Intersectoral Collaboration and Complex Health Emergencies: Insights From a Comparative Analysis of Public Space Regulation During COVID-19 in Four Canadian Provinces

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Abstract
Background: This paper contrasts and examines the perceptions of policy communities on the dynamics and factors shaping intersectoral collaboration in governance of health emergencies, drawing on the example of public space regulation during COVID-19 in four Canadian provinces, with the goal of exploring variation and perceived quality of policy responses. Methods: We compared public space regulation in four Canadian provinces—British Columbia (BC), Nova Scotia (NS), Ontario (ON) and Québec (QC)—during COVID-19 from 2020 to 2022. The study was designed as a comparative, qualitative, and explanatory case study, utilizing in-depth interviews and documents. We conducted 103 interviews with a diverse range of stakeholders, including senior government and non-government leaders, reviewed selected policy documents, and media reports. We utilized multisite qualitative analysis to analyze our data and develop within- and cross-case themes. Results: Respondents reported vastly different provincial approaches to intersectoral collaboration within government and with non-governmental stakeholders in the management of public spaces, ranging from higher (BC, NS) to lower (ON, QC) levels of collaboration in governance, as reflected in the access of government and non-government stakeholders to key decision-makers and decision-making forums and processes, the transparency of those processes, and responsiveness to their input. Institutional frameworks, political factors and organizational culture and capacity were the major distinguishing factors between these provincial approaches to collaboration. Disparities in access to decision-makers were reported, with business interests and certain civil society organizations experiencing easier access compared to other public interest groups. Conclusion: Public health challenges are increasingly complex and intersectoral. Research on intersectoral collaboration must examine collaboration dynamics within and outside government holistically, rather than exploring these dynamics in siloes. Stakeholder engagement which combines institutional structures and inclusive stakeholder engagement within and outside government is crucial to managing complex policy processes during crisis and beyond.

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