Massachusetts has a decentralized governance structure as defined by the National Association of County and City Health Officials. The 351 cities and towns are independently organized for the delivery of local public health services and operate autonomously from the Massachusetts Department of Public Health. Some Massachusetts communities have established public health districts to more effectively and efficiently deliver public health services. Massachusetts does not provide dedicated state funding to support local public health core operations.
The cities and towns, each with its own board of health, are responsible for assuring access to a comprehensive set of public health services defined by state law and regulations. Massachusetts local boards of health are charged with a complex set of responsibilities including enforcement of state sanitary, environmental, housing, and health codes. These include:
- Protection of the food supply through inspections of restaurants and other food establishments; inspections and permitting of septic systems, landfills, and other solid waste facilities
- Health care and disease control, including timely reporting and response to communicable diseases, occupational health and safety violations, food poisoning, and rabies
- Inspections of pools, beaches, camps, motels, and mobile home parks
- Enforcement of state lead poisoning regulations and sanitary code in housing
- Enforcing no-smoking laws
- Developing, testing, and building awareness of emergency preparedness plans for a wide range of hazards
- A wide array of other responsibilities, including issuing burial permits, regulating pesticides, inspecting massage and tattoo parlors, and issuing health reports
The Massachusetts Association of Health Boards provides a summary of Duties of Local Boards of Health in Massachusetts.
In addition to these responsibilities, some boards of health have resources that allow them to extend their role beyond those established through statute or regulation. For example, some boards of health manage school health programs and others partner with community-based organizations for community health improvement planning, policy and program development, and/or prevention activities using grants or other funding.