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.
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.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.