Standardizing public health across Massachusetts

COVID exposed weaknesses in decentralized state system

THE RELATIONSHIP between the state of Massachusetts and its cities and towns is a complicated one. Sometimes, as with liquor licenses, the state is in control, deciding how many licenses should be issued in each community. 

But other times cities and towns are the ones in charge. Regarding public health, for example, Massachusetts has one of the most decentralized systems in the country, with each town or city responsible for its own public health activities, which run the gamut from food safety to disease investigation to housing, tobacco, public health emergencies, and the health and safety of children at summer camps, pools, and other locations.

“That has resulted in a system in which Massachusetts, unlike pretty much every other state, neither has performance standards, workforce standards, or stable funding for local public health. So each of our towns has to decide what kind of preventions and protections do they want to actually pay for out of their tax revenue,” said Phoebe Walker, director of community services for the Franklin Regional Council of Governments.

Walker and Ruth Mori, the president of the Massachusetts Association of Public Health Nurses, talked about public health at the local level on The Codcast with hosts Paul Hattis of the Lown Institute and John McDonough of the T.H. Chan School of Public Health at Harvard University.

Walker said there was little awareness of what local public health departments did before the pandemic, but that changed as society became preoccupied with COVID-19. She said it quickly became apparent that local public health departments, with their varied responsibilities and funding levels, were not up to the task of taking on a new and challenging disease.

She said the lack of capacity at the local level forced the state to step in, including spending $161 million to set up a statewide contact tracing effort that has now been dismantled. She said differences in funding from town to town resulted in divergent services from community to community.  

”What we found in the course of this pandemic is those differences are pretty dramatic and  resulted in really uneven results for the residents of Massachusetts,” Walker said.  

Mori said some issues can’t be left to local control if funding levels are inadequate. “This really shouldn’t be a local public health decision if you need a public health nurse or not,” she said. 

Walker said the problems facing local public health were well documented before COVID hit with the development of a Blueprint for Public Health Excellence in 2019. She said the blueprint showed what needed to be done but unfortunately COVID hit before any of those reforms could be implemented. 

Meet the Author

Bruce Mohl

Editor, CommonWealth

About Bruce Mohl

Bruce Mohl is the editor of CommonWealth magazine. Bruce came to CommonWealth from the Boston Globe, where he spent nearly 30 years in a wide variety of positions covering business and politics. He covered the Massachusetts State House and served as the Globe’s State House bureau chief in the late 1980s. He also reported for the Globe’s Spotlight Team, winning a Loeb award in 1992 for coverage of conflicts of interest in the state’s pension system. He served as the Globe’s political editor in 1994 and went on to cover consumer issues for the newspaper. At CommonWealth, Bruce helped launch the magazine’s website and has written about a wide range of issues with a special focus on politics, tax policy, energy, and gambling. Bruce is a graduate of Ohio Wesleyan University and the Fletcher School of Law and Diplomacy at Tufts University. He lives in Dorchester.

About Bruce Mohl

Bruce Mohl is the editor of CommonWealth magazine. Bruce came to CommonWealth from the Boston Globe, where he spent nearly 30 years in a wide variety of positions covering business and politics. He covered the Massachusetts State House and served as the Globe’s State House bureau chief in the late 1980s. He also reported for the Globe’s Spotlight Team, winning a Loeb award in 1992 for coverage of conflicts of interest in the state’s pension system. He served as the Globe’s political editor in 1994 and went on to cover consumer issues for the newspaper. At CommonWealth, Bruce helped launch the magazine’s website and has written about a wide range of issues with a special focus on politics, tax policy, energy, and gambling. Bruce is a graduate of Ohio Wesleyan University and the Fletcher School of Law and Diplomacy at Tufts University. He lives in Dorchester.

Now, with the help of $200 million in federal relief funds, the weaknesses in the local public system are starting to be addressed. “Funding, bottom line, is what’s going to make a difference in local public health,” Mori said. 

Walker agrees, but says additional funding will only work if the Statewide Accelerated Public Health for Every Community Act 2.0 passes. The legislation would set in motion standardized training and performance standards for local boards of health along with adequate state funding and data gathering.