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While most large Texas cities are served by one public health agency, the presence of two health departments in the Houston area — one run by Harris County and one by the city — creates confusion and inefficiencies that could be reduced if they collaborated in a new way. That’s just one of the takeaways from a “A Tale of Two Departments,” a new comprehensive report by researchers at Rice University’s Kinder Institute for Urban Research and the University of Houston’s Hobby School of Public Affairs. The report was sponsored by Episcopal Health Foundation and six other Houston-area philanthropic organizations.

The report found more than a dozen areas of overlap where both departments provide similar public health services. These include disease control, environmental health, women’s and children’s health, and nutrition. The Houston Health Department provides those services inside the city limits, and Harris County Public Health works outside of the city.

The report also found both health departments often are funded by the same sources — including the federal government —for the same or similar services.

“The inefficiencies in this dual system should be apparent,” said Bill Fulton, director of the Kinder Institute and co-author of the report. “Infectious diseases like COVID-19 don’t respect jurisdictional boundaries. Yet, the two public health departments are obligated to do so.”

The authors suggest the city and the county should either create a combined health district (as San Antonio and Bexar County have done) or put together a comprehensive memorandum of understanding to reduce confusion and overlap (following the example of Austin and Travis County).

“Consolidation of all public health services into the city or county government would create governance and financing challenges that would be hard to overcome,” Fulton said. “But through a formal agreement or by creating a health district, both the city and county could retain considerable control over governance and still provide for greater efficiency and effectiveness in providing the public health services we all need.”

The Kinder-Hobby research team examined how four other large metro areas in Texas (Austin/Travis County, Dallas/Dallas County, San Antonio/Bexar County and  Williamson County) address public health services and found that none of them have two health departments operating purely on city/county lines. Instead, all four areas have more formal coordination between the city and county, providing clarity for the public and efficiency in operations.

“Better coordination, like what is seen in these other large metro areas, can build on successful collaborations that already exist between the city and county in such areas as mosquito control and HIV treatment,” Fulton said.

The report was sponsored by EHF and six other Houston-area philanthropic institutions that provide funding for health-related organizations and projects: Baxter Trust, The Cullen Foundation, The Cullen Trust for Health Care,  Houston Endowment, Rockwell Fund and The Simmons Foundation.

“The goal of this report is really to open a public conversation about the pros and cons of having two health departments,” said Cullen Geiselman, chair of the board for The Cullen Trust for Health Care. “By taking a detailed look how other large cities and counties across Texas deliver public health, the report shows there are clear options to consider.”