THE LEGISLATURE is poised to dramatically reshape Massachusetts’ local public health landscape, after the COVID-19 pandemic spotlighted just how inadequate it is.
“I’ve been doing this work for almost 25 years and it’s just astounding to me the opportunity that we’re being presented with here, and the fact that the Legislature really understands the importance of delivering services fairly and equitably throughout the Commonwealth,” said Cheryl Sbarra, executive director of the Massachusetts Association of Health Boards. “It’s something those of us involved in local public health have been dreaming for our whole careers.”
The House Ways and Means Committee released a bill Wednesday, with a House vote expected as soon as Thursday, that would result in more state funding for local public health boards, along with the creation of minimum standards and the incentivization of shared services. The goal is to transform a system that is comprised today of nearly 351 local boards of health of varying expertise into one where every resident has access to necessary public health services, whether it’s inspecting drinking water or responding to a disease outbreak.
“It’s the way to launch Massachusetts into having an actual 21st century public health system that’s equitable and effective,” said Carlene Pavlos, executive director of the Massachusetts Public Health Association. “Because our local public health system, the way that it has been structured and funded, has not been either of those things. It’s been very inequitable.”
The Senate already passed very similar provisions as part of its earlier American Rescue Plan Act bill. Sarah Blodgett, a spokesperson for Senate President Karen Spilka, said senators will take a look at the House bill, but the issue “has a lot of support in the Senate.” Lawmakers have just four days before the session ends to send a final bill to Gov. Charlie Baker.
Until 2021, local public health departments were funded entirely by municipalities, without any state money other than occasional grant programs for specific programs. This led to an inequitable system, where larger, wealthier communities have large departments with expert nursing and inspectional staff, while some rural communities may have only a volunteer board or a single part-time person paid through fees to do restaurant inspections.
Phoebe Walker, director of community services for the Franklin Regional Council of Governments, said Massachusetts was one of the only states that did not provide state funding for public health through its state budget. “It’s really reliant on the taxes of a particular community what level of protection local residents have,” she said.
During the COVID-19 pandemic, the disparities became clear when local public health departments were unable to provide services like contact tracing or large-scale access to vaccines equally throughout the state. The state ended up paying outside vendors for things like contact tracing and mass vaccination sites, at times causing tensions with municipal health departments.
Sbarra said the COVID-19 pandemic really shone a light on disparities that have existed for years. “Depending on where you live you may be able to get vaccinated or you may not be able to get vaccinated,” Sbarra said. “Depending on where you live you may have access to a WIC [nutrition] program or you may not have access to WIC program. You may have smoke-free laws that protect your family, in other areas you may not.” Some areas have trained housing or septic inspectors; some areas don’t.
With additional money and training, Sbarra said, the state can ensure that every municipality has access to trained staff. “Public health affects everyone’s day to day life. And until now it hasn’t really been seen as a priority,” Sbarra said.
A commission had already studied the public health system and made recommendations for improving it before the pandemic broke out.
Eileen McAnneny, president of the business-backed Massachusetts Taxpayers Foundation and a commission member, said she became aware through that work of the variation in public health services. “You can compare and contrast Boston, that has a robust public health department, to small towns in Western Mass. where they might have one public health official serving numerous towns,” she said. “And if you also look at what we expect public health officials to do, it’s everything from inspecting restaurants to looking at contaminated drinking water to smoking cessation programs.”
McAnneny said it was also impossible to compare how much different towns were spending and what health services they were offering because there was such limited data. “You can’t manage if you can’t measure some of these things,” she said.
Baker signed a bill in April 2020 that put in place some first steps toward fulfilling the commission’s recommendations, including creating training and grant programs and helping communities share regional public health services. The state allocated $10 million for these programs in fiscal 2021, $15 million in fiscal 2022, and another $15 million is on Baker’s desk in the fiscal 2023 budget.
Then in November 2021, the Legislature approved spending $200 million in federal COVID recovery money over five years to bolster local public health departments. The bill currently going through the Legislature puts in place the policies meant to guide the spending of that money and would implement the rest of the recommendations of the commission.
Under the bill, the state would establish standards related to how departments should operate in areas including inspections, epidemiology, communicable disease investigation and reporting, environmental permitting, workforce education and credentialling, and data reporting. The state would then create a funding mechanism where every local public health department would get some foundational amount of state money to run their department in conformance with these standards. A funding formula is not laid out in the bill, but the bill says it would be related to population size, service sharing, and socio-demographic characteristics. State programs would be set up to assist departments in getting up to speed. The state would create financial incentives to help communities share services across municipalities. It would offer trainings and technical assistance to public health professionals to meet educational and credentialing standards.
The bill would also standardize data reporting requirements and set up new systems so that the Department of Public Health could collect data on what municipalities are doing. Advocates say this is necessary since today there is no way to track public health data and trends because there are such limited standards for what information gets reported in what way.
Walker said the COVID pandemic made it “obvious how broken the system was.” She said if this bill becomes law, and new standards and funding are put in place, she is hopeful that the “next pandemic doesn’t find us like it did this time where we weren’t ready, and we didn’t have what it took to protect people locally.”