Public Health Governance at the Watershed Scale: Exploring Opportunities for Multi-sector Governance to Advance Planetary Health in Northeastern Massachusetts

Abstract

Many health and environmental regulations apply only within specific political or administrative boundaries, creating a mismatch between the spatial scale of natural systems which impact health and the spatial extents of relevant regulations. For example, in Massachusetts, local Boards of Health govern specific public health and environmental issues through spatialized regulatory powers that carry significant weight in both local and larger geopolitical contexts. Despite the fact that watershed management influences regional public health outcomes through impacts to water quality, water quantity, and climate resilience measures, the organizations focused on watershed management do not have influence that matches the power of public health entities. This thesis explores how watershed management decisions could have similar weight to other public health governance decisions by exploring the specific speculative case of what interest there is in, and what barriers there are to, watershed management organizations in Northeastern Massachusetts working as public health governing units, such as local Boards of Health. Using a mixed methods approach, combining organizational and policy analyses with semi-structured key informant interviews and surveys, I assessed the opportunities, barriers and interest for multi-sector watershed and health governance to advance Planetary Health in Northeastern MA. The findings showed low receptiveness towards adopting a new regional governance system due to both perceived and actualized legal, organizational and social barriers. The findings also highlighted an interest towards strengthening existing regional partnerships and building new collaborations across the fields of public health and watershed management for more effective approaches towards environmental health decision making. These results suggest a need for additional interdisciplinary training for both sectors, and the creation of new spaces and relationships for collaboration between actors involved in public health, watershed management, and related fields.