Monica Bharel, realistic optimist

Despite challenges, state public health commissioner upbeat

MONICA BHAREL, the state’s public health commissioner, is definitely a glass-half-full type of person.

On the Health or Consequences edition of the Codcast with Paul Hattis of Tufts University Medical School and John McDonough of Harvard’s T.H. Chan School of Public Health, Bharel went through a series of major challenges facing her agency and in each instance ended her discussion on an optimistic note.

On vaping, Bharel expressed confidence that her agency’s ban on all vaping products was the wise course to follow while health officials determine what is causing a strange new type of pulmonary disease. She said her other top priority with vaping products is getting them out of the hands of young people – she says 40 percent of high school students have vaped and 20 percent do so regularly. She says e-cigarettes are not safe, as many young people believe, and flavored e-cigs should be taken off the market.

As if on cue, the House is preparing to take up legislation on Wednesday that would ban the sale of flavored e-cigarettes and impose a 75 percent excise tax on them.

On Eastern Equine Encephalitis, she said it was a tough year, with 12 confirmed cases and three deaths. Her top priority is to provide the public with information on the best ways to protect themselves. “Our job is to make sure people understand what the risks are,” she said.

Similarly, with opioids, she said Massachusetts is seeing a decline in deaths by making treatment and Narcan available, while alerting everyone to the risks associated with opioids. “The interventions we’ve put in place are starting to work,” she said.

In response to a question from Hattis, Bharel acknowledged her agency has never tried to block a hospital merger or a major expansion despite her agency’s management of the so-called determination of need process. Bharel said her agency has put in place annual reporting mechanisms to make sure mergers or expansions are monitored and tracked over the long haul to make sure they provide the benefits claimed.

She also said her agency wants to encourage a broader definition of health care, one that extends beyond hospitals and doctors to include housing and diet. “Our zip code is far more important than our genetic code in terms of how healthy we are,” she said. “What we’re trying to do with these changes is shift our thinking of health to be in the community and make real commitments to communities being healthy so that all of us, regardless of our background, our income, have opportunities for health here in Massachusetts.”

McDonough asked if a new law is needed to eliminate the religious exemption for vaccination. Bharel said more than 95 percent of the state’s school-age children are vaccinated for measles and mumps.  “I think we’re on the right track here,” she said.

McDonough cited an alarming increase in obesity among children, three years of declining life expectancy in the United States, an epidemic of gun violence, and the worst rate of maternal and infant mortality of any developed country in the world. “Is public health failing America or is America failing public health?” he asked.

Bharel described herself as a “realistic optimist,” and then proceeded to show why. “It is true that in the United States, we have a problem in the way we think about health. We are, of course, the country that spends the most on health care and has some of the worst quality outcomes when it comes to health care.  To me this comes back to how we think about health versus disease,” she said.

The commissioner said it would help if other states followed the lead of Massachusetts and provided greater access to health care. She said it would also help if people placed a greater emphasis on healthy living. In that vein, she said, her agency is tapping all sorts of public health data and making that information available to communities so they can better tailor health services to residents. She said the use of the state’s public health data warehouse is working.

McDonough repeated his question, asking if public health is failing in the United States.

“We’re one of the healthiest states in the country,” Bharel said.

McDonough, pointing to an earlier CommonWealth article he wrote on the subject, begged to differ. “We look good in comparison among the 50 states and we actually look pretty mediocre to poor when we look at ourselves versus other nations,” he said.

“What that raises is that there’s always work to do,” said Bharel, the realistic optimist.