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

Grant Description: What is the effect of regionalization of public health structures? The researchers used four comparative case studies to: 1) document the variation in the rationale for creating regional public health structures, 2) understand how these structures have been organized, implemented, and governed, and 3) assess the current and likely impact of regional structures on public health preparedness and public health systems more generally. The case studies addressed coordination, standardization, and developing regional capacity. The objective of the study was to provide a better understanding of the regionalization of pubic health systems in order to inform the many state and local health departments currently developing regional structures.

Policy Summary: Most states have responded to the increased interest in and funding for public health preparedness by setting up regional structures, but the rationale for these structures, the way they are implemented, and presumably the impact of this organizational change vary considerably. In order to learn from areas that have adopted a regional approach, the researchers used comparative case studies in Massachusetts, Northern Illinois, Nebraska, and the Washington D.C. National Capital Region to: 1) document the variation in the rationale for creating regional public health structures; 2) understand how these structures have been organized, implemented, and governed; and 3) assess the current and likely impact of regional structures on public health preparedness and public health systems more generally. The impetus for forming regions was some combination of the following: a crisis or perceived need for a coordinated response, a need to build local public health capacity, or an effort to use federal preparedness funds more efficiently. The relationship between public health regions and geopolitical jurisdictions in which they sit was complex. Some involve combinations of local health departments, and one set up new health departments for groups of counties. The National Capital Region has multiple definitions, including some that crossed state lines. The regions vary in terms of their congruence with regional structures for partner agencies such as emergency management agencies as well as hospital and health services markets and organizational structure. Some of the regions focus on building formal organizational relationships to coordinate and sometimes standardize preparedness and response activities, and sometimes build regional capacity, while others focused on building informal professional networks. It is not clear which approach will have the largest effect on building social capital. Whatever the approach is chosen, however, it is clear that strong leadership and trust are required for effective planning, emergency response, and sustainability. Does regionalization improve emergency preparedness? Logically, regionalization allows for more efficient use of resources and since disease outbreaks do not represent geopolitical boundaries coordination is needed. The case studies demonstrated progress in terms of planning and coordination; memoranda of understanding; regional capacity-building, training, and exercises; and development of professional networks. The case studies also showed effects in terms of the public health response to the flu vaccine shortage in 2004 and anthrax and tularemia alarms in the National Capital Area in 2005. Does regionalization improve public health generally? Logically, the same arguments about sharing resources and coordinated response apply. Also, the case studies identify a number of areas where regional capacities address other needs. It seems likely that preparedness concerns are forcing communities to think about public health structures in a way that has not been done in decades, and that network development may be creating social capital that helps with other concerns. But concerns that preparedness efforts were drawing resources and attention from other areas of public health were also heard.