Abstract
Public health agencies at all levels are now under increasing pressure to prepare for and respond to emerging natural and manmade threats to the health and wellness of those they serve. In particular, local health departments must be prepared to provide front-line defense and first response as threats of terrorism have become increasingly real. Success in meeting this monumental task will be highly dependent on funding as well as the availability of other resources. Although local health departments serving smaller counties may have fewer resources and receive less preparedness funding, they must still develop similar plans, surveillance systems, and response capabilities as local health departments serving larger counties (albeit on a smaller scale). Although local health departments serving larger counties may have more resources and receive more preparedness funding, they may face a greater chance of an intentional terrorist act and could benefit from support from local health departments serving smaller counties. Regional planning and response solutions to this challenge will allow partnerships of small and large local health departments to pool their resources and cooperatively provide more services with less duplication using whatever funding is available. This article describes that process as it is occurring in western New York among eight local county health departments.