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Regionalization in Local Public Health: Variation in Rationale, Implementation, and Impact on Public Health Preparedne

Regionalization in Local Public Health: Variation in Rationale, Implementation, and Impact on Public Health Preparedness. Michael A. Stoto PHSR CyberSeminar, May 2007. Washington Metropolitan Area . Definitions National Capital Region (NCR)

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Regionalization in Local Public Health: Variation in Rationale, Implementation, and Impact on Public Health Preparedne

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  1. Regionalization in Local Public Health: Variation in Rationale, Implementation, and Impact on Public Health Preparedness Michael A. Stoto PHSR CyberSeminar, May 2007

  2. Washington Metropolitan Area Definitions • National Capital Region (NCR) • Metropolitan Washington Council of Governments (COG) • Media market • Healthcare markets • Federal government

  3. NCR organization and governance • Who’s in charge? • “Let me speak to the health officer for the National Capital Region” • MWCOG Health Officers Committee (HOC) • Forum to communicate on a regular basis, but no legal authority • Senior Policy Group (SPG) and COG Chief Administrative Officers (CAO) committee • Receive and distribute federal funds

  4. Regional capacity in the NCR • ESSENCE II regional surveillance system • MWCOG • Conference call facility • Regional Incident Communication and Coordination System (RICCS) • DC Hospital Association emergency radio network (H-MARS) • VDH Northern Virginia Regional Team

  5. NCR conclusions • Regional capacity created • Numerous regional entities and relationships among public health and partners • Relationships tend to be informal • More formality may not be possible • May be optimal: personal relationships more important than formal arrangements in an emergency • “Who’s in charge” will remain an issue • Biggest challenge is role of the federal government

  6. Cross-cutting issues:Impetus for regionalization • Efficient use of preparedness funds • MA, others to lesser degree • Crisis or perceived need for a coordinated response • MA 4b, NCR, others to lesser degree • Building local public health capacity • Strengthening existing local public health structures (No. IL) • Building local public health itself (NE)

  7. Formal organizational relationships vs. informal professional networks • NACCHO Public Health Ready typology • Coordination Standardization • Centralization Networking • Describes collaboration of existing LHDs • Not as effective for building local public health capacity (e.g. MA, NE) • Does organization build social capital? • Or, are the professional networks built through regionalization the most important effect?

  8. Relationship between public health regions and geopolitical jurisdictions • Variety of combinations • Combinations of local LHDs (No. IL, MA) • Combinations of counties (NE) • NCR: multiple definitions, cross-state, sub-regions • Congruence with • Regional structures for partner agencies (e.g. EMA) • Hospital markets, HRSA funding regions, etc. • Need to preserve existing relationships if possible • Impact on political support and social capital? • Authority and resources for public health follow jurisdictional lines, but outbreaks don’t

  9. Leadership, trust and sustainability • MA 4b started with a small group formed in a crisis and grew from 15 to 27 communities with state funding • Cambridge (fiscal agent) had to ensure it was not perceived as “driving” • Competition for UASI funds in NCR • Can the perceived need for regional response overcome home rule barriers? • Need perception that at the end of the day it will be worth it • Do regions build social capital? • Does this help with sustainability?

  10. Does regionalization improve preparedness? • May depend on setting, existing resources, and variety of regionalization • Logically, yes • More efficient use of resources • Outbreaks don’t respect geopolitical boundaries, so need coordination • Demonstrated progress in • Planning and coordination • Memoranda of Understanding, etc. • Development of local and regional capacity, training, exercises • Professional network development • Response to • Flu vaccine shortage (MA) • Anthrax and tularemia alarms (NCR)

  11. Does regionalization improve public health generally? • Same efficiency, communication needs • Regional capacities address other needs • Regional epidemiology in NCR • Preparedness concerns are forcing us to think about public health structures in a way not done in decades • Communities think about preparedness in terms of day-to-day activities • Network development may be creating social capital that helps with other concerns • But, do preparedness demands draw resources and attention from other areas?

  12. AcknowledgementsRWJ HCFO Public Health Systems InitiativeMA: Howard Koh, Christine JudgeMA 4b: John Grieb, Mary ClarkNo. IL: Patrick LenihanNE: Dave Palm, Colleen SvobodaNCR: Lindsey Morse Contact Information stotom@georgetown.edu (202) 687-3292

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