HEALTH PROMOTION INTERNATIONAL
# Oxford University Press 1997
Vol. 12, No. 1
Printed in Great Britain
Coalition theory as a framework for understanding and
implementing intersectoral health-related interventions
MICHEL O'NEILL1,4, VINCENT LEMIEUX 2,4, GISE©LE GROLEAU 2,3,
JEAN-PAUL FORTIN 3,4 and PAUL A. LAMARCHE 3,4
1
Ëcole des sciences in¢rmie©res et Groupe de recherche et d'intervention en promotion de la santë
(GRIPSUL), Universitë Laval, Quëbec, Canada, 2Dëpartement de Science politique, Universitë Laval,
Quëbec, Canada, 3Dëpartement de Mëdecine sociale et prëventive, Universitë Laval, Quëbec, Canada
and 4Rëseau de recherche sociopolitique et organisationnelle en santë, Quëbec, Canada
SUMMARY
Although it is regarded as a central concept in the practice of health promotion, intersectoral health-related
action (IHA) has, to date, failed more often than it has
succeeded. In this paper we review relevant social scienti¢c literature, o¡er a working de¢nition of intersectoral
action and explore the usefulness of coalition theory as a
theoretical framework through which to understand
IHA theoretically and practically. Coalition theory has
been previously used to study political alliances but it
encompasses a series of parameters pertinent to the analysis of IHA. These parameters are: the rewards people
expect to gain from participation in a coalition; the poli-
tical assets they have to bring to the coalition; the nonutilitarian preferences they develop; the coalition's
rules for decision-making; and the organisational context in which the coalition operates. We used these ¢ve
parameters to study three intersectoral endeavours in
Quebec, one at the local level and two at the provincial
level, including activities associated with the Healthy
Cities movement. Coalition theory proved useful in unravelling the mechanisms of these endeavours and appears
promising as a tool for studying and/or implementing
intersectoral health-related interventions.
Key words: Healthy Cities; health promotion; intersectoral action; Quebec
INTRODUCTION
Despite being central to current conceptualisations of health promotion [World Health Organization (WHO), 1984, 1986c; Kickbusch, 1986; de
Leeuw, 1989; Nutbeam, 1994], the idea of intersectoral action for health su¡ers from the same problem that Pederson et al. (1988) identi¢ed
regarding most health promotion concepts:
because these concepts are primarily ideological
and action driven, they are usually not soundly
scienti¢cally or theoretically based, despite significant e¡orts by early health promotion thinkers
to connect action and science (Kickbusch, 1994).
With this in mind, in 1991 we established a
research project with three aims: (i) to clarify the
notion of intersectoral health-related action
(IHA); (ii) to specify a precise conceptualisation
of it; and (iii) to use this conceptualisation to analyse concrete actions from which to subsequently
formulate recommendations for practitioners.
This paper reports on the more theoretical elements of our explorations, the practical recommendations having been disseminated elsewhere
(Fortin et al., 1994a, b, 1996) in accordance with
our wish to produce sound but readily applicable
science (O'Neill et al., 1994). We begin this paper
with a presentation of the conclusions of a literature review we conducted, ending with our working de¢nition of IHA, as well as our rationale for
79
80
Michel O'Neill et al.
choosing coalition theory as the conceptual
framework for our empirical analysis of IHA. We
then outline coalition theory in more detail. The
third part of the paper uses coalition theory to
analyse three cases of intersectoral interventions.
Finally, we o¡er some preliminary recommendations for further study of IHA.
POSITIONING INTERSECTORAL
H E A L T H A C T I O N I N T H E L I T E R AT U R E
Our ¢rst foray into the literature included international materials (Milio, 1986a; WHO, 1986a, b;
Eklundh and Pettersson, 1987; Taket, 1988a, b;
Springett, 1989; de Kadt, 1989; de Leeuw and
Hueben, 1991; Means et al., 1991), as well as
those with a special emphasis on Quebec [Ministe©re de la santë et des services sociaux du Quëbec
(MSSS), 1986, 1992a, b; Bëlanger, 1987; Harnois
et al., 1987; Commission d'enqueªte sur les services
de santë et les services sociaux (CESSS), 1988;
Veilleux, 1990; Beaulne, 1991], pertaining directly
to IHA. We were immediately struck by the paucity of materials in this ¢eld. Nevertheless, we
came to three major conclusions.
First, there is a clear consensus in this literature
about the necessity of intersectoral action to promote the health of populations. Consistent with
the perspective of healthy public policies popularised by health promotion writers (Hancock,
1982; Milio, 1986; O'Neill, 1990; Evers et al.,
1990), it is now taken for granted that a great
deal, if not most, of what has a direct impact on
health is outside the realm of curative or even preventive health services. Hence, the authors
reviewed stress the necessity of involving the nonhealth sectors which have such signi¢cant impact
on health in health-related policies and interventions. Second, there is a clear consensus in this literature about what the key elements of a
de¢nition of IHA should be. Finally, although
concrete and speci¢c suggestions are occasionally
made on how to work intersectorally (e.g. Asval,
1988; Roberts, 1988; Saan, 1988; Van Londen,
1988; Winsemius, 1988), there is very little consensus. What the authors generally do concede, in
fact, is that this type of work fails more often than
it succeeds.
We attribute such failures to two factors. First,
because health-related professionals are used to
operating in a very prestigious sector of society,
they often approach other sectors expecting them
to `buy in' to health-related issues without regard
for how the health sector can support the legitimate agendas of other sectors. Second, recommendations for IHA are usually based on lessons
derived from trial and error rather than on
science. Accordingly, we decided to explore several bodies of social scienti¢c literature that we
thought pertinent.
We thus looked at research on collaboration
and co-operation (e.g. Mazur, 1968; Aldrich,
1976; Booth, 1981; Weiss, 1981; Stahlberg, 1983;
Gray, 1985; Gray and Hay, 1986; Schneider,
1987) but, more importantly, at studies on interorganisational relationships. We found the work
done on `organisational sets' (e.g. Caplow, 1956,
1964, 1968; Evan, 1971; Hall, 1972) especially
interesting, as well as the pioneering research on
interorganisational exchange by Levine and
White (1961). From these studies, we came to
three conclusions. First, it is vital to move beyond
the ideological statements favourable to IHA
found in the health promotion literature and to
conceptualise intersectoral action in terms of the
(often sel¢sh) interests pursued by individual or
organisational actors. Second, the relative power
of actors interacting in intersectoral ventures is of
paramount importance. Finally, the nature of the
formalöbut especially the informalöties
between the actors, is also of central importance
in shaping collaborative e¡orts.
Following this literature review, to which more
recent work (Delaney, 1994; Eisenga, 1994; Nutbeam, 1994; Ouellet et al., 1995; Springett, 1995)
does not, in our view, add anything substantially
new, we decided that the notion of coalition was
probably the most useful way to conceptualise
IHA. The notion of `coalition' not only incorporates most of the characteristics identi¢ed by our
literature review as relevant for IHA, but it also
has been the subject of a signi¢cant body of theoretical and empirical work, especially in political
science and sociology. The study of coalitions in
the health sector has also begun to receive some
interest (e.g. Health Education Research, 1993),
but the focus of these studies has not been on
their contribution to the understanding of IHA.
We thus ended the ¢rst part of our research by
tentatively de¢ning IHA as `a process through
which actors belonging to di¡erent sectors unite
to address a given health-related issue' (Fortin et
al., 1994a, p. 15) and by choosing coalition theory
as our conceptual framework for IHA.
Coalition theory and IHA
COALITION THEORY
Let us note at the outset that we do not mean to
imply that intersectoral groups in the health
sector always have all the characteristics de¢ning
a coalition. However, we decided to employ coalition theory heuristically in the hope of constructing a new and useful approach to analysing
intersectoral action.
While there are numerous researchers in this
arena (e.g. Von Neuman and Morgenstern, 1944;
Riker, 1962; Caplow, 1964, 1968; Adrian and
Press, 1968; Kelly, 1968; Deswaan, 1970; Groennings et al., 1970; Hirshman, 1970; Browne, 1973;
Komorita, 1974, 1979; Lawler, 1975; Lawler and
Youngs, 1975; Brudge and Herman, 1978; Warwick, 1979), William A. Gamson is probably the
most important among the founders of coalition
theory (Bolduc and Lemieux, 1992). In a highly
in£uential article, Gamson (1961) de¢ned coalitions as temporary alliances among individuals
or groups which di¡er in goals. He proposed four
parameters which predict the formation and evolution of a coalition, that is who will join with
whom in any speci¢c instance. These four parameters de¢ne, in our opinion, key conditions for
IHA as well.
Gamson's ¢rst parameter is the `initial distribution of resources'. Participants in intersectoral
activities bring with them di¡erent resources,
including a sense of purpose, information, prestige, contacts, authority derived from their size,
wealth, and so on. These resources are important
predictors of the processes by which intersectoral
activities will occur.
Second, there are the `payo¡s' or the `rewards'
that the members expect from their participation
in the coalition. Fundamentally, the individual
members hope to receive rewards that they would
not obtain if they were to act alone. In many
cases, as Gamson describes it, the payo¡ for joining a coalition is the expected value of future decisions multiplied by the probability of the
coalition functioning. The same phenomenon
occurs with intersectoral action: it is not the
immediate but the future payo¡s which, generally
speaking, are of interest.
Gamson's third parameter he calls `non-utilitarian preferences'. This parameter relates to
each participant's inclination to join with any
other player, whatever that player's control of the
resources might be. The participant's inclinations
can be seen as ties, some being positive whereas
others are negative or neutral. There is often a big
81
di¡erence between intersectoral groups where
positive ties are numerous and others where this
is not the case.
The fourth of Gamson's parameters is the
`e¡ective decision point'. These `rules of the
game' will frequently specify the portion and
nature of resources formally necessary to control
decisions. One approach is majority rule. In other
cases there may not be a formal rule, but rather a
kind of informal agreement to aim toward consensus or unanimity in decisions. In the same way, if
there were con£ict within the coalition, another
informal rule could specify that the members
have to ¢nd a consensual way to resolve the con£ict.
Considering that IHA usually take place within
an organisational context independent of the
members, we added a ¢fth parameter to Gamson's
list based on Hinckley's (1981) suggestions: the
`organisational context' refers to rules de¢ned by
the environment. Among these rules are those
concerning the number of players, the occurrence
(or not) of meetings, the bargaining rules and the
information conditions. As we shall see, in the
empirical case studies we conducted the organisational context turned out to be signi¢cant in determining the existence and e¡ectiveness of IHA.
Consequently, this ¢fth parameter is an important
addition to our conceptual model of IHA.
THREE EMPIRICAL CASE STUDIES:
KEY METHODOLOGICAL ELEMENTS
In our empirical study, three di¡erent types of
health-related intersectoral actions were studied
from the viewpoint of coalition theory, with the
adjustments just discussed. In addition to the ¢ve
characteristics of coalition theory, we identi¢ed a
number of other parameters to consider in our
analyses. First, we chose to examine IHA at different levels of action, ranging from the local to
the central, as also recommended by Delaney
(1994). In Canada, `central' tends to mean at the
provincial level, because the provinces have constitutional responsibility for health and welfare
services. At the central level, we decided to distinguish between governmental intersectoral actions
and actions not driven by the provincial government. This led us to conduct three case studies;
one at the local level and two at the provincial
one.
In addition to considering di¡erent levels of
action, we analysed our cases according to time,
82
Michel O'Neill et al.
i.e. to see whether being at the emergence or at the
implementation phase of an intersectoral process
made any di¡erence. Taking into account the
stage of the process was prompted by earlier ¢ndings from study of the Quebec Healthy Cities network (Fortin et al., 1992).
Data were collected through semi-structured
interviews with key informants and a written
questionnaire, between February and August
1992, with ¢nal contacts in 1993 and 1994. Content analysis of various historical documents was
also performed. A total of 36 individual or small
group interviews, lasting an average of 2 h, were
conducted; 26 questionnaires were completed
well enough to be usable in the analysis and a
total of 371 documents were perused. A combination of qualitative and quantitative analyses was
conducted, including Lemieux's (1991, 1992) classi¢cations of the various power resources of political actors as well as the payo¡s expected from the
coalition. Additional details on the methodological choices made for these case studies as well as
on the data collection and analytic procedures
are available elsewhere (Fortin et al., 1994a).
MAJOR FINDINGS OF THE CASE
STUDIES
The local level
The local case we studied was that of a mediumsized city (population 80 000), where we looked at
the coalitions established to launch the Healthy
Cities project as well as to implement ¢ve speci¢c
actions. We chose these actions from several
others because they captured variations in the
duration of the coalition, the stability of coalition
membership over time and the level of achievements of the group. The issues addressed by the
actions studied were: toxic waste disposal;
improvement of an inner-city pedestrian mall plagued by marginal teenage groups; architectural
adaptation of housing to suit the needs of the
elderly; prevention of at-risk situations among
the elderly population; and bicycle paths. The
intersectoral groups studied had a life span ranging from 0 to 48 months.
Several observations were made from this case.
The most interesting ¢ndings were that the e¡ective coalitions started among people who were
already acquainted. This situation, however,
sometimes made life di¤cult for newcomers who
joined subsequently. We also realised that the
more practical the projects, the more likely they
are to rally people and succeed. Keeping a strong
political link with the political authorities was
de¢nitely advantageous, as was the capacity to
establish a minimal material infrastructure. Decision-making was consensual and the capacity of
group leaders to provide con£ict resolution strategies was very central to the survival of the coalition. Indeed, in several cases, due to natural
a¤nities among certain group members, subgroups emerged, which had the tendency to generate con£ict. Another conclusion we drew was
that at the emergence phase of the coalitions,
believing in the cause is the key resource brought
in and the main bene¢t expected from participating in the coalition. At a later stage, the fact that
someone was an expert (informational resource)
or was well placed in the power structure of the
community (positional resource) could become
more prominent reasons for a person joining.
Governmental intersectoral action at the
provincial level
The governmental intersectoral action we studied
was the development and implementation of a
provincial nutrition policy for elementary and secondary schools. This policy initiative involved
people from three provincial ministries (Health
and Social Services; Agriculture and Nutrition;
and Education), one regional public health
agency, and one school board known for its longterm involvement in this area. The developments
analysed lasted nearly a decade. The original
phase spanned from 1984 to 1987. It was followed
by a reorientation phase, with a di¡erent set of
members, which began in 1987 with a change of
the party in power in the provincial government
and which continued at least until 1993 when we
last gathered information on this venture.
There are several important ¢ndings from this
case. The ¢rst is that even at this central level, the
policy was initiated by a group of people who had
worked together on a pilot project and who had
successfully pushed their various ministries to put
their concern on the policy agenda. The second
¢nding pertains to the importance for all the delegates on intersectoral inter-ministerial committees of keeping the channels of information with
their administrators open and of having good
political sensitivity. Failing on these two criteria
was one of the major reasons why the work of the
committee was totally disregarded by one of the
ministers concerned, resulting in a major switch
in the committee's mandate following an election.
Coalition theory and IHA
Open and ongoing communication links with
administrative o¤cials are critical in cases such
as this because, more often than not, decisionmaking authority resides with the administrators
or the politicians, not with those sitting on the
inter-ministerial committee itself. Our third ¢nding is that because the civil servants on these committees cannot resign in the same way as
volunteers might (if they resign, they are replaced
by someone else from their ministry), these intersectoral ventures often have a kind of structural
guarantee that they will survive and are almost
doomed to succeed at something, even if the something is very di¡erent from what was originally
planned.
Provincial coalition of public health agencies
The last intersectoral coalition we studied was a
provincial coalition created by a group of regional
public health agencies and people from the Ministry of Health. This group, though composed only
of people from the public health sector (thus
more sectoral than intersectoral), had a reputation for e¡ectiveness. This reputation was arising
from a series of very visible interventions on
trauma prevention, including mobilising local
communities about dangerous spots for tra¤c
accidents and lobbying campaigns at the municipal, provincial and federal levels on safety belts,
gun control, crash helmets for cyclists, safe equipment for semi-professional hockey teams, the
banning of three-wheeled all-terrain vehicles, etc.
This coalition was established in 1980 and though
initially it operated informally, it has been a more
formal organisation since 1986. We studied it in
1991^1992.
Our main ¢ndings were that this coalition, while
made up of quasi-governmental or governmental
agencies, acted like a non-governmental organisation (NGO) or an interest group. Its style of intervention was very political, in contrast to how
most governmental organisations operate and,
like many NGOs, its power base from which to
mobilise participants from various sectors was
not very strong. The coalition relied heavily, to
carry out its activities, on purposive assets and on
the personal capacity of coalition members to
develop non-material ties with a variety of individuals occupying key positions in organisations.
The coalition was not generally constructed in an
intersectoral manner, but mobilised in di¡erent
sectors, depending upon the issue at hand. This
approach partially explains the coalition's variable rate of success and also why it had a reputa-
83
tion, in the public health sector, for being
unusual. Ironically, this coalition acted in a
manner that was ultimately to become, in 1993,
part of the legal mandate of public health agencies
in Quebec, i.e. advocacy to inform the general
public on health related issues.
DISCUSSION: THE USEFULNESS OF
C O A L I T I O N T H E O R Y PA R A M E T E R S T O
STUDY IHA
Returning to coalition theory as an analytic tool,
our particular case studies exempli¢ed the importance of organisational context (the parameter
we added to the Gamson's original four) in the formation and evolution of intersectoral groups.
Among the di¡erent rules pertaining to the organisational context, the criteria for selecting coalition members appeared to be the most important
in both the formation and consolidation phases
of the group. Two aspects of the selection process
were particularly decisive. First, the ideal case
was when the members to be selected were persons
who had worked together in the past and who had
convergent views on the action to be conducted
by the group. Second, these persons were better
o¡ if they had the capacity to be legitimately mandated to participate by their own group, especially
if they joined the coalition after it had been
started.
What may be called the `tutorial rule' also
proved important, particularly in the case of
inter-ministerial action. When an intersectoral
group depends on governmental or administrative
authorities external to the coalition and having
the ultimate decisional powers, it has to maintain
a direct link with these authorities, and to
manage frequent contacts with the intermediate
authorities who are accountable for the group.
This is the best way to ensure continuous support
for the group mandate and a uniform interpretation of it among the members.
The resources are instrumental to the rewards
the members try to obtain from their participation in the coalition. It is useful to think of
rewards in terms of Clark and Wilson's (1961) distinction between purposive, utilitarian and solidarity incentives in organisations. In the
intersectoral groups we studied, purposive incentives or rewards were the most important. The
sense of purpose is both a resource and a reward
to its members, functioning like a self-nourishing
asset. In other words, purposive resources are
84
Michel O'Neill et al.
invested in intersectoral action and often end up
in producing purpose as a result. In the coalitions
studied, that health or quality of life are goals
that can generate signi¢cant mobilisation or
motivation is obvious. While there were certainly
additional rewards sought by group members,
generally speaking they are not satis¢ed with
those other rewards without a purposive dimension in them. One could explain this perhaps by
the unconventional nature of intersectoral
action, which stirs up a very special sense of purpose among participants. Another explanation,
more consistent with coalition theory, is that purpose, when shared among the members, is a
means of ensuring the domination of co-operation over con£ict.
Though many authors (e.g. Springett, 1989;
Delaney, 1994) contend that non-instrumental
ties are a key parameter in the operation of intersectoral coalitions, we found it somewhat di¤cult
to obtain information about such ties. Some of
these ties are undoubtedly of an a¡ective nature,
so there may be reluctance to speak about them to
interviewers. Fortunately, other positive ties are
of a less a¡ective nature and are easier to see. For
instance, we observed that when the organisational context is not too constraining at the
moment of the group formation, the positive ties
between a small number of persons are usually
crucial, as they are when there are tensions within
the group, or if it becomes necessary to transform
the group in some way.
The `e¡ective decision point', the last of Gamson's parameters, operates on a coalition di¡erently when a group has no adversaries as
compared to a situation where many groups are
in con£ict. In an intersectoral group without
external adversaries, it is intra-group con£icts
which are signi¢cant. Consequently, we observed
that measures have to be taken to reduce the possibility of such con£icts, or at least to manage them
if they occur. From this viewpoint, rather than
sophisticated formal processes as are often used
in complex political coalitions, consensus is the
decision-making strategy in these kinds of groups
and, more generally, in small or medium-sized
groups. We found that a persuasive style of con£ict resolution by a leader is better than an authoritative one if there is a failure in reaching a
consensus. Perhaps such a leadership style is
more appropriate to the purposive nature of
health-related intersectoral groups.
To conclude about the ¢ve parameters as a
whole, we suggest that the key to whether a coali-
tion is successful depends on the mixture of the
parameters rather than the characteristics of any
of them. An intersectoral group is made up of
members which have co-operative and con£ictual
interests at the same time. To succeed (i.e. to
emerge, to maintain itself over time, and to realise
activities related to its goals), co-operative interests have to dominate con£ictual ones. Our main
¢ndings can thus be formulated from this perspective.
If convergence is to dominate over divergence,
the organisational context must be such that the
selection rules governing coalition membership
and tutorial rules governing coalition relationships with external authorities are working in
that direction. Members must have the capacity
to work together and relationships with the authorities must be such that they nurture convergence
within the group. If dedication to a cause and purposive incentives are this important as resources
and rewards, respectively, it is because they are
non-divisive assets within the group, providing
that the purpose is the same among the members.
The importance of strong positive ties among the
initiators of the group operates the same way.
Strong ties are an insurance against the domination of con£ictual trends over co-operative ones.
Similarly, the search for consensus and the use of
non-authoritarian ways of restoring it are also
two ways of proceeding which are oriented
toward the domination of convergence over divergence.
Finally, it should be noted that there is an
important di¡erence between the coalitions that
can be studied in the context of health promotion
and the types of coalitions which have usually
been the subject of coalition theory. Speci¢cally,
most of the time, the intersectoral enterprises we
are dealing with have no adversaries, in contrast
to the coalitions that have usually been studied
(i.e. those which occur within organisations,
between political parties or other groups, or
between nation states at the international level).
Each of our ¢ve parameters takes on a particular meaning in this non-adversarial context. In
the case of the organisational parameter, the
rules of the game are set up not to counter actual
or potential adversaries, but to insure that the cooperative nature of the coalition and its ability to
work together will be maintained against the con£ictual tendencies among members. In relation to
the resources within the coalition, the assets
which are of greater value are not so much the
external ones, designed to be e¡ective against
Coalition theory and IHA
opponents, but the internal ones. In the same way,
payo¡s depend mainly on co-operation within
the coalition rather than on other actors in the environment. Negative ties with some actors in the
environment typically absent, the coalition is
deprived of `common enemies' to bind itself
together. Finally, the e¡ective decision point
depends to some degree on the organisational
authorities which are managing the intersectoral
activities, but also on the consensus to be reached
within the members of the coalition.
CONCLUSION
The exploratory nature of this research and methodological limitations obviously constrain the
conclusions to be drawn from this work. Nevertheless, we are convinced of several things at this
stage in our exploration of IHA. First, it is important to go beyond ideological enthusiasm for
intersectoral action, especially since most empirical evidence actually points to the failure of intersectoral coalitions. Second, using theoretical
insights about coalitions helps understanding of
how IHAs succeed or fail. Third, among the various possible theoretical formulations available,
our revised coalition theory seems to be useful,
regardless of whether one is interested in advancing social science or health action.
About one thing we are certain. IHA is heralded
as a signi¢cant strategy in restructuring health
care systems world-wide. It is important to conduct further additional research on IHAs, lest
they remain a theoretical and/or ideological
panacea for the problems in health care delivery
today. It is our belief that coalition theory provides a good starting point for such future
research and warrants further examination.
ACKNOWLEDGEMENTS
This project has been funded by the provincial
component of the Community Health Research
Fund of the Quebec Ministry of Health and
Social Services, as well as by the Regional Board
of Health and Social Services of the Quebec City
area. Thanks to Ms Ann Pederson for her editorial
assistance and to an anonymous reviewer for
useful suggestions.
85
Address for correspondence:
Michel O'Neill
GRIPSUL
Ëcole des Sciences in¢rmie©res
Universitë Laval, Ste-Foy
Qc, Canada, G1K 7P4
REFERENCES
Adrian, C. R. and Press, C. (1968) Decision costs in coalition
formation. American Political Science Review, 62, 556^563.
Aldrich, H. (1976) Resource dependence and interorganizational relations. Administration and Society, 7, 419^454.
Asval, J. E. (1988) Foreword. In Taket, A. R. (ed.) Making
Partners: Intersectoral Action for Health. Proceedings and
outcome of a WHO Joint Working Group on Intersectoral
Action for Health, Utrecht, The Netherlands, 30 November^2 December.
Beaulne, G. (ed.) (1991) Les traumatismes au Quëbec: comprendre pour prëvenir. Les Publications du Quëbec, Quëbec.
Bëlanger, J.-P. (1987) La concertation dans le rëseau des services de santë et des services sociaux au Quëbec, collection
`Dossiers thëmatiques'. Commission d'enqueªte sur les services de santë et les services sociaux, Quëbec.
Bolduc, N. and Lemieux, V. (1992) Les facteurs in£uenc°ant la
formation des coalitions. Unpublished document, Universitë Laval, Dëpartement de Science politique, Quëbec.
Booth, T. (1981) Collaboration between the health and social
services: Part I, a case study in joint care planing. Policy and
Politics, 9, 23^49.
Browne, E. C. (1973) Coalitions Theories: A Logical and
Empirical Critique. Sage, Beverley Hills, CA.
Brudge, I. and Herman, V. (1978) Coalitions and government
formation: an empirically relevant theory. British Journal
of Political Science, 8, 459^477.
Caplow, T. (1956) A theory of coalitions in the triad. American
Sociological Review, 21, 489^493.
Caplow, T. (1964) Principles of Organisation. Columbia University and Harcourt, Brace & World Inc., New York.
Caplow, T. (1968) Two against One. Coalitions in Triads.
Prentice-Hall, Englewood Cli¡s, NJ.
Clark, P. B. and Wilson, J. Q. (1961) Incentive systems: a theory
of organizations. Administrative Science Quarterly, 6, 129^
166.
Commission d'enqueªte sur les services de santë et les services
sociaux (CESSS) (1988) Rapport de la commission d'enqueªte
sur les services de santë et les services sociaux. Les Publications du Quëbec, Quëbec.
Delaney, F. G. (1994) Muddling through the middle ground:
theoretical concerns in intersectoral collaboration in health
promotion. Health Promotion International, 9, 217^227.
de Kadt, E. (1989) Making health policy management intersectoral: issues of information analysis and use in less developed
countries. Social Science and Medicine, 29, 503^514.
de Leeuw, E. (1989) Concepts in health promotion: the notion
of relativism. Social Science and Medicine, 29, 1281^1288.
de Leeuw, E. and Hueben, F. (1991) Intersectorale samenwerking: de theorie en de praktijk. In de Leeuw, E. (ed.) Gezonde
steder: Lokale gezondheidsbevordering in theorie, politiek
en praktijk. Van Gorcum, Maastricht, pp. 107^131.
Deswaan, A. (1970) An empirical model of coalition formation
as an n-person game of policy distance minimization. In
Groennings, S., Kelly, E. W. and Lieserson, M. (eds) The
86
Michel O'Neill et al.
Study of Coalition Behavior: Theoretical Perspectives and
Cases from four Continents. Holt, Rinehart & Winston,
New York, pp. 312^339.
Eisenga, M. (1994) Characteristics and Implementation of
Intersectoral Action: Theories of Collaboration and Networking Tested, Research for Healthy Cities Monograph
No. 5. University of Limburg, Maastricht.
Eklundh, B. and Pettersson, B. (1987) Health promotion policy
in Sweden: means and methods in intersectoral action.
Health Promotion, 2, 177^194.
Evan, W. M. (1971) The organization-set: toward a theory of
interorganizational relations. In Thompson, J. D. and
Vroom, V. H. (eds) Organizational Design and Research.
University of Pittsburgh Press, Pittsburgh, PA.
Evers, A., Farrant, W. and Trojan, A. (eds) (1990) Healthy
Public Policy at the Local Level. Campus-Westview,
Boulder, CO.
Fortin, J. P., O'Neill, M., Groleau, G., Lemieux, V.,
Cardinal, L. and Racine, P. (1992) Quebec's Healthy Communities projects, the ingredients of success. Health Promotion Canada, 31, 6^10.
Fortin, J. P., Groleau, G., Lemieux, V., O'Neill, M. and
Lamarche, P. (1994a) L'action intersectorielle en santë (rapport ¢nal). Universitë Laval et Ëquipe de recherche en organisation et ëvaluation des services de santë de la Direction
rëgionale de la santë publique de Quëbec, Quëbec.
Fortin, J. P., Groleau, G., Lemieux, V., O'Neill, M. and
Lamarche, P. (1994b) L'action intersectorielle en santë (rapport synthe©se). Universitë Laval et Ëquipe de recherche en
organisation et ëvaluation des services de santë de la Direction rëgionale de la santë publique de Quëbec, Quëbec.
Fortin, J. P., Groleau, G., Lemieux, V., O'Neill, M. and
Lamarche, P. (1996) Intersectoral Action for Health (Summary Report). Universitë Laval and Ëquipe de recherche en
organisation et ëvaluation des services de santë de la Direction rëgionale de la santë publique de Quëbec, Quëbec.
Gamson, W. (1961) A theory of coalition formation. American
Sociological Review, 26, 373^382.
Gray, B. (1985) Conditions facilitating interorganizational collaboration. Human Relations, 38, 911^936.
Gray, B. and Hay, T. M. (1986) Political limits to interorganizational consensus and change. Journal of Applied Behavioural
Science, 22, 95^111.
Groennings, S., Kelly, E. W. and Lieserson, M. (1970) The
Study of Coalition Behavior: Theoretical Perspectives and
Cases from four Continents. Holt, Rinehart & Winston,
New York.
Hall, R. H. (1972) Organisations: Structure and Process. University of Minnesota and Prentice-Hall, Englewood Cli¡s,
NJ.
Hancock, T. (1982) Beyond health care. The Futurist, August,
4^13.
Harnois, G., Tremblay, M. and Bouchard, S. (1987) Pour un
partenariat ëlargi: projet de politique de santë mentale pour
le Quëbec. Comitë pour la politique de santë mentale du
Gouvernement du Quëbec, Quëbec.
Health Education Research (1993) Special issue of the journal
(Vol. 8, No. 3), devoted to de¢ning and evaluating health
coalitions.
Hinckley, B. (1981) Coalitions and Politics. Harcourt, Brace,
Jovanovich, New York.
Hirschman, A. O. (1970) Exit, Voice and Loyalty. Harvard
University Press, Cambridge, MA.
Kelly, E. W. (1968) Techniques of studying coalition formation.
Midwest Journal of Political Science, 12, 62^84.
Kickbusch, I. (1994) Tell me a story. In Pederson, A., O'Neill,
M. and Rootman, I. (eds) Health Promotion in Canada: Provincial, National and International Perspectives. W. B. Saunders, Toronto, pp. 8^19.
Kickbusch, I. (1986) Health promotion: a global perspective.
Canadian Journal of Public Health, 77, 321^327.
Komorita, S. S. (1974) A weighted probability model of coalition formation. Psychological Review, 81, 242^256.
Komorita, S. S. (1979) An equal excess model of coalition formation. Behavioral Science, 24, 369^381.
Lawler, E. J. (1975) An experimental study of factors a¡ecting
the mobilization of revolutionary coalitions. Sociometry,
38, 163^179.
Lawler, E. J. and Youngs, G. A. (1975) Coalition formation: an
integrative model. Sociometry, 38, 1^17.
Lemieux, V. (1991) L'utilitë politique des rivaux. Revue canadienne de science politique, 24, 735^753.
Lemieux, V. (1992) Ëlëments d'une thëorie politique des voix,
Cahier 92-12. Laboratoire d'ëtudes politiques et administratives, Universitë Laval, Quëbec.
Levine, S. and White, P. E. (1961) Exchange as a conceptual
framework for the study of interorganizational relationships. Administrative Science Quarterly, 5, 342^362.
Mazur, A. (1968) A non rational approach to theories of con£ict and coalitions. The Journal of Con£ict Resolution, 12,
196^205.
Means R., Harrison, L., Je¡en, S. and Smith, R. (1991) Coordination, collaboration and health promotion: lessons
and issues from an alcohol education program. Health Promotion International, 6, 31^40.
Milio, N. (1986) Promoting Health through Public Policy.
Canadian Public Health Association, Ottawa.
Milio, N. (1986a) Multisectoral policy and health promotion:
where to begin? Health Promotion, 1, 129^132.
Ministe©re de la santë et des services sociaux du Quëbec (MSSS)
(ed.) (1986) La promotion de la santë: les acteurs en promotion de la santë. Concertation et action intersectorielle.
Santë et Sociëtë, Collection Promotion de la santë.
Ministe©re de la santë et des services sociaux du Quëbec (MSSS)
(1992a) La politique de la santë et du bien-eªtre. Ministe©re de
la santë et des services sociaux du Quëbec, Quëbec.
Ministe©re de la santë et des services sociaux du Quëbec (MSSS)
(1992b) Cadre de rëfërence pour l'ëlaboration du programme
de santë publique et pour l'organisation du rëseau de santë
publique. Direction de la Santë publique, Ministe©re de la
santë et des services sociaux du Quëbec, Quëbec.
Nutbeam, D. (1994) Inter-sectoral action for health: making it
work. Health Promotion International, 9, 143^144.
O'Neill, M. (1990) Healthy Public Policy: the WHO perspective. Health Promotion Canada, 28, 6^8, 24.
O'Neill, M., Fortin, J. P., Lemieux, V., Groleau, G. and Cardinal, L. (1994) Academic partners of the movement: the
Laval University research team on Healthy Cities. Research
for Healthy Cities, 6, 2^4.
Ouellet, F., Harrison, L., Je¡en, S. and Smith, R. (1995) L'action intersectorielle, un jeu d'ëquipe. Direction de la santë
publique de Montrëal centre et CECOM de l'Hoªpital Rivie©res des prairies, Montrëal.
Pederson, A. P., Edwards, R. K., Kelner, M., Marshall, V. M.
and Allison, K. R. (1988) Coordination de la politique publique favorisant la santë. Santë et Bien-eªtre social Canada,
Direction de la promotion de la santë, Ottawa.
Riker, W. H. (1962) The Theory of Political Coalitions. Yale
University Press, New Haven, CT.
Roberts, J. (1988) Mechanisms for intersectoral cooperation.
Coalition theory and IHA
In Taket, A. R. (ed.) Making Partners: Intersectoral Action
for Health. Proceedings and outcome of a WHO Joint Working Group on Intersectoral Action for Health, Utrecht, The
Netherlands, 30 November^2 December.
Saan, H. (1988) A checklist to assist in the planning of intersectoral action. In Taket, A. R. (ed.) Making Partners: Intersectoral Action for Health. Proceedings and outcome of a
WHO Joint Working Group on Intersectoral Action for
Health, Utrecht, The Netherlands, 30 November^2 December.
Schneider, R. (1987) Gestion par concertation. Agence d'Arc,
Montrëal.
Springett, J. (1995) Making connections: towards an understanding of the role of networks in intersectoral collaboration for healthy public policy in cities, unpublished. Centre
for Health Studies, John Moores University, Liverpool, UK.
Springett, J. (1989) Intersectoral Collaboration and the Liverpool Healthy City Project. Unpublished MA dissertation in
health sciences, University of Leeds, UK.
Stahlberg, K. (1983) Local complexity and central bureaucracy
in Finnish health care planning. Journal of Health Politics,
Policy and Law, 8, 444^462.
Taket, A. R. (ed.) (1988a) Making Partners: Intersectoral
Action for Health. Proceedings and outcome of a WHO
Joint Working Group on Intersectoral Action for Health,
Utrecht, The Netherlands, 30 November^2 December.
Taket, A. (1988b) Working Group on Intersectoral Action:
Practical Argumentation and Mechanisms, Draft Report.
Utrecht, The Netherlands, 30 November^2 December.
Van Londen, J. (1988) Opening address to the meeting. In
Taket, A. R. (ed.) Making Partners: Intersectoral Action for
87
Health. Proceedings and outcome of a WHO Joint Working
Group on Intersectoral Action for Health, Utrecht, The
Netherlands, 30 November^2 December.
Veilleux, S. (1990) La concertation intersectorielle, un exemple: Kino-Quëbec. Essai de ma|ª trise en santë communautaire, Universitë Laval, Quëbec.
Von Neumann, J. and Morgenstern, O. (1944) Theory of Games
and Economic Behavior. Princeton University Press, Princeton, NJ.
Warwick, P. (1979) The durability of coalition governments in
parliamentary democracy. Comparative Political Studies,
11, 476^498.
Weiss, J. (1981) Substance vs. symbol in administrative reform:
the case of human services co-ordination. Policy Analysis,
7, 21^45.
Winsemius, P. (1988) Intersectoral negotiation. In Taket, A. R.
(ed.) Making Partners: Intersectoral Action for Health. Proceedings and outcome of a WHO Joint Working Group on
Intersectoral Action for Health, Utrecht, The Netherlands,
30 November^2 December.
World Health Organization (WHO) (1984) Health Promotion:
A Discussion Document on the Concept and Principles. European O¤ce of the World Health Organization, Copenhagen.
World Health Organization (WHO) (1986a) The role of intersectoral cooperation in national strategies for Health For
All. Health Promotion, 1, 239^251.
World Health Organization (WHO) (1986b) Intersectoral
Action for Health. World Health Organization, Geneva.
World Health Organization (WHO) (1986c) The Ottawa Charter for Health Promotion. Health Promotion, 1, iii^v.