Collaboration between local health and local government agencies for health improvement

Background In many countries, national, regional and local inter‐ and intra‐agency collaborations have been introduced to improve health outcomes. Evidence is needed on the effectiveness of locally developed partnerships which target changes in health outcomes and behaviours. Objectives To evaluate the effects of interagency collaboration between local health and local government agencies on health outcomes in any population or age group. Search methods We searched the Cochrane Public Health Group Specialised Register, AMED, ASSIA, CENTRAL, CINAHL, DoPHER, EMBASE, ERIC, HMIC, IBSS, MEDLINE, MEDLINE In‐Process, OpenGrey, PsycINFO, Rehabdata, Social Care Online, Social Services s, Sociological s, TRoPHI and Web of Science from 1966 through to January 2012. 'Snowballing' methods were used, including expert contact, citation tracking, website searching and reference list follow‐up. Selection criteria Randomized controlled trials (RCTs), controlled clinical trials (CCTs), controlled before‐and‐after studies (CBAs) and interrupted time series (ITS) where the study reported individual health outcomes arising from interagency collaboration between health and local government agencies compared to standard care. Studies were selected independently in duplicate, with no restriction on population subgroup or disease. Data collection and analysis Two authors independently conducted data extraction and assessed risk of bias for each study. Main results Sixteen studies were identified (28,212 participants). Only two were considered to be at low risk of bias. Eleven studies contributed data to the meta‐analyses but a narrative synthesis was undertaken for all 16 studies. Six studies examined mental health initiatives, of which one showed health benefit, four showed modest improvement in one or more of the outcomes measured but no clear overall health gain, and one showed no evidence of health gain. Four studies considered lifestyle improvements, of which one showed some limited short‐term improvements, two failed to show health gains for the intervention population, and one showed more unhealthy lifestyle behaviours persisting in the intervention population. Three studies considered chronic disease management and all failed to demonstrate health gains. Three studies considered environmental improvements and adjustments, of which two showed some health improvements and one did not. Meta‐analysis of three studies exploring the effect of collaboration on mortality showed no