Monica Bharel, realistic optimist

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.

BRUCE MOHL


BEACON HILL

The House is preparing to vote on a bill banning the sale of flavored e-cigarettes and also imposing a 75 percent excise tax on them. (MassLive)

With the sunset date for the state’s film tax credit looming, Sen. Michael Rodrigues, the chair of the Ways and Means Committee, said he continues to have deep reservations about the tax benefit. (CommonWealth)

Shirley Leung breaks down the push for more transportation into three big buckets of increasingly ambitious visions — and price tags. (Boston Globe)

Sen. Joan Lovely wants to ensure that insurance companies don’t jack up the rates on people just because they have a prescription for an overdose-reversing drug. (Gloucester Daily Times

MUNICIPAL MATTERS

The city of Haverhill has contracts with three pot shops, and the city solicitor won’t say whether the city has been subpoenaed by federal prosecutors looking into those local agreements. (Eagle-Tribune

Secretary of the Commonwealth William Galvin will be on the Cape this week to address regional issues that could affect a complete and accurate count of residents in the 2020 US Census. (Cape Cod Times) 

A formerly homeless Navy veteran says he has found sobriety and a fresh start thanks to Father Bill’s and MainSpring housing in Quincy and Brockton. (Brockton Enterprise) 

WASHINGTON/NATIONAL/INTERNATIONAL

US Rep. Lori Trahan outlines her priorities in the Higher Education Act. (CommonWealth)

ELECTIONS

Is Gov. Charlie Baker launching a new political party with the Massachusetts Majority super PAC? Republican Ed Lyons thinks so. (CommonWealth)

Unimpressed by the performance of the three frontrunners in the Democratic primary, former governor Deval Patrick is once again considering a White House run. (New York Times) Check out this Jack Sullivan interview with Patrick as he was about to step down as governor. Interesting to see what he was thinking then. Joe Battenfeld offers a quick refresher on the hurdles Patrick would face, including being “notoriously thin-skinned” about press scrutiny. (Boston Herald)

Elizabeth Warren, who has been pounding at the billionaires she says have too much money and power, now has one in particular to tee up with word that former New York mayor M ichael Bloomberg is considering jumping in the Democratic fray. (Boston Globe)

Shannon Liss-Riordan, a self-funding candidate, has called for a spending cap in the Democratic primary contest where she and Congressman Joe Kennedy have challenged Sen. Ed Markey. (WGBH) Joan Vennochi looks at a climate change forum that Liss-Riordan and Markey attended, but Kennedy skipped. (Boston Globe)

BUSINESS/ECONOMY

On the development front, Amy Dain has two takes — one on the lack of connectedness at developments on municipal peripheries and one on the promise of Mystic + Malden. (CommonWealth)

EDUCATION

After parents complained, state authorities faulted Billerica Public Schools for its safe rooms, which are supposed to be used to de-escalate when students are acting dangerously. One room had nails sticking out of an exterior wall and another was built into a storage closet. (Lowell Sun

A student petition is pushing back against the appointment of former senator Scott Brown, who is currently the US ambassador to New Zealand, as dean and president of New England Law Boston. (Boston Globe

HEALTH/HEALTH CARE

Doctors are both alarmed and puzzled by an increase they are seeing in cases of extreme days-long vomiting episodes associated with heavy marijuana use. (Boston Globe

ARTS/CULTURE

The Boston Children’s Theater met with parents Sunday night to talk about allegations of sexual impropriety against Burgess Clark, the former director. (WBUR

TRANSPORTATION 

The overdose of a passenger in one car allegedly led to a three-car crash in Peabody that injured seven. (Salem News

ENERGY/ENVIRONMENT

Weymouth Mayor Robert Hedlund sent a letter to a state regulator last week saying a proposed natural gas compressor station should be reviewed because two companies that had contracted to use a pipeline that would be connected to the 7,700-horsepower station have pulled out of the project. (Patriot Ledger) 

CRIMINAL JUSTICE/COURTS

The DACA program that has allowed immigrants brought into the country illegally as minors to work and study here goes before the Supreme Court, which is hearing a challenge to the Trump administration decision to end it. (Boston Globe)

Attorney Margaret Monsell says Auditor Suzanne Bump, in her recent audit, follows the lead of the state’s district attorneys. (CommonWealth)

A former state trooper convicted in the overtime fraud scandal implicated a number of higher-ups in the department, according to an unredacted court document detailing an April meeting he had with officials in the attorney general’s office. (Boston Herald

MEDIA

The nation’s leading newspaper union issued a scathing assessment of the soon-to-be-completed merger of Gannett and GateHouse Media. (Washington Post)

Media critic Dan Kennedy gives three reasons to be optimistic about local news. (Media Nation)