Differences in healthcare systems, government structures, cultural nuances and public health priorities all impact the coordination of streamlined international crisis response. And, while many informal communication pathways exist at the local level, official mechanisms are needed for effective state to province partnership in both routine and emergency situations.

Enter the  Great Lakes Border Health Initiative. Originally undertaken as the Michigan-Ontario Border Health Initiative in early 2004, the program expanded in the fall of 2004 to include Minnesota , New York and Wisconsin . In August 2006, the GLBHI welcomed the state of Ohio to the initiative. Recently Pennsylvania and Indiana have also begun the process to join GLBHI.  Funded by the Centers for Disease Control and Prevention's Early Warning Infectious Disease Surveillance (EWIDS) project, GLBHI aims to formalize relationships between U.S. and Canadian public health and emergency preparedness agencies responsible for communicable disease tracking, control and response.

The Michigan Department of Community Health has taken a leadership role with this effort. Border Health Program Coordinator Kathy Allen-Bridson and EWIDS International Liaison Michelle Bruneau, working under the Surveillance Section of MDCH's Communicable Disease Division, staff the  Michigan arm of the Great Lakes Border Health Initiative.

As  the Great Lakes Border Health Initiative enters its fifth year, it continues to build essential cross-border relationships.

Professionals in the fields of epidemiology, public health laboratories, emergency preparedness, public health law and infection control teleconference regularly via subcommittee, with representation from local, regional, state/provincial and federal public health levels. Tribal and First Nation stakeholders on both sides of the border have also been invited to the partnership.

Chief among the initiative's current projects:

• The implementation of an international test of the Michigan Health Alert Network
• Yearly tests of the GLBHI Infectious Disease Emergency Communications Guideline
• Continued exploration into development of a possible Memorandum of Agreement (MOA) between  Ontario and the involved states.
• Formalizing protocols for moving laboratory samples across the border
• Consideration of surge capacity near the border and identification of related issues.

Questions about the Great Lakes Border Health Initiative may be directed to Kathy Allen-Bridson at (517) 335-8199 or allen-bridsonk@michigan.gov or Michelle Bruneau at (517) 335-6533 or bruneaum@michigan.gov.