Local-option COVID approach slammed

Carlene Pavlos, executive director of the Massachusetts Public Health Association, says the Baker administration’s policy of leaving many of the major COVID decisions to local boards of health helps explain why local officials are facing harassment and many are leaving public service.

The Baker administration has adopted a local-option approach in many cases. For example, the state issued guidance earlier this month that masks are no longer needed in schools as of today, but school systems are free to adopt their own timetables. The state eased restrictions on wearing masks indoors, but again communities were free to adopt their own policies.

Pavlos said the local-option approach leads to bad public policy and leaves many local officials vulnerable to harassment and abuse. There have been reports of incidents in Salem, Westford, Abington, Framingham, and East Longmeadow. 

Speaking on a Health or Consequences episode of the CommonWealth Codcast with Paul Hattis of the Lown Institute and John McDonough of the T.H. Chan School of Public Health at Harvard University, Pavlos indicated public health policy works best with more of a one-size-fits-all approach. 

“Not only are we seeing a patchwork of different rules in different communities in this state, which is confusing for the public and also less effective for the public health protections, but it also means that the decisions are getting pushed on to the backs of local public health staff who are then the folks who are being harassed and threatened,” Pavlos said. “That’s really unacceptable.”

Those doing the harassing tend to be a loud but small portion of the general public, Pavlos said. “The people who have been behaving so badly, with threats and intimidation, are really a small but organized minority of people,” she said. “In some ways, they are using the pretext of public health for what’s a larger hostile agenda.” 

Massachusetts is vulnerable to such pressure because each of the 351 cities and towns has its own public health board, responsible for a wide variety of functions, including dealing with COVID, restaurant and pool inspections, and chronic disease protection. Huge states such as Texas and California have fewer local public health boards than Massachusetts, she said. 

“It’s fractured, it’s inefficient, it’s almost always ineffective, but it is always inequitable,” Pavlos said. “Some people in Massachusetts have access to excellent public health services and others do not.” 

Pavlos said many years of under-investment in public health infrastructure came due during the pandemic and required municipalities and the state to invest in infrastructure on the fly. She is hopeful lawmakers will direct a significant amount of the state’s American Rescue Plan Act money to local boards of health and use some $200 million in the budget for competitive grants to the local boards to encourage cooperation and consolidation. 

She said COVID — and the nearly 23,000 people who have died from the disease — have reinforced a very tough lesson about the importance of public health in Massachusetts. “That is a number that is a little hard to grasp. I don’t think we take in the magnitude of that enough,” she said of the death toll. “Those deaths haven’t hit communities equally. Race and economic status and city or town in which people live — all of those things have shaped the pattern of this pandemic in Massachusetts, not to mention the country as a whole.”




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