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Occasional Paper

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Amidst rising global concerns about bioterrorism and pandemic flu preparedness, the delivery capacity and effectiveness of public health service assumes increased importance and relevance. In the United States, the lack of a centralized, national public health system has meant that “public health” is the primary responsibility of state and local governments. Many states have established various types of intrastate regional structures to deliver the range of on-going, occasional, and/or episodic services that characterize the world of public health. However, Massachusetts is not among them. Despite its global reputation as a pre-eminent medical center, the state of Massachusetts has a highly balkanized public health system, with a separate health department for each of its 351 cities and towns. This structure reflects the state’s long-standing tradition of weak county government and strong home rule. The result, however, is a state-wide public health system characterized by strong local autonomy, lack of accountability, no credentialing or licensure requirements, disparate delivery capabilities, increased funding problems, and the real potential for ineffectiveness in the event of a devastating disease or attack. This paper examines how public health is currently organized and delivered both nationally and within Massachusetts, and it concludes by identifying criteria and potential regionalization structures that could lead to a more efficient and comprehensive public health delivery capability for the state. The findings have relevance not only for Massachusetts but also any state looking to improve the delivery of its public health services.


Working Paper #1025



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