Mass. plagued by regional inequities

These differences emerge on transportation, clean water, even politics

THIS PAST ELECTION DAY, Massachusetts celebrated several historic milestones with the shattering of glass ceilings that we have long sought to break through.  As we look ahead to the new administration and the new legislative session in 2023, I hope we can begin to address long-entrenched regional inequities across the Commonwealth.

Until we take a serious look at these regional inequities, we will continue to perpetuate the systems that cause many residents to have unequal access to public goods, to rights enshrined in the Massachusetts Constitution, and to the services and opportunities that so many of us take for granted.  These regional inequities lead to very different sentiments about the role of government across the state, and these differences are clearly visible when one looks at the town-by-town election results for the ballot questions and for governor, attorney general, and auditor earlier this month.

While there were clear election victories for the statewide offices (and narrower margins for ballot questions 1 and 4), the aggregated state-level results obscure the extent to which there are clear regional differences of opinions about the role of government and who should lead.  These deep differences have ramifications not just on political races but also on health, as demonstrated by notable differences in COVID-19 vaccination rates, with the geographic patterns lining up pretty squarely with the election maps referenced above.  If we had the data, we would probably also see similar patterns in the investments (or lack of investments) in transportation, health care services, economic development, and more across the 351 cities and towns in Massachusetts.

I have witnessed these regional differences as my experiences have taken me to different parts of the state, including central Massachusetts where I now work at The Health Foundation of Central Massachusetts.  The foundation serves 81 cities and towns in central Massachusetts, and, over our 23-year history, we have come to know the challenges of trying to meet the diverse needs within our service area.  The opportunities and challenges in Worcester, the second largest city in New England with a population of 207,000, are very different from those in Warwick, the smallest town in our service area with a population of 780.  When I visit small rural communities in central Massachusetts, the aging infrastructure is evident, and the frustrations of years of limited investments and opportunities are palpable.

Over the past few years, the foundation has invested over $2 million on issues that have long been overlooked by policymakers in Boston: rural transportation and private wells. The Quaboag Connector aims to develop a sustainable model of rural transportation in the Ware region.  It was created after decades of unmet need when community partners came together in 2017 to piece together a local solution.  The Quaboag Connector helps residents access health care, which has become even more challenging after the closure of Baystate Health’s Mary Lane Hospital, and it helps transport residents to the Walmart Supercenter to purchase groceries and pick up prescriptions when there are few other options in the area. It has emerged as a model for other rural communities that are beyond the reach of the regional transit authorities, and it could also serve as a model for last-mile transportation for the West-East Rail when that project comes to fruition.

This collaboration and innovation should catch the attention of policymakers in Boston as an example of the unrecognized potential existing in rural parts of the state to help address some of the pressing challenges in the metro Boston area (e.g., lack of affordable housing) if we can strengthen literal and figurative connections to these areas.

In addition, the foundation’s investments in the Private Well Program to Protect Public Health are helping to build the case that private well owners, who predominantly live in rural areas, should have access to safe drinking water.  Though the right to clean water is enshrined in Article 97 of the Massachusetts Constitution, over 500,000 residents rely on drinking water from private wells which are unregulated by the state.  In contrast, urban and suburban residents connected to public water systems have access to drinking water that is routinely tested, as required by the state.

When contaminants are found in public water systems, municipalities can access different funding streams to pay for water treatment.  No such financial assistance is available for private well owners who need to remediate private wells contaminated by PFAS (“forever chemicals”), arsenic, E. coli, uranium, or other contaminants.  Recent water quality testing conducted by our partner RCAP Solutions found that ~30 percent of private wells tested had contaminants exceeding state primary standards and/or suggesting health risks.  These contaminant levels are not allowable in public water systems, yet they are allowable in private wells. The time has come to finally address inequitable drinking water protections across the state.

Philanthropy has often been accused of having a rural blind spot, so I have been actively trying to overcome my own blind spots and biases in my time at the foundation.  As someone who has spent most of my life in urban and suburban areas in Massachusetts, I appreciate the allure and opportunities of these areas.  At the same time, these recent foundation investments have helped me recognize the vast potential in the people and places of rural Massachusetts.  I hope others will also recognize this potential and guide investments and attention to these rural areas so we do not continue to perpetuate long-standing inequities and blind spots.

The return on investment in rural areas is not always clear in purely financial terms, but we can shift our metrics to a more holistic understanding of the benefits of investing in communities to include health, well-being, and social cohesion.  As we look ahead to January 2023, let us call upon our elected leaders to prioritize regional representation and regional equity so that all Massachusetts residents can benefit from the opportunities that abound in this great Commonwealth.

Amie Shei is president and CEO of The Health Foundation of Central Massachusetts.