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Baystate Franklin Medical Center's service area includes all 26 communities in Franklin County and four adjacent northwestern Worcester County towns. [show map]

Franklin County is the most rural of the fourteen counties in Massachusetts with 72,000 people over 725 square miles—a population density of only 102 people per square mile. Three quarters of the land is covered in forests. Rivers, streams and lakes are plentiful, and farms of all kinds dot the land.

Most towns have fewer than 2,000 residents—some hilltowns have fewer than 500—the vast majority of which are White and English-speaking.

The overall population is declining and also aging.

Our communities are resilient and resourceful


Membership associations, interconnection, and collaboration are great strengths in the region. Although each community is staunchly independent they come together to solve challenging problems.

For example, when Franklin County's government was dissolved, the Franklin Regional Council of Governments was formed as a volunteer organization to help the county's small towns. Today, a majority of communities benefit from one or more of  FRCOG's services, such as building inspections, accounting services and software, public health nursing, and collective purchasing program.

Franklin County was the first region in the state to recognize and actively address heroin and opioid addiction with its Opioid Taskforce.

We have had discernible reductions in teen risk behaviors such as drug and alcohol use through the efforts of Communities that Care

A $150,000 grant from the Metro Area Planning Council (MAPC) was awarded to the Franklin Regional Transit Authority (FRTA) to partner with a team of non-profit service providers and local businesses to launch a taxi service designed to help Franklin County residents secure and keep late shift jobs. for employees that may have car trouble, lack of funds to buy a car, or other transportation challenges. Until people know they have a reliable way to get to and from a 2nd or 3rd shift job that starts or ends at 11:00 p.m. or midnight, they tend not to apply. This potential workforce will become visible and available to employers now that we can offer a reliable transportation option.” The program was created to solve the transportation problem in Franklin County for late night workers when there is no fixed bus service.

Another measure of community engagement—voter turnout—is high in the region with 77% of eligible voters in Franklin County turning out in 2016, slightly higher than the state rate of 75% and much higher than the nation’s 61%.

Education is a Strength

Even though our schools are struggling with a declining number of students and the high cost of busing them across large districts, a higher percentage of Franklin County residents aged 25 years and older have a high school or equivalent diploma compared to the state and the nation.

And the percentage with a bachelor’s degree or higher is greater than the nation as a whole—and is higher than all but six states.

There are some real challenges as well

Franklin County is the poorest in Massachusetts. 

Approximately 10% of its residents report food insecurity, and about a third are housing cost-burdened. And with local housing some of the oldest in the country, lead, mold, outdated wiring and plumbing, and inefficient heating systems are common issues.

Homelessness is a persistent problem, and area agencies are not able to meet the demand for shelter and services.

There aren't enough primary care providers, specialists, and dentists to meet local need.

With one primary care doctor to serve 1,280 people, HRSA has designated North Quabbin and much of Franklin County a  Health Care Professional Shortage Area.

It is also considered medically underserved, indicating either a shortage of primary care providers, high infant mortality, high poverty, or a high elderly population. And while 97 percent of its residents have health insurance, many providers do not accept MassHealth.

Access to public transportation is an overwhelming need.

Most residents of Franklin County and the North Quabbin region are car-dependent.

The region is served by the Franklin Regional Transit Authority which has the largest service area in the state. But it doesn't travel to all communities and there is no night or weekend service. So most residents need their own vehicle to get anywhere, and they often must drive long distances. In Franklin County, more than three-quarters of the workforce drives to work alone, and about half of those commute 30 minutes or more.

Spotty Connectivity /digital divide disparity =reduced opportunities for jobs and education

Broadband and cell phone access are still not available in some of the region’s most rural communities.

About 20% of Franklin County households did not have broadband in 2017. Although broadband access improved as income increased, still 10% of households with income over $75,000 lacked broadband internet.

Priority Health Issues

Chronic conditions of obesity, cardiovascular disease, diabetes, respiratory disease, and cancer are common in the region.

Heart disease and cancer are the two leading causes of death for area residents. Asthma is the most common chronic disease among children.

Other priority health conditions include mental health and substance abuse, and infant and perinatal health, including low birth weight, preterm birth, teen birth, utilization of prenatal care, smoking during pregnancy, and neonatal abstinence syndrome.

Social isolation and loneliness are problems for many, especially older adults, people with disabilities, people in more remote areas, older teens and young adults who are not in school or employed, and people in marginalized groups who do not feel entirely welcome in the broader community.

2019 CHNA