Metro Boston municipalities have a ready opportunity to improve public health service delivery, improve equity, and save costs through the regionalization of public health services.  As with other services, a regional approach will help municipalities to share costs, benefit from a broader range of essential services, achieve economies of scale, and coordinate planning.  A unique benefit of public health regionalization is that it also allows for more comprehensive and effective response to public health emergencies such as disease outbreaks that do not recognize municipal boundaries.  

Massachusetts is one of the few states in the nation that has no county or regional public health system, and no direct state funding for local boards of health and health departments.  Public health departments must compete with other essential services for limited local funds, often resulting in under-funded departments and lack of staff.  At the same time, local health departments are facing increasing demands as a result of new mandates and emergency preparedness responsibilities.  

The Massachusetts Public Health Regionalization Project has evaluated the need for regional health services, assessed existing efforts, and identified alternative models for implementation.  A “full district” approach involves two or more municipalities pooling resources to provide comprehensive public health services.  Other approaches include the “shared services” model in which municipalities might jointly deliver specific services; or the “cafeteria” model in which a regional entity would provide a variety of services that towns could obtain via contract on an as-needed basis.  

There are examples of such collaboration already existing in Massachusetts, such as the delivery of regionalized public health services through the Franklin Regional Council of Governments and Barnstable County.  These programs demonstrate that public health services can be delivered regionally in a way that respects municipalities but provides both economies of scale and increased technical sophistication.  MAPC has already been involved in public health issues in other ways, such as the development of emergency plan templates for DPH.

Increased regional public service delivery will require additional guidance and legislative changes.  While existing Massachusetts law allows for the creation of regional health districts, it does not address important issues: home rule and local authority; workforce credential standards; and financial sustainability.  The Public Health Regionalization Project Working Group has identified legislative recommendations to address these issues, and is currently developing recommendations for district minimum requirements, funding structures, and reorganization of the Department of Public Health to support regionalization.

6.a    The Legislature should adopt legislation specifically authorizing regional health districts and regional health officers

6.b    DPH should reorganize its assets to support regionalization of public health services

6.c    The Legislature should provide funding to support a “Full District” pilot project

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