{
  "slug": "massachusetts-county-primary-care-access-2026",
  "title": "Massachusetts County Primary-Care Access & Health-Burden Scorecard",
  "summary": "A county-level targeting index for Massachusetts, fusing adult chronic-disease and social-risk prevalence (CDC PLACES) with federally designated primary-care provider shortages (HRSA). Ranks all 14 counties by combined need so a health department or rural-health office can see where high burden and thin provider supply overlap.",
  "state": "Massachusetts",
  "category": "Public Health & Risk",
  "tags": [
    "public-health",
    "health-access",
    "geospatial-risk",
    "government-data",
    "massachusetts"
  ],
  "publishedDate": "2026-08-01",
  "accessAxisLabel": "Access & SDOH barriers",
  "generatedAt": "2026-08-01T06:58:48+00:00",
  "dataVintage": {
    "places": "PLACES: Local Data for Better Health, County Data, 2025 release (measure year 2023)",
    "hpsa": "HRSA Primary Care HPSA detail extract, accessed 2026-08-01",
    "acs": "ACS 2019-2023 5-year estimates"
  },
  "methodology": "A Health-Burden axis is built from CDC PLACES crude adult prevalence (diagnosed diabetes, obesity, high blood pressure, coronary heart disease, fair or poor self-rated health, frequent physical distress). An Access & SDOH barriers axis combines uninsured (adults 18-64), lack of reliable transportation, food insecurity, housing insecurity, below poverty (acs), households without a vehicle (acs) (Census ACS measures join CDC PLACES here). Each measure is min-max normalized across the state's counties to 0-100, then averaged within its axis. A Provider-Shortage axis scales each county's worst designated primary-care HPSA score against the HRSA 0-26 severity scale. The combined Targeting-Priority Index is the equal-weighted mean of the three axes. PLACES values are model-based estimates with confidence intervals (carried per county), not direct counts. Scores are relative WITHIN Massachusetts: a 100 marks the worst county in the state on that axis, not a national benchmark.",
  "limitations": [
    "Scores are intra-state relative, not absolute or cross-state comparable.",
    "PLACES values are small-area model-based estimates with confidence intervals, not direct counts.",
    "HPSA aggregation takes the worst designated primary-care score per county; geographic, population-group, and facility designations are pooled.",
    "Equal axis weighting is a transparent default, not a calibrated policy model.",
    "Socioeconomic measures are ACS 2019-2023 5-year estimates; ACS estimates carry margins of error not reflected in the composite.",
    "This is informational analysis of public data, not clinical, individual, or actuarial advice."
  ],
  "sources": [
    {
      "name": "CDC PLACES — Local Data for Better Health (County Data)",
      "dataset": "PLACES: Local Data for Better Health, County Data, 2025 release (measure year 2023)",
      "url": "https://www.cdc.gov/places/",
      "apiUrl": "https://data.cdc.gov/resource/swc5-untb.json",
      "accessedDate": "2026-08-01"
    },
    {
      "name": "HRSA — Primary Care Health Professional Shortage Areas",
      "dataset": "Shortage Area HPSA detail (Primary Care discipline, designated)",
      "url": "https://data.hrsa.gov/data/download",
      "accessedDate": "2026-08-01"
    },
    {
      "name": "U.S. Census Bureau — American Community Survey (5-year)",
      "dataset": "ACS 2019-2023 5-year estimates",
      "url": "https://www.census.gov/programs-surveys/acs/",
      "apiUrl": "https://api.census.gov/data/2023/acs/acs5",
      "accessedDate": "2026-08-01"
    }
  ],
  "measures": {
    "burden": [
      {
        "id": "DIABETES",
        "label": "Diagnosed diabetes"
      },
      {
        "id": "OBESITY",
        "label": "Obesity"
      },
      {
        "id": "BPHIGH",
        "label": "High blood pressure"
      },
      {
        "id": "CHD",
        "label": "Coronary heart disease"
      },
      {
        "id": "GHLTH",
        "label": "Fair or poor self-rated health"
      },
      {
        "id": "PHLTH",
        "label": "Frequent physical distress"
      }
    ],
    "access": [
      {
        "id": "ACCESS2",
        "label": "Uninsured (adults 18-64)"
      },
      {
        "id": "LACKTRPT",
        "label": "Lack of reliable transportation"
      },
      {
        "id": "FOODINSECU",
        "label": "Food insecurity"
      },
      {
        "id": "HOUSINSECU",
        "label": "Housing insecurity"
      },
      {
        "id": "ACS_POVERTY",
        "label": "Below poverty (ACS)"
      },
      {
        "id": "ACS_NOVEHICLE",
        "label": "Households without a vehicle (ACS)"
      }
    ]
  },
  "stats": {
    "counties": 14,
    "countiesWithHpsa": 14,
    "countiesWithHpsaPct": 100,
    "medianDiabetes": 10.4,
    "diabetesMin": {
      "county": "Hampshire",
      "value": 8.2
    },
    "diabetesMax": {
      "county": "Hampden",
      "value": 12.1
    },
    "medianUninsured": 4.6
  },
  "keyFindings": [
    "14 of Massachusetts's 14 counties (100%) fall within a federally designated primary-care Health Professional Shortage Area.",
    "Adult diagnosed-diabetes prevalence ranges from 8.2% in Hampshire County to 12.1% in Hampden County, a 3.9-point spread within a single state.",
    "Hampden County carries the highest combined targeting-priority index (79.5/100), led by its health burden score.",
    "The median county uninsured rate (adults 18-64) is 4.6%, and the median adult diabetes prevalence is 10.4%."
  ],
  "counties": [
    {
      "fips": "25013",
      "name": "Hampden",
      "population": 460291,
      "priorityIndex": 79.5,
      "burdenScore": 89.7,
      "accessScore": 87.4,
      "shortageScore": 61.5,
      "topDriver": "Health burden",
      "hpsaMaxScore": 16,
      "hpsaDesignations": 11,
      "raw": {
        "DIABETES": 12.1,
        "OBESITY": 34.9,
        "BPHIGH": 34.7,
        "CHD": 7.0,
        "GHLTH": 22.8,
        "PHLTH": 16.0,
        "ACCESS2": 8.1,
        "LACKTRPT": 10.4,
        "FOODINSECU": 18.7,
        "HOUSINSECU": 16.0,
        "ACS_POVERTY": 15.7,
        "ACS_NOVEHICLE": 12.1
      },
      "ci": {
        "DIABETES": {
          "lo": 10.5,
          "hi": 13.8
        },
        "OBESITY": {
          "lo": 30.1,
          "hi": 40.1
        },
        "BPHIGH": {
          "lo": 31.4,
          "hi": 37.8
        },
        "CHD": {
          "lo": 6.1,
          "hi": 8.0
        },
        "GHLTH": {
          "lo": 19.5,
          "hi": 26.0
        },
        "PHLTH": {
          "lo": 13.9,
          "hi": 18.0
        },
        "ACCESS2": {
          "lo": 6.3,
          "hi": 9.9
        },
        "LACKTRPT": {
          "lo": 8.9,
          "hi": 12.1
        },
        "FOODINSECU": {
          "lo": 15.6,
          "hi": 22.3
        },
        "HOUSINSECU": {
          "lo": 13.5,
          "hi": 18.6
        }
      },
      "rank": 1
    },
    {
      "fips": "25005",
      "name": "Bristol",
      "population": 581841,
      "priorityIndex": 65.6,
      "burdenScore": 69.0,
      "accessScore": 54.8,
      "shortageScore": 73.1,
      "topDriver": "Provider shortage",
      "hpsaMaxScore": 19,
      "hpsaDesignations": 4,
      "raw": {
        "DIABETES": 10.8,
        "OBESITY": 32.1,
        "BPHIGH": 33.5,
        "CHD": 6.8,
        "GHLTH": 20.0,
        "PHLTH": 14.6,
        "ACCESS2": 5.9,
        "LACKTRPT": 8.4,
        "FOODINSECU": 14.9,
        "HOUSINSECU": 13.2,
        "ACS_POVERTY": 11.6,
        "ACS_NOVEHICLE": 9.7
      },
      "ci": {
        "DIABETES": {
          "lo": 9.2,
          "hi": 12.4
        },
        "OBESITY": {
          "lo": 27.8,
          "hi": 36.9
        },
        "BPHIGH": {
          "lo": 30.5,
          "hi": 36.6
        },
        "CHD": {
          "lo": 5.9,
          "hi": 7.8
        },
        "GHLTH": {
          "lo": 16.8,
          "hi": 23.4
        },
        "PHLTH": {
          "lo": 12.6,
          "hi": 16.8
        },
        "ACCESS2": {
          "lo": 4.5,
          "hi": 7.6
        },
        "LACKTRPT": {
          "lo": 7.0,
          "hi": 10.0
        },
        "FOODINSECU": {
          "lo": 12.1,
          "hi": 18.6
        },
        "HOUSINSECU": {
          "lo": 11.0,
          "hi": 15.6
        }
      },
      "rank": 2
    },
    {
      "fips": "25025",
      "name": "Suffolk",
      "population": 768425,
      "priorityIndex": 61.0,
      "burdenScore": 19.3,
      "accessScore": 90.7,
      "shortageScore": 73.1,
      "topDriver": "Access & SDOH barriers",
      "hpsaMaxScore": 19,
      "hpsaDesignations": 18,
      "raw": {
        "DIABETES": 9.3,
        "OBESITY": 24.2,
        "BPHIGH": 27.4,
        "CHD": 4.8,
        "GHLTH": 17.2,
        "PHLTH": 11.4,
        "ACCESS2": 6.6,
        "LACKTRPT": 10.4,
        "FOODINSECU": 17.2,
        "HOUSINSECU": 15.3,
        "ACS_POVERTY": 16.5,
        "ACS_NOVEHICLE": 31.8
      },
      "ci": {
        "DIABETES": {
          "lo": 8.1,
          "hi": 10.5
        },
        "OBESITY": {
          "lo": 20.7,
          "hi": 27.8
        },
        "BPHIGH": {
          "lo": 25.0,
          "hi": 29.9
        },
        "CHD": {
          "lo": 4.3,
          "hi": 5.4
        },
        "GHLTH": {
          "lo": 14.7,
          "hi": 19.8
        },
        "PHLTH": {
          "lo": 9.9,
          "hi": 13.0
        },
        "ACCESS2": {
          "lo": 5.1,
          "hi": 8.4
        },
        "LACKTRPT": {
          "lo": 8.7,
          "hi": 12.1
        },
        "FOODINSECU": {
          "lo": 14.0,
          "hi": 20.6
        },
        "HOUSINSECU": {
          "lo": 12.8,
          "hi": 18.0
        }
      },
      "rank": 3
    },
    {
      "fips": "25009",
      "name": "Essex",
      "population": 810089,
      "priorityIndex": 55.6,
      "burdenScore": 49.2,
      "accessScore": 44.5,
      "shortageScore": 73.1,
      "topDriver": "Provider shortage",
      "hpsaMaxScore": 19,
      "hpsaDesignations": 32,
      "raw": {
        "DIABETES": 10.3,
        "OBESITY": 30.0,
        "BPHIGH": 32.1,
        "CHD": 6.2,
        "GHLTH": 16.9,
        "PHLTH": 13.0,
        "ACCESS2": 6.2,
        "LACKTRPT": 7.6,
        "FOODINSECU": 13.3,
        "HOUSINSECU": 11.4,
        "ACS_POVERTY": 9.4,
        "ACS_NOVEHICLE": 9.6
      },
      "ci": {
        "DIABETES": {
          "lo": 8.8,
          "hi": 11.8
        },
        "OBESITY": {
          "lo": 25.6,
          "hi": 34.5
        },
        "BPHIGH": {
          "lo": 29.1,
          "hi": 35.1
        },
        "CHD": {
          "lo": 5.4,
          "hi": 7.2
        },
        "GHLTH": {
          "lo": 14.3,
          "hi": 19.9
        },
        "PHLTH": {
          "lo": 11.3,
          "hi": 15.0
        },
        "ACCESS2": {
          "lo": 4.7,
          "hi": 7.9
        },
        "LACKTRPT": {
          "lo": 6.4,
          "hi": 9.0
        },
        "FOODINSECU": {
          "lo": 10.8,
          "hi": 16.2
        },
        "HOUSINSECU": {
          "lo": 9.5,
          "hi": 13.6
        }
      },
      "rank": 4
    },
    {
      "fips": "25003",
      "name": "Berkshire",
      "population": 126818,
      "priorityIndex": 54.7,
      "burdenScore": 69.6,
      "accessScore": 33.1,
      "shortageScore": 61.5,
      "topDriver": "Health burden",
      "hpsaMaxScore": 16,
      "hpsaDesignations": 22,
      "raw": {
        "DIABETES": 10.9,
        "OBESITY": 31.2,
        "BPHIGH": 34.8,
        "CHD": 7.8,
        "GHLTH": 17.8,
        "PHLTH": 13.9,
        "ACCESS2": 4.8,
        "LACKTRPT": 7.1,
        "FOODINSECU": 11.4,
        "HOUSINSECU": 9.6,
        "ACS_POVERTY": 11.0,
        "ACS_NOVEHICLE": 9.5
      },
      "ci": {
        "DIABETES": {
          "lo": 9.2,
          "hi": 12.8
        },
        "OBESITY": {
          "lo": 25.4,
          "hi": 36.7
        },
        "BPHIGH": {
          "lo": 30.9,
          "hi": 38.4
        },
        "CHD": {
          "lo": 6.7,
          "hi": 8.9
        },
        "GHLTH": {
          "lo": 14.8,
          "hi": 21.0
        },
        "PHLTH": {
          "lo": 11.9,
          "hi": 16.1
        },
        "ACCESS2": {
          "lo": 3.5,
          "hi": 6.1
        },
        "LACKTRPT": {
          "lo": 5.8,
          "hi": 8.4
        },
        "FOODINSECU": {
          "lo": 8.8,
          "hi": 14.3
        },
        "HOUSINSECU": {
          "lo": 7.7,
          "hi": 11.7
        }
      },
      "rank": 5
    },
    {
      "fips": "25011",
      "name": "Franklin",
      "population": 70836,
      "priorityIndex": 54.2,
      "burdenScore": 61.2,
      "accessScore": 32.1,
      "shortageScore": 69.2,
      "topDriver": "Provider shortage",
      "hpsaMaxScore": 18,
      "hpsaDesignations": 23,
      "raw": {
        "DIABETES": 10.8,
        "OBESITY": 26.3,
        "BPHIGH": 36.3,
        "CHD": 7.3,
        "GHLTH": 17.3,
        "PHLTH": 13.8,
        "ACCESS2": 4.7,
        "LACKTRPT": 6.9,
        "FOODINSECU": 11.0,
        "HOUSINSECU": 9.6,
        "ACS_POVERTY": 12.2,
        "ACS_NOVEHICLE": 8.2
      },
      "ci": {
        "DIABETES": {
          "lo": 9.1,
          "hi": 12.7
        },
        "OBESITY": {
          "lo": 20.8,
          "hi": 32.8
        },
        "BPHIGH": {
          "lo": 32.2,
          "hi": 40.4
        },
        "CHD": {
          "lo": 6.3,
          "hi": 8.3
        },
        "GHLTH": {
          "lo": 14.1,
          "hi": 20.7
        },
        "PHLTH": {
          "lo": 11.6,
          "hi": 16.0
        },
        "ACCESS2": {
          "lo": 3.5,
          "hi": 6.2
        },
        "LACKTRPT": {
          "lo": 5.7,
          "hi": 8.2
        },
        "FOODINSECU": {
          "lo": 8.5,
          "hi": 13.7
        },
        "HOUSINSECU": {
          "lo": 7.6,
          "hi": 11.7
        }
      },
      "rank": 6
    },
    {
      "fips": "25027",
      "name": "Worcester",
      "population": 866866,
      "priorityIndex": 52.9,
      "burdenScore": 55.6,
      "accessScore": 41.5,
      "shortageScore": 61.5,
      "topDriver": "Provider shortage",
      "hpsaMaxScore": 16,
      "hpsaDesignations": 12,
      "raw": {
        "DIABETES": 10.4,
        "OBESITY": 32.6,
        "BPHIGH": 33.2,
        "CHD": 6.0,
        "GHLTH": 17.4,
        "PHLTH": 13.4,
        "ACCESS2": 5.4,
        "LACKTRPT": 7.7,
        "FOODINSECU": 13.1,
        "HOUSINSECU": 11.1,
        "ACS_POVERTY": 10.3,
        "ACS_NOVEHICLE": 8.5
      },
      "ci": {
        "DIABETES": {
          "lo": 9.0,
          "hi": 11.9
        },
        "OBESITY": {
          "lo": 28.3,
          "hi": 36.9
        },
        "BPHIGH": {
          "lo": 30.2,
          "hi": 36.1
        },
        "CHD": {
          "lo": 5.2,
          "hi": 6.9
        },
        "GHLTH": {
          "lo": 14.6,
          "hi": 20.2
        },
        "PHLTH": {
          "lo": 11.5,
          "hi": 15.3
        },
        "ACCESS2": {
          "lo": 4.3,
          "hi": 6.8
        },
        "LACKTRPT": {
          "lo": 6.5,
          "hi": 9.1
        },
        "FOODINSECU": {
          "lo": 10.6,
          "hi": 16.2
        },
        "HOUSINSECU": {
          "lo": 9.2,
          "hi": 13.4
        }
      },
      "rank": 7
    },
    {
      "fips": "25001",
      "name": "Barnstable",
      "population": 231735,
      "priorityIndex": 42.3,
      "burdenScore": 63.1,
      "accessScore": 6.2,
      "shortageScore": 57.7,
      "topDriver": "Health burden",
      "hpsaMaxScore": 15,
      "hpsaDesignations": 4,
      "raw": {
        "DIABETES": 10.7,
        "OBESITY": 26.3,
        "BPHIGH": 38.2,
        "CHD": 8.0,
        "GHLTH": 15.6,
        "PHLTH": 13.4,
        "ACCESS2": 3.6,
        "LACKTRPT": 5.3,
        "FOODINSECU": 8.3,
        "HOUSINSECU": 7.3,
        "ACS_POVERTY": 7.4,
        "ACS_NOVEHICLE": 4.9
      },
      "ci": {
        "DIABETES": {
          "lo": 8.9,
          "hi": 12.8
        },
        "OBESITY": {
          "lo": 21.2,
          "hi": 31.8
        },
        "BPHIGH": {
          "lo": 34.2,
          "hi": 42.2
        },
        "CHD": {
          "lo": 6.8,
          "hi": 9.4
        },
        "GHLTH": {
          "lo": 12.6,
          "hi": 19.2
        },
        "PHLTH": {
          "lo": 11.2,
          "hi": 15.9
        },
        "ACCESS2": {
          "lo": 2.7,
          "hi": 4.7
        },
        "LACKTRPT": {
          "lo": 4.3,
          "hi": 6.3
        },
        "FOODINSECU": {
          "lo": 6.3,
          "hi": 10.6
        },
        "HOUSINSECU": {
          "lo": 5.8,
          "hi": 8.9
        }
      },
      "rank": 8
    },
    {
      "fips": "25023",
      "name": "Plymouth",
      "population": 535308,
      "priorityIndex": 41.2,
      "burdenScore": 47.3,
      "accessScore": 26.2,
      "shortageScore": 50.0,
      "topDriver": "Provider shortage",
      "hpsaMaxScore": 13,
      "hpsaDesignations": 2,
      "raw": {
        "DIABETES": 10.3,
        "OBESITY": 29.7,
        "BPHIGH": 32.6,
        "CHD": 6.2,
        "GHLTH": 15.9,
        "PHLTH": 12.8,
        "ACCESS2": 4.4,
        "LACKTRPT": 6.8,
        "FOODINSECU": 11.3,
        "HOUSINSECU": 10.9,
        "ACS_POVERTY": 7.1,
        "ACS_NOVEHICLE": 6.2
      },
      "ci": {
        "DIABETES": {
          "lo": 8.9,
          "hi": 11.9
        },
        "OBESITY": {
          "lo": 25.4,
          "hi": 34.7
        },
        "BPHIGH": {
          "lo": 29.5,
          "hi": 35.7
        },
        "CHD": {
          "lo": 5.4,
          "hi": 7.2
        },
        "GHLTH": {
          "lo": 13.1,
          "hi": 18.7
        },
        "PHLTH": {
          "lo": 10.9,
          "hi": 14.7
        },
        "ACCESS2": {
          "lo": 3.3,
          "hi": 5.6
        },
        "LACKTRPT": {
          "lo": 5.7,
          "hi": 8.1
        },
        "FOODINSECU": {
          "lo": 8.9,
          "hi": 14.1
        },
        "HOUSINSECU": {
          "lo": 8.9,
          "hi": 13.2
        }
      },
      "rank": 9
    },
    {
      "fips": "25007",
      "name": "Dukes",
      "population": 20819,
      "priorityIndex": 39.4,
      "burdenScore": 52.5,
      "accessScore": 8.1,
      "shortageScore": 57.7,
      "topDriver": "Provider shortage",
      "hpsaMaxScore": 15,
      "hpsaDesignations": 3,
      "raw": {
        "DIABETES": 10.6,
        "OBESITY": 25.5,
        "BPHIGH": 36.0,
        "CHD": 7.3,
        "GHLTH": 15.4,
        "PHLTH": 12.7,
        "ACCESS2": 3.9,
        "LACKTRPT": 5.7,
        "FOODINSECU": 8.7,
        "HOUSINSECU": 7.9,
        "ACS_POVERTY": 5.4,
        "ACS_NOVEHICLE": 5.1
      },
      "ci": {
        "DIABETES": {
          "lo": 8.8,
          "hi": 12.4
        },
        "OBESITY": {
          "lo": 19.1,
          "hi": 32.7
        },
        "BPHIGH": {
          "lo": 31.6,
          "hi": 40.4
        },
        "CHD": {
          "lo": 6.2,
          "hi": 8.4
        },
        "GHLTH": {
          "lo": 12.4,
          "hi": 19.0
        },
        "PHLTH": {
          "lo": 10.6,
          "hi": 15.0
        },
        "ACCESS2": {
          "lo": 2.9,
          "hi": 5.2
        },
        "LACKTRPT": {
          "lo": 4.6,
          "hi": 6.9
        },
        "FOODINSECU": {
          "lo": 6.4,
          "hi": 11.2
        },
        "HOUSINSECU": {
          "lo": 6.2,
          "hi": 9.9
        }
      },
      "rank": 10
    },
    {
      "fips": "25021",
      "name": "Norfolk",
      "population": 727473,
      "priorityIndex": 31.3,
      "burdenScore": 14.3,
      "accessScore": 14.3,
      "shortageScore": 65.4,
      "topDriver": "Provider shortage",
      "hpsaMaxScore": 17,
      "hpsaDesignations": 1,
      "raw": {
        "DIABETES": 9.0,
        "OBESITY": 23.5,
        "BPHIGH": 29.8,
        "CHD": 5.2,
        "GHLTH": 13.3,
        "PHLTH": 10.8,
        "ACCESS2": 3.8,
        "LACKTRPT": 6.0,
        "FOODINSECU": 9.4,
        "HOUSINSECU": 8.3,
        "ACS_POVERTY": 6.6,
        "ACS_NOVEHICLE": 8.9
      },
      "ci": {
        "DIABETES": {
          "lo": 7.7,
          "hi": 10.5
        },
        "OBESITY": {
          "lo": 19.9,
          "hi": 27.8
        },
        "BPHIGH": {
          "lo": 27.0,
          "hi": 32.8
        },
        "CHD": {
          "lo": 4.5,
          "hi": 6.0
        },
        "GHLTH": {
          "lo": 11.0,
          "hi": 15.8
        },
        "PHLTH": {
          "lo": 9.2,
          "hi": 12.5
        },
        "ACCESS2": {
          "lo": 3.0,
          "hi": 4.9
        },
        "LACKTRPT": {
          "lo": 5.0,
          "hi": 7.2
        },
        "FOODINSECU": {
          "lo": 7.3,
          "hi": 11.9
        },
        "HOUSINSECU": {
          "lo": 6.7,
          "hi": 10.2
        }
      },
      "rank": 11
    },
    {
      "fips": "25015",
      "name": "Hampshire",
      "population": 162502,
      "priorityIndex": 31.0,
      "burdenScore": 9.9,
      "accessScore": 25.5,
      "shortageScore": 57.7,
      "topDriver": "Provider shortage",
      "hpsaMaxScore": 15,
      "hpsaDesignations": 8,
      "raw": {
        "DIABETES": 8.2,
        "OBESITY": 22.2,
        "BPHIGH": 26.7,
        "CHD": 5.5,
        "GHLTH": 14.0,
        "PHLTH": 11.7,
        "ACCESS2": 4.2,
        "LACKTRPT": 7.2,
        "FOODINSECU": 10.0,
        "HOUSINSECU": 8.7,
        "ACS_POVERTY": 10.9,
        "ACS_NOVEHICLE": 6.8
      },
      "ci": {
        "DIABETES": {
          "lo": 7.0,
          "hi": 9.6
        },
        "OBESITY": {
          "lo": 17.9,
          "hi": 27.2
        },
        "BPHIGH": {
          "lo": 23.7,
          "hi": 29.9
        },
        "CHD": {
          "lo": 4.7,
          "hi": 6.3
        },
        "GHLTH": {
          "lo": 11.6,
          "hi": 17.0
        },
        "PHLTH": {
          "lo": 10.0,
          "hi": 13.6
        },
        "ACCESS2": {
          "lo": 3.1,
          "hi": 5.5
        },
        "LACKTRPT": {
          "lo": 5.9,
          "hi": 8.9
        },
        "FOODINSECU": {
          "lo": 7.6,
          "hi": 12.8
        },
        "HOUSINSECU": {
          "lo": 7.0,
          "hi": 10.7
        }
      },
      "rank": 12
    },
    {
      "fips": "25017",
      "name": "Middlesex",
      "population": 1623952,
      "priorityIndex": 30.3,
      "burdenScore": 5.7,
      "accessScore": 19.9,
      "shortageScore": 65.4,
      "topDriver": "Provider shortage",
      "hpsaMaxScore": 17,
      "hpsaDesignations": 3,
      "raw": {
        "DIABETES": 8.5,
        "OBESITY": 23.8,
        "BPHIGH": 27.6,
        "CHD": 4.9,
        "GHLTH": 13.4,
        "PHLTH": 10.0,
        "ACCESS2": 4.0,
        "LACKTRPT": 6.4,
        "FOODINSECU": 9.5,
        "HOUSINSECU": 9.0,
        "ACS_POVERTY": 7.5,
        "ACS_NOVEHICLE": 10.4
      },
      "ci": {
        "DIABETES": {
          "lo": 7.3,
          "hi": 9.6
        },
        "OBESITY": {
          "lo": 20.5,
          "hi": 27.2
        },
        "BPHIGH": {
          "lo": 25.2,
          "hi": 30.0
        },
        "CHD": {
          "lo": 4.2,
          "hi": 5.6
        },
        "GHLTH": {
          "lo": 11.2,
          "hi": 15.8
        },
        "PHLTH": {
          "lo": 8.6,
          "hi": 11.5
        },
        "ACCESS2": {
          "lo": 3.1,
          "hi": 5.2
        },
        "LACKTRPT": {
          "lo": 5.3,
          "hi": 7.7
        },
        "FOODINSECU": {
          "lo": 7.5,
          "hi": 12.0
        },
        "HOUSINSECU": {
          "lo": 7.3,
          "hi": 10.9
        }
      },
      "rank": 13
    },
    {
      "fips": "25019",
      "name": "Nantucket",
      "population": 14444,
      "priorityIndex": 22.1,
      "burdenScore": 16.1,
      "accessScore": 8.0,
      "shortageScore": 42.3,
      "topDriver": "Provider shortage",
      "hpsaMaxScore": 11,
      "hpsaDesignations": 1,
      "raw": {
        "DIABETES": 8.6,
        "OBESITY": 27.7,
        "BPHIGH": 29.4,
        "CHD": 5.1,
        "GHLTH": 13.1,
        "PHLTH": 10.6,
        "ACCESS2": 4.5,
        "LACKTRPT": 5.6,
        "FOODINSECU": 8.7,
        "HOUSINSECU": 8.9,
        "ACS_POVERTY": 3.0,
        "ACS_NOVEHICLE": 3.5
      },
      "ci": {
        "DIABETES": {
          "lo": 7.2,
          "hi": 10.1
        },
        "OBESITY": {
          "lo": 20.6,
          "hi": 35.7
        },
        "BPHIGH": {
          "lo": 25.4,
          "hi": 33.7
        },
        "CHD": {
          "lo": 4.3,
          "hi": 5.9
        },
        "GHLTH": {
          "lo": 10.7,
          "hi": 15.8
        },
        "PHLTH": {
          "lo": 9.0,
          "hi": 12.5
        },
        "ACCESS2": {
          "lo": 3.5,
          "hi": 5.8
        },
        "LACKTRPT": {
          "lo": 4.7,
          "hi": 6.8
        },
        "FOODINSECU": {
          "lo": 6.8,
          "hi": 11.1
        },
        "HOUSINSECU": {
          "lo": 7.2,
          "hi": 11.0
        }
      },
      "rank": 14
    }
  ],
  "faq": [
    {
      "question": "What does the Massachusetts county health-access scorecard measure?",
      "answer": "It ranks all 14 Massachusetts counties by a combined Targeting-Priority Index that fuses adult chronic-disease and social-risk prevalence from CDC PLACES with federally designated primary-care provider shortages from HRSA, highlighting where health need and thin provider supply overlap."
    },
    {
      "question": "Which public datasets is it built from?",
      "answer": "CDC PLACES county estimates (PLACES: Local Data for Better Health, County Data, 2025 release, measure year 2023) and the HRSA Primary Care Health Professional Shortage Area detail file, both fully open federal sources accessed 2026-08-01."
    },
    {
      "question": "How should the Targeting-Priority Index be used?",
      "answer": "As a transparent first-pass screen for where to focus outreach, workforce, or program resources. Scores are relative within the state and equal-weighted by default; a real engagement would calibrate weights to a program's goals and add socioeconomic and utilization layers."
    }
  ],
  "contentHash": "99283280a0b172b4"
}