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.

History
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.  From that point onward, the program was known as the Great Lakes Border Health Initiative (GLBHI).  In February 2009, Ohio, Indiana, and Pennsylvania became the latest regional partners to ratify the necessary agreements in order to allow them to fully participate in all that GLBHI undertakes.

Funding
Funded by the US Department of Health and Human Services, and managed through the Centers for Disease Control and Prevention's Early Warning Infectious Disease Surveillance (EWIDS) project, GLBHI aims to formalize and strengthen relationships between local and state and provincial-level public health and emergency preparedness agencies in both the United States and Canada responsible for communicable disease tracking, control and response.

Partners & Committees
The Michigan Department of Community Health (MDCH) has taken a leadership role with this effort, along with the New York State Department of Health (NYSDOH).  Since the funding is allocated by number of crossings at land borders each year, these two states receive the bulk of the monies allowing them to dedicate many more resources than the others to the project.

Professionals in the fields of epidemiology, public health laboratories, emergency preparedness, food protection and defense, 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.

Currently, Diane Krueger, the EWIDS Project Coordinator, working under the Surveillance and Infectious Disease Epidemiology Section of MDCH's Communicable Disease Division, heads the Michigan arm of the Great Lakes Border Health Initiative and serves as the Steering Committee Co-Chair, along with Phil Graham of Ontario.

Further details about the subcommittees can be viewed here.

Current Projects
Chief among the initiative's current projects:

• Cross-border enrollment on the CDC's Epi-X system and Canada's CIOSC alerting system started last year and continues to expand today

• 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 and testing protocols for moving laboratory samples across the border

• Consideration of surge capacity near the border and identification of related issues

• Key GLBHI documents, the Infectious Disease Emergency Communication Guideline and the Public Health Data Sharing Agreement, along with several reference directories continue to be refined to ensure usability and relevance

• Reviewing the use of the CDC's newly developed Cascade Alerting System amongst GLBHI partners' Health Alert Networks.

Questions about the Great Lakes Border Health Initiative may be directed to the EWIDS Project Coordinator in Michigan, Diane Krueger (KruegerD@michigan.gov or 517/335-6533) or Richard Buck ( RJB06@health.state.ny.us or 518/402-7713).