This model (exemplified in New England, e.g., New Hampshire, Maine) constitutes one in which elements of both centralized and decentralized arrangements co-exist in various communities throughout the state. In some larger communities, local government has been granted greater legal authority from the state to operate the local health agency/department with little, if any involvement by the state (unless specifically called upon). In other, often smaller communities with less infrastructure, local governments choose not to form a local agency and remain
dependent upon the state to assure whatever level of public health services are provided and available