Prehospital and Disaster Medicine

Original Research

State, Territorial, and Local Health Departments’ Reporting of Partnership Strength Before and After the H1N1 Response

Karen E. Kuna1, John Zimmermana2, Dale A. Rosea1 c1 and Stephanie Rubela1

a1 Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

a2 ICF International, Inc., Fairfax, Virginia, USA


Introduction Research has shown that partnerships between public health agencies, service providers, and other key stakeholders can expand resources and facilitate focus on community health issues more effectively than can any agency or organization acting alone. There is, however, little empirical evidence drawn from actual public health emergency responses to support this claim. The US response to novel influenza A (H1N1) virus provided the Centers for Disease Control and Prevention (CDC) the opportunity to explore whether, and the extent to which, state, local and territorial health departments strengthened partnerships with key partner agencies and sectors.

Methods Participants included the CDC Public Health Emergency Response (PHER) grantees comprised of 62 state, territorial and local health departments. PHER grantees completed an assessment instrument in May 2011, including questions asking them to rate their partnership strength (on a four-point ordinal scale) with six types of partners before and after the H1N1 response. Grantees additionally reported if and how PHER funding contributed to enhancing the strength of these partnerships.

Results Sixty-one PHER grantees (61/62, 98%) completed the assessment instrument's partnerships section. PHER grantees reported that their partnerships with retail pharmacies were most strengthened (mean increase = 1.11 (on a four-point ordinal scale), SD = .82). This was followed by schools (K-12) (mean increase = .90, SD = .58); private medical providers (mean increase = .81, SD = .68); immunization authorities (mean increase = .80, SD = .61); main education authorities (mean increase = .75, SD = .68); and businesses (mean increase = .74, SD = .61). Mean PHER grantee increases in the strength of each partner type were statistically significant for all partner types (P < .01). Grantees reported that PHER funding contributed to enhancing the strength of their partnerships with schools most frequently (46/46, 100%), and businesses least frequently (31/37, 83.8%).

Conclusions This inquiry provides evidence that state, territorial, and local health department partnerships with key sectors, agencies, and programs were strengthened after the H1N1 response. It further demonstrates that the CDC's PHER funding contributed to the health departments’ reports of increased partnership strength.

K Kun, J Zimmerman, D Rose, S Rubel. State, territorial, and local health departments’ reporting of partnership strength before and after the H1N1 response. Prehosp Disaster Med. 2013;28(6):1-6 .

(Received June 12 2013)

(Accepted June 29 2013)

(Online publication November 07 2013)


  • disasters;
  • Influenza A virus;
  • H1N1 subtype;
  • pandemics;
  • public health;
  • public-private sector partnerships


  • CDC:Centers for Disease Control and Prevention;
  • H1N1:Novel influenza A (H1N1);
  • H:hemagglutinin;
  • N:neuraminidase;
  • PHER:Public Health Emergency Response


c1 Correspondence: Dale A. Rose, PhD Office of Public Health Preparedness and Response Centers for Disease Control and Prevention 1600 Clifton Road, NE, Mailstop D18, Atlanta, GA 30333 USA E-mail


  Conflicts of interest: None.