BMC Public Health 2006, 6:285 http://www.biomedcentral.com/1471-2458/6/285 Advances in preparedness were also described in more personal terms: "Potential is unlimited, but we are limited by resources and ability" Limits of Business-Public Health Partnerships Discussion of limitations of partnerships between busi- ness and public health fell into the following categories: "It has taken five or more years to move from casual 'hand- shake' relationships to one where people are on one another's speed dials. Relationship building cannot be rushed." "I can speak straight with him [a colleague in business] in a way that couldn't be done earlier." "Now we have access to the top folks in business..." "...People are on one another's speed dials." "When I call to offer help in a crisis, they [senior government officials] know who I am and they'll take my call." "We're learning to think like them and they're learning to think like us." More tangible benefits to public health include the engagement of logistics expertise and volunteers from businesses in the July 2005 SNS dispensing exercise and the commitment of businesses to expand the model to all five metropolitan Atlanta health districts. In addition, the success of the partnership has enabled expansion of its agenda to include pandemic influenza planning. For example, the Division of Public Health has involved BENS in encouraging the business community to participate in regional pandemic planning groups throughout the state and in developing procedures for corporate occupational health systems to support home healthcare in the event of a pandemic. Altogether, these activities represent substan- tial, although un-tallied in dollar terms, investment of pri- vate resources into emergency preparedness in Georgia. Limits of volunteerism and pro bono engagement As BENS is being asked to do more by its government part- ners, the partnership is facing the limits of volunteerism and of pro bono member engagement. In this regard, BENS is a "victim of its own success" resulting both from the value that government agencies in Georgia have gained from the partnership and from the ongoing efforts of BENS to promote business-government partnerships. In addition, CDC views the BENS-public health collabora- tion in Georgia as a model for SNS dispensing that should be emulated by other states, and CDC has enlisted BENS members to consult with businesses and public health officials in other states. As BENS staff or members have observed: "A few people have donated a lot of time. We need to wrestle with how much time we can ask people to give." "We're being asked to do a lot. It's now more than what we can do. We're being included in everything [regarding emergency preparedness]." Institutional constraints Limits are also shaped by the lines of accountability and procedures within businesses and governments. Ulti- mately business managers are accountable to investors or shareholders, and actions must be compatible with com- panies' long-term interests. For example, a company may endorse the principle of supporting SNS dispensing, but there are limits to how many employees a company may be willing to dismiss from work to participate in a dis- pensing exercise, which can represent a significant cost. Similarly, public health officials "live in a political world" and must act in ways that are politically feasible. Despite the potential value that may be gained from such collabo- ration, some respondents expressed concern that the part- nership may be constrained if the public perceives the SNS dispensing model as a form of favoritism for business. Timing There are limits to the speed at which business-public health partnerships can take on projects. Efforts to expand the collaboration beyond the Atlanta region within Geor- gia or to replicate the Georgia experience in other states may not be successful if the scope of projects does not match the status of relationships. Keeping focus on preparedness Some in public health would like to extend the scope of the partnership to address other health problems, such as promoting workplace obesity prevention or smoking ces- sation programs. But, there is recognition that pushing in this direction could strain the still-developing relation- ship with BENS. Noting that attention to emergency pre- paredness has enabled public health to strengthen infrastructure generally, one public health official cau- tioned against over-reaching: "The homeland security divi- dend only works so far." While workplace health promotion is certainly a worthy cause, BENS members advised that other business organizations would be a better fit for such efforts. Respondent recommendations Respondents were consistent in recommending that the partnership between BENS and government agencies, including public health, in Georgia be sustained and Page 8 of 13 (page number not for citation purposes)