Sharing knowledge, creating alliances: Crossing borders to improve public health

Graduate public health nursing students from Connecticut traveled to Toronto, Canada to visit a public health unit, an acute care hospital, a large school of nursing, and a professional organization. The purpose of this trip was to compare and contrast public health and acute health care systems, nursing education, and professional organization in Ontario and Connecticut. This comparative analysis of public health in Toronto and the state of Connecticut provides useful insights for international public health collaborations. Toronto Public Health (TPH) is the largest public health unit in Canada with 1900 employees, 32 percent of whom are public health nurses (PHNs). Thirty-six local health units across Ontario (including TPH) provide public health services for more than 12 million residents. In contrast, the Connecticut Department of Public Health employs 850 people, 11 percent of whom are PHNs. Connecticut's 81 local health departments (LHDs), 30 of them part-time, are responsible for providing public health services to 3.5 million residents. Our analysis suggests differences between TPH and Connecticut LHD responses to current and emerging public health threats. The SARS outbreak in Toronto was managed primarily by TPH, using a bottom-up approach. In contrast, and despite the large number of LHDs in Connecticut, recent anthrax and TB outbreaks were managed from the top down. In both Toronto and Connecticut, PHNs were integral to disease identification, surveillance and containment. Public health crises have no borders; knowledge of local, state, provincial, national and international public health infrastructures are critical when planning for public health emergencies. Developing international alliances among public health professionals may streamline disease control efforts in multinational outbreaks, and facilitate public health learning opportunities.