1. 1 Public Health Information Sharing Along the Canada-U. S. Border: Opportunities for Improvement

2. 2 Overview Background Study design and limits Observations Relevance to this audience

3. 3 Info Flows Province Public Individual Intn’l Media Federal Public Health Units Primary Care Giver

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7. 7 EWIDS Early Warning Infectious Disease Surveillance Project (EWIDS). assist regional health agencies identify and control infectious disease outbreaks border states base funding of $15,000 each towards: –the improvement of laboratory conditions and surveillance capabilities, –the improved cross-border sharing of information, and –the maintenance of a database storing results from all regional sentinel/clinical labs.

8. 8 Border Initiatives Great Lakes Indiana Michigan Minnesota New York Ohio Pennsylvania Wisconsin Ontario Eastern Border Nova Scotia New Brunswick Maine New Hampshire New York Québec Vermont Pacific Alaska Yukon British Columbia Alberta ??? Washington Oregon Idaho Montana

9. 9 Border Initiatives

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11. 11 Question Set: 1.From your perspective, what are the main barriers to sharing health information across the Canada-U. S. border? 2.Who has the authority to share such information? 3.Which public health information sharing initiatives across the Canada-U. S. border are you or your group focussing on? If more than one, how are they related? 4.Is the information being shared done predominantly for the purpose of alerting other public health groups, or is research being shared as well? 5.What, in your opinion, are the outstanding issues that still need to be addressed regarding the sharing of information (including health data and alerts) across the Canada-U. S. border? 6.Are there any other concerns about improving information sharing across the Canada-U. S. border – or other issues regarding Canadian participation in these efforts – that you would like to see addressed?

12. 12 Study limitations: disparate backgrounds of the interview subjects so no comments can be considered as agreed upon by all. limited representation with respect to some of the regions under consideration narrow focus of this study on information sharing precluded a wider analysis of other areas of cross-border public health emergency preparedness, such as the transportation of laboratory samples.

13. 13 Results: Improve federal participation in border initiatives ensure that those who have the permission to share public health information be aware that they hold such authority Recognize turn over of border group members and incorporate strategies to update rosters inform new members… a desire more consistent, dedicated source of funding to support cross-border initiatives Bring in non participating provinces/states and work towards harmonized policies/agreements.

14. 14 Results:

15. 15 Take homes: Issues not unique to US/Canada border Formal arrangements are necessary to address critical issues/emergencies But formal agreements are not enough Most issues/barriers to the sharing of information are not legal ones Roles --- and relationships--of all levels of government must be understood

16. 16 Take homes: International National State/RegionalProvince/Territory Local * * International Health Regulations

17. 17 acknowledgements: Christopher Knudson Carleton University, Ottawa Captain Andrew Stevermer Health Emergency Preparedness Liaison Health and Human Services

18. 18 André La Prairie Health Emergency Liaison Officer (Canada) Office of the Assistant Secretary for Preparedness and Response Health and Human Services Washington, DC 20201 email: andre.laprairie@hhs.gov andre_la_prairie@phac-aspc.gc.ca