No more Band-Aids on broken public health system

Mass. should dedicate 5% of ARPA funds to problem

WE KNOW MASSACHUSETTS has a broken local public health system because our organizations represent the thousands of health directors, board of health members, public health nurses, and other staff and volunteers who have been on the front lines throughout the pandemic.

Over the past 18 months, our members have been working overtime and then some to prevent and respond to COVID, including delivering vaccines to our hardest-to-reach residents. Most are working with scant resources; many are overwhelmed and exhausted.

Even before the pandemic, our local public health system was in crisis. Although some communities maintained well-run health departments, others had so little funding or trained staff they were unable to meet even basic responsibilities. Among the smallest, most rural communities, nearly a quarter had no staff at all, relying instead on volunteers.

Even communities with well-run health departments and qualified staff struggle to meet the wide range of legal obligations that fall to them. These range from inspecting children’s summer camps, food establishments, public and semi-public pools, septic systems, and beauty establishments, to protecting residents from substandard housing and lead poisoning, managing insect-borne diseases, animal control, hazardous waste disposal, and responding to cases of communicable disease. The list goes on.

Enter COVID-19. The arrival of the virus exposed every weakness and inequity in the system. And while strong local health departments would not have stopped the pandemic from occurring, it would have allowed for effective community-level contact tracing, timely implementation of isolation and quarantine, consistent enforcement of public health regulations, and more effective and equitable vaccine distribution. Have no doubt, these measures would have meant fewer deaths, fewer hospitalizations, and lower costs to the health care system.

Now, we have a chance to transform our state’s local public health system and implement the critical safeguards it should provide. By dedicating just 5 percent of the American Rescue Plan Act of 2021 (ARPA) funds coming to Massachusetts from the federal government – roughly $251 million over 5 years – we can ensure that the Commonwealth transitions to a local public health system that is efficient, effective, and equitable.

Making this investment now would be a major step forward in solving a problem that has dogged Massachusetts for decades. A series of blue-ribbon commissions have documented the dangerous and inadequate state of local public health in our Commonwealth. Most of these reports have sat on the shelf, gathering dust. The most recent Special Commission on Local and Regional Public Health, established by the Legislature in 2016, called attention to the chronic underfunding of the system and recommended significant structural reforms and an infusion of funding from the state.

These changes are needed because Massachusetts is one of the only states in the nation that delivers local public health services through hundreds of municipalities, rather than through a county or regional structure. Case in point, California, with more than five times the population of Massachusetts, has 61 local health departments, while we have 351.

We are also one of the only states with no categorical state funding for local health, leaving funding exclusively up to cities and towns. This means that wealthier communities often fund robust health departments, while lower income communities are forced to make do with bare bones. Additionally, we have no minimum credentialing requirements for local public health staff.

We have urged the Legislature and Gov. Charlie Baker to make new investments; and we are tremendously grateful that they have responded with important new funding over the last two years. In 2020, the state also enacted the State Action for Public Health Excellence (SAPHE) Act, which provides incentives to cities and towns that share services across municipal boundaries.

Meet the Author

Ruth Mori

President, Massachusetts Association of Public Health Nurses
Meet the Author

Carlene Pavlos

Executive director, Massachusetts Public Health Association
Meet the Author

Sigalle Reiss

President, Massachusetts Health Officers Association
Meet the Author

Cheryl Sbarra

Senior staff attorney/Director of policy and law, Massachusetts Association of Health Boards
Meet the Author

Diane Chalifoux-Judge

President, Massachusetts Environmental Health Association
Meet the Author

Sharon Hart

President, Western Massachusetts Public Health Association
These are important steps in the right direction, but the dollars invested over the last two years fall far short of what is needed to truly transform this broken system.

Failure to act now would represent acceptance of the status quo and would perpetuate inequity and poor health outcomes – and allow rural communities and low-income urban areas to fall even further behind. Massachusetts must act decisively to ensure that all residents – regardless of their race, income, or zip code – receive high-quality public health protections. The time to act is now.

Diane Chalifoux-Judge is president of the Massachusetts Environmental Health Association, Sharon Hart is president of the Western Massachusetts Public Health Association, Ruth Mori, is president of the Massachusetts Association of Public Health Nurses, Carlene Pavlos is executive director of the Massachusetts Public Health Association, Sigalle Reiss is president of the Massachusetts Health Officers Association, and Cheryl Sbarra is executive director of the Massachusetts Association of Health Boards.