BMC Public Health 2006, 6:285 http://www.biomedcentral.com/1471-2458/6/285 should be a part of the solution" were perspectives that exem- plify the motivation of BENS members. From the perspective of public health agencies, the moti- vation to work with businesses is simple. Public health officials recognize their limitations and see the value of business resources for emergency preparedness and response. With respect to SNS dispensing, this includes logistics expertise, access to large numbers of potential volunteers, and business infrastructures for training, organizing, and communicating with volunteers. The motivation for public health to work with an organization such as BENS also reflects a desire for simplicity because BENS has ties to multiple businesses, reducing the need for public health to cultivate links independently with dif- ferent businesses. BENS represents many of the largest companies in metropolitan Atlanta, as well as smaller firms with specific expertise relevant to emergency prepar- edness. The ability to reach these companies through BENS is clearly valuable to public health, given both the assets these companies can enlist in an emergency and the number of people they can reach. As one respondent observed, "We are surrounded by opportunities." Challenges to collaboration Differences between the cultures of business and govern- ment in general and public health in particular repre- sented the most frequently cited challenge to collaboration. Manifestations of these differences included a lack of familiarity with one another's values, metrics, resources, constraints, lines of accountability, management styles, lingo, and modes of operation. As a result, business leaders and public health officials often do not know how to approach one another or whom to call to establish a relationship. Additionally, there is a stereotypical view that people in business and public health have of one another. Many in public health are suspicious of the profit motive of busi- nesses and are thus guarded when approached by busi- ness representatives. Entrees from business representatives may be viewed with suspicion, e.g., "What is this guy trying to sell me?" This perspective was amplified after September 11, 2001 and the subsequent anthrax attacks, when government officials felt besieged by entre- preneurs seeking to promote new security or health pro- tection products. From the business perspective, suspicion of government reflects a perception that government offi- cials typically want "something for nothing," often seek to impose burdensome regulations, and have a bureaucratic mindset. As one BENS staff member noted: There is also a perception among some business execu- tives that government management styles are at times inefficient and wasteful. This latter concern is a manifesta- tion of differences in the ways that business and govern- ment value efficiency and effectiveness. While both are important to businesses and governments, one business respondent characterized the difference in the following way. "In business, you are constantly trying to shift dollars from the cost to the profit side of the ledger. The way you do that is to improve efficiency. If something costs you a dollar, the first question a good manager asks is whether you can get that cost down to ninety-five cents. When you get it down to ninety-five cents, the next question is how to get it down to eighty-seven point five. If you don't do that, your competitors will do it for you, and the next thing you know you're out of business. In gov- ernment, the priority is making sure you can get the job done [effectively], and it is less important that you do it at the lowest possible cost. That's why...when public health approaches busi- ness and asks for 200 volunteers for an exercise, the first reac- tion from someone in business person is likely to be, 'Why wouldn't 100 volunteers be enough?"' This difference, viewed from the perspective of a public health official was described in the following way: "Public health and business people speak a different language. Business people...focus on measurable outcomes based on dol- lars. Public health people are [concerned about the] well-being of humanity, but you can't reduce that to dollars..." Historically, business-government interactions have often centered on regulation or investigations that may lead to regulation, casting business and public health people into adversarial positions. From this perspective, business peo- ple are apt to worry about misinformed or unnecessary government regulation, while people in public health may see their role as constraining businesses from pro- moting unhealthy products, polluting the environment, or threatening the health of workers. This perspective has also blinded many in public health from recognizing the critical role of businesses in assuring community continu- ity. The notion that perceptions of business are shaped by adversarial engagements with governments is troubling to BENS members: "Most business leaders cringe when tobacco is held up as an example of business in public health...You only hear about busi- ness when there's fraud. Our members are the first to argue that bad actors [should] get what they deserve." "We need to get past the image of the public employee as some- one resistant to change, just works 9-5...couldn't get a real job" As cultural gaps have narrowed through the establishment of trust and collaborative efforts to act in response to Page 4 of 13 (page number not for citation purposes)