Massachusetts Regionalization Project

The Commonwealth of Massachusetts is one of six states that make up the New England region of the United States with a population of approximately 6.4 million. It is the smallest, but most populous, state in the New England region and comprises a mix of urban, suburban, and rural areas, with most of the population living in the Boston metropolitan area.

Since 1799, each of Massachusetts' 351 cities and towns has been responsible for protecting the health of its citizens through the provision of public health services. Funding for local public health services comes largely from local tax dollars and revenue generated from fines and fees because there is no direct state funding for local boards of health or health departments. Regardless of population size, all municipalities are expected to provide state mandated public health services in addition to locally mandated ones. Although larger municipalities may have the resources to meet most of their responsibilities, these are few in number. The majority of public health departments do not have the capacity to meet the accreditation standards.

Discussions about restructuring local public health in Massachusetts emerged from local activists and practitioners concerned with disparities in public health services across the state, as well as from positive experiences with regional programming, such as tobacco control measures, West Nile virus prevention, and emergency preparedness planning. The Working Group for Public Health Regionalization in Massachusetts (comprising local and state public health practitioners, legislative representatives, local governing bodies, and academics advocating for resources to promote healthy communities) was formed to identify legal and funding concerns that needed to be addressed in order to facilitate regionalization. Working group members drafted legislation to that end, and on Jan. 15, 2009, the Act Relative to Public Health Regionalization (Chapter 529 of the Acts of 2008) was signed into law, giving communities the authority to voluntarily form public health districts. While the new law does not provide funding for public health districts, it does provide the legal basis for state-matched funding of district start-up and operating costs. The Massachusetts case study describes various elements of the working group's efforts, with an emphasis on activities performed during NACCHO's support.

The working group plans to develop strategies to talk with communities that are beginning to discuss sharing public health services with one another, as well as continue to make statewide presentations to discuss the recommendations developed. In addition, the working group plans to develop a data-informed process for local communities to use when making decisions about regionalization. This process will draw on lessons learned from both Kansas and Massachusetts in their respective efforts to regionalize local public health services in their states. View more information about Massachusetts' initiative by visiting the Boston University School of Public Health's Web site on the project.