the most part, of summarizing what we know or at least what we think we know about successful partnerships. They highlight the many challenges of forming cross-sector partnerships, given the different goals, objectives, and cultures of potential partners. They also provide ideas and evidence for overcoming some of these challenges; the importance of leadership, governance, measurement and accountability, focus, and trust are all emphasized. What these discussions lack is consideration of the interrelated practices and behaviors that may prove useful, given widely varying community contexts — geographic, political, economic, and social. Some examples of what is missing that I suggest as a basis for further discussion include the following: 1. Partnerships need to be both internally and externally aligned. Partners should achieve domain consensus among themselves with sufficient overlap of goals and should understand what is expected of the partnership by external groups. 2. The partnership should gain legitimacy and credibility within the community. Drawing on the developing literature on social capital would improve this process (1). 3. Partnerships can gain legitimacy by understanding their centrality in the political economy of the community. Social network concepts involving direct and indirect ties, the strength of ties, network density, and structural holes are relevant. 4. Every partner has a core competence and comparative advantage. Partnerships can fail because individual members either overestimate or underestimate their comparative advantage and misdiagnose their core competence. 5. Leadership should be explored more fully: the kind of leadership needed, the kind of partnership that can deliver it, and the stage of the partnership's life cycle that is best suited for it. The role of individual leadership versus organizational leadership should be discussed (2). 6. Forming a partnership has a transaction cost. The literature on transaction cost economics originally developed by Williamson may be relevant (3). 7. The process of selecting partners, including tradeoffs and …