Discusses the impact of consolidating small jurisdictions of local health departments to create multi-county health departments that serve at least 50,000 people, in effort to build economies of scale and better improve population health. Includes an interview with Becky Johnson, administrator of the SEK Multi-County Health Department (SEKMCHD) in southeast Kansas, that provides insight on the benefits of multi-county health departments and strategies to overcome obstacles and sustain services. -- Kansas Health Institute