Public health benefiting from private-sector partnerships: Health departments reaping results
=============================================================================================

* Teddi Dineley Johnson

For more than two decades, the Capital Metropolitan Transportation Authority has kept the wheels of commerce spinning in Austin, Texas. Each day, more than 140,000 residents hop on the system’s buses to get where they need to go.

But in 2003, the transit system’s skyrocketing health care costs shined a spotlight on the grim possibility that many of the system’s bus drivers would be too unhealthy to meet the tough new health standards about to be imposed on them.

A crisis seemed imminent, but the timing was right: A few miles down the road, the Austin-Travis County Health and Human Services Department had just received funding from the Centers for Disease Control and Prevention’s Steps program to implement the agency’s Steps to a Healthier Austin initiative. CDC’s five-year Steps effort, which is now winding down, promoted health and wellness in communities around the nation through public-private partnerships aimed at promoting health and stemming chronic disease.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/39/7/1.3/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/39/7/1.3/F1)

Capital Metro workers in Austin, Texas, benefited from a partnership that included the Austin-Travis County Health and Human Services Department.

Photo courtesy Capital Metro

“It was a fortunate coincidence,” said Rick Schwertfeger, Austin-Travis County Health and Human Services’ program manager for chronic disease prevention and control. “When we got the Steps funding, one of the things we wanted to do was a work site wellness program.”

The health department invited Capital Metropolitan Transportation Authority to be its work site wellness partner, and contracted with Health & Lifestyles Corporate Wellness Inc., a private company based in Austin, to implement the work site wellness program. Health & Lifestyles had already been working with the transit system on a wellness program. But partnering with the health department enabled the private-sector company to expand the program and purchase some much-needed equipment for the onsite fitness center. Over time, the health of the transportation authority’s employees began to improve, costs associated with their health began to fall and the rate of absenteeism dropped, according to CDC data.

Without the partnership, the health department would have lacked the expertise and resources necessary to ensure a successful work site wellness program at the transportation agency, Schwertfeger said.

“It was a mutually beneficial partnership,” he said.

As resources dwindle and health care costs soar, creative strategic partnerships between public health agencies and the private sector are garnering new attention. Faced with a growing burden of chronic disease, public health partnerships with the private sector, including businesses, can yield myriad benefits that can seldom be garnered by the public health community alone, agencies are finding.

Among those who have experienced partnership success is the Hawaii Department of Health. The department partners with the Chamber of Commerce of Hawaii and the Hawaii Department of Business, Economic Development and Tourism to assist and reward businesses that operate in an environmentally responsible way. Meanwhile, Steps to a Healthier Cleveland — a program of the Cleveland Department of Public Health — also reaped success when it joined with the Rite Aid Cleveland Marathon, YMCA of Greater Cleveland and the Cleveland Metropolitan School District to encourage healthy habits and exercise in students.

Public-private collaborations — many of which were highlighted in a recent partnership-themed issue of a CDC journal — should allow public health professionals to achieve their public health goals while maintaining the integrity of their institutions and their missions, said Elizabeth Majestic, MPH, MS, associate director for program development at CDC’s National Center for Chronic Disease Prevention and Health Promotion.

“The case has to be made that public health can no longer afford to operate like a monopoly, by which I mean public health can’t do it all alone,” Majestic told *The Nation’s Health.* “When you look at public health, you are looking at not just what’s impacting the individual, but you are looking at the environmental forces that impact that person’s health. Essentially we need to take our strategies and exert our public health leadership to where people live, work and play, and also pray.”

CDC provides guidelines to help its employees negotiate the ins and outs of partnerships, said Majestic, who has developed implementation guidelines for her own staff. Among other important information, the guidelines walk employees through partnership decisions in a systematic way to help them understand if a particular partnership is right.

“In public health, we are always short on money, which is one of the rationales for actually working in partnerships,” Majestic said. “Having that money dangled in front of your eyes can be pretty hard to turn away when you have such a great need in your program, so following guidelines and having guidelines available is important.”

At their best, public health partnerships with the private sector bring strength in resources, numbers, diversity and relationships, said APHA member Frances Butterfoss, PhD, MSED, a professor at Eastern Virginia Medical School. Butterfoss, who runs Coalitions Work, a private consultancy that evaluates the work of partnerships, recommends that public health agencies be open to organizations that are willing to accept the agency’s mission.

That was the case in 2005 when the Durham Fitness and Nutrition Council in Durham, N.C., collaborated with the local *Herald-Sun* newspaper on Lose to Win, a 15-week weight-loss intervention. Participants had access to weekly feature articles in the newspaper’s “Healthy Living” section, educational seminars and other weight-loss materials. The program, as detailed in the July issue of CDC’s *Preventing Chronic Disease,* pointed to a weight loss of close to 6 pounds per participant.

While the partnership between the Durham business and the health council was mutually beneficial, not everyone in health is as comfortable bringing for-profit organizations to the public health table, Butterfoss noted.

“You might need to learn to live with a little discomfort, because you will have a better product if you involve a diversity of perspectives,” Butterfoss told *The Nation’s Health*. “Don’t only invite the usual suspects. Think about some of the other folks that might not at first seem like likely partners.”

Such an approach worked for the Illinois Department of Public Health, which invited the Chicago White Sox, along with a prostate awareness group called Ed Randall’s Bat for the Cure, to partner with them in a promotion tied to Men’s Health Week in June. Dozens of men participated in the promotion, which awarded baseball tickets to the first 100 men screened at the White Sox stadium.

The screenings were conducted by physicians from Northwestern University’s Feinberg School of Medicine in mobile testing vans set up around the stadium, said Kelly Jakubek, spokeswoman for the Illinois Department of Public Health. During a similar partnership in April, the Illinois department joined with Ed Randall’s Bat for the Cure and the Chicago Bulls basketball team to provide additional prostate cancer screenings.

![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/39/7/1.3/F2.medium.gif)

[Figure2](http://www.thenationshealth.org/content/39/7/1.3/F2)

At an April Chicago Bulls game, men await free cancer screenings provided through a partnership with the Illinois Department of Public Health and the basketball team, among others.

Photo courtesy Illinois Department of Public Health

“Partnering with organizations like these has helped us tremendously in terms of drawing in people for much-needed services and screenings that they might not otherwise have received,” Jakubek said.

The Illinois public health agency also reaches out to women through its partnerships, Jakubek said. Last fall, for example, hundreds of women received free gift cards to Walgreens when the health department partnered with the drugstore giant in an incentive-based program designed to encourage women to sign up for the Illinois Breast and Cervical Cancer program. The program provides free mammograms, breast exams, pelvic exams and Pap tests.

![Figure3](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/39/7/1.3/F3.medium.gif)

[Figure3](http://www.thenationshealth.org/content/39/7/1.3/F3)

Men seek prostate cancer screenings at the White Sox stadium thanks to an Illinois partnership.

Photo courtesy Illinois Department of Public Health

Back in Austin, the health department continues to see benefits of its partnerships. Schwertfeger said he received an unexpected but welcome phone call in July from a transportation authority executive inviting the health department to partner in a new community-oriented health promotion.

“It showed we have such a good relationship and partnership that they thought of working with us on it,” Schwertfeger said.

For more on public health partnerships, visit [www.cdc.gov/PCD/issues/2009/apr/toc.htm](http://www.cdc.gov/PCD/issues/2009/apr/toc.htm) and [www.coalitionswork.com](http://www.coalitionswork.com).

*   Copyright The Nation’s Health, American Public Health Association