Fences and ambulances: Governance for intersectoral action on health

Fences and ambulances: Governance for intersectoral action on health ଝ 'Twas a dangerous cliff, as they freely confessed, Though to walk near its crest was so pleasant; But over its terrible edge there had slipped A duke and full many a peasant.So the people said something would have to be done, But their projects did not at all tally; Some said, "Put a fence 'round the edge of the cliff," Some, "An ambulance down in the valley."'-Joseph Malins, "The Ambulance in the Valley," 1895 It is a commonplace of health policy that prevention is better than cure -that a fence on the cliff is cheaper, in money and in lives, than an ambulance in the valley.Avoiding road traffic accidents, falls, dangerous pollutants, unhealthy childhoods and problematic lifestyles is cheaper than acute health care.Malins' 1895 poem concludes optimistically that the "sensible few, who are practical too,Will not bear with such nonsense much longer;They believe that prevention is better than cure,And their party will soon be the stronger."This part of the argument is not so clearly borne out in policy and practice today.Roads are built that lead to physical inactivity and untimely death, pollutants harm health, and in many other ways policies fail to prevent ill health.Over the years there have been many public health names for the basic insight that we are foregoing the opportunity to improve health through the full range of policies governments make.There have been calls for attention to the "wider determinants of health" [1], broken down into "social determinants of health" [2,3] and "commercial determinants of health" [4].There have been calls to address these determinants by incorporating health into policies outside the traditional health sector: "health in all policies" [5,6] and "intersectoral governance for health" [7,8].There are significant differences between these