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Abstract: In late 2008, government officials in Summit County, Ohio began to discuss the possibility of combining the county's three public health districts. These early discussions set the stage for more than two years of negotiations that eventually led to the consolidation of the health departments in late 2010 and early 2011. This case tells the story of why and how officials in Summit County combined their public health districts and includes an epilogue that describes the consolidated agency's first year of operations.
Learning Objective: This case highlights the political, financial, and health factors that triggered a merger of three health departments as well as the administrative and political difficulties that leaders encountered when implementing it. It prompts students of public administration and management to analyze the benefits and drawbacks of the regional consolidation of services as well as the factors finances, politics, and personalities that affect intergovernmental relations and public health at the local level.