Building on our last article, which applied previous Management Moment messages to the development of the Information Network for Public Health Officials (INPHO), we would like to share lessons learned from a later program, the Health Alert Network (HAN). Once again, the value of partnerships will be highlighted along with insights into the politics of funding for public health practice. Finally, we will relate the HAN to the overall theme of public health preparedness.

The Health Alert Network Vision

In keeping with the vision of INPHO described in our previous column, the purpose of the HAN was to create an information network, such that every local health agency would be connected electronically and be able to use information technology to support its mission. The initial emphasis was on "network," not on the "alert" part of the name. As you will see later, "alerting" became a central and highly visible feature following September 11, 2001.

Getting Started: The NACCHO Partnership

In the mid to late 1990s, the National Association of County and City Health Officials (NACCHO) experienced growth on its way to becoming a major national force in public health practice. As part of its annual planning conference, the NACCHO leadership decided to become more active in advocacy and to focus its advocacy on two priorities: training and information system development. Without the active involvement of NACCHO working at the national level, the HAN would never have become a reality.

Much effort had been invested by the Public Health Practice Program Office (PHPPO) of the Centers for Disease Control and Prevention (CDC) in strengthening NACCHO as an organization through the late 1980s and early 1990s. This commitment to the growth of NACCHO by PHPPO resulted in a continuously expanding relationship, which provided the foundation of the HAN program.

Establishing a strong foundational relationship before initiating program development discussions is often bypassed in the haste to "get to work." We learned from this initiative that relationship development, with attendant enhancement of trust and understanding, was central to the success of the HAN program and was a precondition for its success.

Working Within the Political Process

Once the NACCHO leadership decided to adopt advocacy as a priority, the organization set forth to establish itself as a force in Washington. The most important first step in that journey was the hiring of a very experienced former senior congressional staff worker who understood the workings of Congress, particularly the appropriations process. Her wisdom, coupled with her strategic insights and tactical skill, enabled the process to obtain extraordinary attention on Capitol Hill and, subsequently, substantial funding. Coincidentally, she had also helped to secure funding for the INPHO program several years earlier.

At around the same time, another congressional staff member, who had a public health background, learned of the CDC's interest in strengthening the public health infrastructure and particularly in providing information technology as a tool to improve local and state public health agencies. She also made a key connection between the need for a strong infrastructure and growing fears in Congress related to bioterrorism.

"Funding Follows Fear" is a maxim that has characterized the way in which our political system has addressed public health threats for decades. For example, the CDC Epidemic Intelligence Service (EIS) was funded in the 1950s in response to fears of biological warfare. In the case of the HAN, we decided, before September 11, 2001, to link our case for funding to early efforts to fund terrorism preparedness.

Making the Case, Creating the Name

Through the efforts of NACCHO, a report was requested by the Senate Appropriations Committee (a tactic often used to establish the case for a new funding initiative). In the course of developing the report, a senior PHPPO staff member coined the name "Health Alert Network." The name was vitally important in that it accurately described the program and served as a succinct label for use in lobbying for funding. Furthermore, by being asked to write a report justifying the HAN, the CDC team was forced to clearly articulate needs, opportunities, challenges, and approaches. Developing a "case statement" for any new initiative can be very valuable as a way of crystallizing the vision and helping to mobilize support.

Building the Network, Defining Success

As part of the initial phase of implementation, a dedicated team was assembled 1 and, as part of the initial planning, created definitions of success with respect to the building of the network. The team developed an operational definition of what it meant to be connected to the network (eg, continuous high-speed Internet access). Today, many of us have continuous high-speed Internet access in our homes; in 1999, at the start of the HAN initiative, most health agencies did not have this capacity and many did not think they even needed it. By defining success in operational terms, the HAN team provided leadership and established a key success parameter, which was maintained over time. Then, major technical assistance and cooperative agreement funding was put in place, which allowed the "construction" of the HAN. At that time (1999-2000), the focus was on network development. On one occasion, the system was "tested" with an "alert" to explore the ability to transmit a message over the network.

Responding to Terrorism and Urgent Health Threats

On September 11, 2001, the HAN was to send its first alert message to public health leaders. Had the groundwork not been laid in previous years, this vital communication infrastructure would not have been in place. The foresight and concerted effort that preceded September 11 allowed for utilization of the system; in some respects, but not all, the public health system had been prepared though strategic partnerships and focused technical capacity building. Subsequently, the HAN was used hundreds of times for national notification following the anthrax attacks, during West Nile Fever outbreaks, and for other emergencies. Furthermore, enhanced Federal funding allowed for greater expansion of the HAN such that all local health agencies are now connected to the Network.

Developing Local and State Health Alert Networks, Sustaining the Vision

Although the HAN was originally conceived as a national system, state and local HANs have been developed, such that the HAN vision has become part of the fabric of public health practice. In North Carolina, for example, the state's HAN is used regularly to notify practitioners of infectious disease outbreaks and public health implications of national disasters, such as hurricanes. Today the sustainability of the HAN is ensured as a result of the clear demonstration of ongoing value to public health practitioners.

Summary

The extraordinary success of the HAN initiative was based on a number of factors. First, a strong, preexisting partnership with the NACCHO enabled development of a shared vision. Second, advocacy, guided by an experienced former congressional staff member, was essential in building political support, with attendant resources to build the Network. Third, defining success in operational terms and providing technical assistance and funding to achieve success was essential in bringing the vision to reality and preparing for use of the HAN. Fourth, using the HAN following September 11 and during the anthrax threats demonstrated the value of investing in the public health infrastructure and helped to secure additional funding. Finally, institutionalization of HANs across the nation at the state and local level has ensured that the HAN vision will be sustained for decades to come.

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