title: Cross-Jurisdictional Resource Sharing in Changing Public Health Landscape: Contributory Factors and Theoretical Explanations.
abstract: Local health departments (LHDs) are striving to meet public health needs within their jurisdictions, amidst fiscal restraints and complex dynamic environment. Resource sharing across jurisdictions is a critical opportunity for LHDs to continue to enhance effectiveness and increase efficiency.
  
  
  
  This research examines the extent of cross-jurisdictional resource sharing among LHDs, the programmatic areas and organizational functions for which LHDs share resources, and LHD characteristics associated with resource sharing.
  
  
  
  Data from the National Association of County & City Health Officials' 2013 National Profile of LHDs were used. Descriptive statistics and multinomial logistic regression were performed for the 5 implementation-oriented outcome variables of interest, with 3 levels of implementation.
  
  
  
  More than 54% of LHDs shared resources such as funding, staff, or equipment with 1 or more other LHDs on a continuous, recurring basis. Results from the multinomial regression analysis indicate that economies of scale (population size and metropolitan status) had significant positive influences (at P ≤ .05) on resource sharing. Engagement in accreditation, community health assessment, community health improvement planning, quality improvement, and use of the Community Guide were associated with lower levels of engagement in resource sharing. Doctoral degree of the top executive and having 1 or more local boards of health carried a positive influence on resource sharing.
  
  
  
  Cross-jurisdictional resource sharing is a viable and commonly used process to overcome the challenges of new and emerging public health problems within the constraints of restricted budgets. LHDs, particularly smaller LHDs with limited resources, should consider increased resource sharing to address emerging challenges.
authors.affiliation: Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro (Drs Shah and Robb and Mr Badana); and Center for Health Equity and Quality Research, UF College of Medicine-Jacksonville, Florida (Dr Livingood).
authors.forename: Gulzar H
authors.initials: GH
authors.lastname: Shah
authors.forename: Adrian N S
authors.initials: ANS
authors.lastname: Badana
authors.forename: Claire
authors.initials: C
authors.lastname: Robb
authors.forename: William C
authors.initials: WC
authors.lastname: Livingood
mesh_terms: D003430:Cross-Sectional Studies; D006295:Health Resources / Q000191:economics / Q000600:supply & distribution*; D006801:Humans; D009111:Local Government; D011580:Psychological Techniques; D011634:Public Health / Q000191:economics / Q000379:methods* / Q000639:trends*