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APHA Scientific Session and Event Listing

Howard K. Koh, MD, MPH¹, Amie Shei, BA¹, Christine M. Judge, MS¹, Mike Stoto, PhD², Loris J. Elqura, MS¹, Harold Cox, MSSW³, Gilbert Nick¹, Jonathan L. Burstein, MD⁴, and Suzanne K. Condon, MS⁵. (1) Center for Public Health Preparedness, Harvard School of Public Health, 677 Huntington Avenue, Landmark Center, 3rd Floor East, Boston, MA 02115, 617-495-4000, hkoh@hsph.harvard.edu, (2) Department of Biostatistics, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, (3) School of Public Health, Boston University, 715 Albany Street, T340W, Boston, MA 02118-2526, (4) Department of Population and International Health, Harvard School of Public Health, Beth Israel Deaconess Medical Center, Emergency Medicine W/CC-2, 330 Brookline Avenue, Boston, MA 02215, (5) Center for Environmental Health and Center for Emergency Preparedness, Massachusetts Department of Public Health, 250 Washington St., Boston, MA 02108

It is widely recognized that no single town or city can fully prepare for or respond to a large-scale public health emergency on its own. Spurred by post-9/11 preparedness planning, intrastate regionalization of public health resources and services has become more prevalent throughout the United States. In this study, we examine the development of regional public health infrastructures in Massachusetts with a decentralized structure of 351 autonomous local boards of health. The goal of this study is to document the process and outcomes to date of this regionalization effort through literature review and semi-structured interviews with state and local public health professionals. The purpose of this study is to understand the rationale for implementation, variation in approaches within different public health systems, barriers to implementation and sustainability, outcomes to date, and the potential for improving both public health preparedness and public health overall. We document many expected beneficial outcomes of regionalization, such as regionalized sharing of resources (e.g. communication equipment, staff), coordination (e.g. flu vaccine clinics), and capacity building (e.g. 24/7 notification system), and uncover and explore the impact of social capital (e.g. personal relationships between staff in neighboring towns) on the success of public health practice. Finally, we summarize lessons learned and propose standards for implementing and sustaining regional public health infrastructures.

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