The Commonwealth of Kentucky provides a unique opportunity to study cross-jurisdictional sharing by local health departments. With 120 counties, Kentucky’s local governmental public health system includes 47 single-county health departments alongside 17 multi-county health department districts.
To better understand the strengths, weaknesses, and opportunities found in cross-jurisdictional collaboration to deliver public health services, investigators from the University of Kentucky College of Public Health met with stakeholders from both multi-county and single-county health departments in the Barren River Area Development District (BRADD) in southern Kentucky and completed research via focus groups and semi-structured interviews. Their findings have resonance beyond Kentucky, as they may inform future efforts to facilitate collaboration and coalition-building among geographically separated public health organizations. The resulting publication by Dr. Angela Carman and Dr. Margaret McGladrey (past CPH Assistant Dean for Research, presently at Tufts University) appears in Frontiers in Public Health.
Cross-jurisdictional sharing is defined as “the deliberate exercise of public authority to enable collaboration across jurisdictional boundaries to deliver essential public health services and solve problems that cannot be easily solved by single organizations or jurisdictions.” Researchers have studied the extent of cross-jurisdictional sharing among LHDs however, despite the need for efficient use of local health department (LHD) resources, little has been known about cross-jurisdictional sharing in community health improvement efforts.
The authors note that accomplishing goals like community health improvement by convening community organizations across jurisdictions can be complex. In Kentucky, organizations may serve similar populations within a county, but have very different goals and funding sources. In addition, LHDs seeking to mobilize their community partners around health improvement initiatives have limited resources with which to accomplish their increasing responsibilities. These internal LHD resource constraints are compounded by the challenge of organizing health improvement efforts with community organizations distributed across geographically isolated rural areas.
The study is novel in that it leverages the local expertise of BRADD community partners in the Barren River Initiative to Get Healthy Together (BRIGHT). With resource constraints and geographic isolation, coalition work in BRIGHT is complex. Investigators sought to identify how and why rural partners across the 10 counties and three public health jurisdictions convened as a health improvement coalition. They also explored how community partners sustained their efforts by assessing health needs and developing and implementing cross-jurisdictional community health initiatives to address those needs.
The authors conclude that “…the lessons learned from the community partners contributing to this case study are ironically not cross-jurisdictionally focused. The practice of subdividing the larger coalition into workgroups that draw upon members' areas of expertise and circles of influence, the value of a focusing model, and the importance of a facilitator to provide organization and administrative support are lessons applicable to many multi-stakeholder efforts.”
These lessons emphasize the “how” of convening and sustaining members who, due to geographic or jurisdictional barriers, many of whom may have little knowledge of each other as individuals, yet deeply understand each other's circles of influence – health care, works sites, schools, and communities – and the potential for impact that working together makes possible.