Renewed Push Afoot to Boost Local Health Infrastructure
Kane: Inequities Show Need to Accelerate Work
9/30/20 3:28 PM
SEPT. 30, 2020.....Five months after Gov. Charlie Baker signed a bill to strengthen local public health infrastructure, lawmakers and advocates who backed that measure warned that it will not secure changes quickly enough and that additional legislation must be approved to accelerate long-overdue improvements.
The state's 351 cities and towns all have their own individual health boards and departments that play roles in protecting the public, from enforcing food safety to managing municipal-level emergency preparedness.
But speakers at a press conference cautioned Wednesday that the "decentralized" system fails to set a minimum standard for local health infrastructure and directs no dedicated funding to city and town departments -- gaps that exacerbate inequity and leave the state at greater risk in the face of crises like the COVID-19 pandemic.
"We have an opportunity to change the quantity and quality of life for Massachusetts residents by supporting an act to accelerate the equity and effectiveness of our local and regional public health system and to build core public health services necessary to keep our neighborhoods healthy and safe," said Damon Chaplin, health director for the city of New Bedford.
A bill Baker signed on April 29 incorporated recommendations a commission made in 2019 such as increasing training for local public health workers and outlining a set of baseline standards for each department to meet.
However, advocates and legislators argued that the current law is no longer sufficient, particularly amid the COVID-19 pandemic and the faults it exposed in the state's local health systems.
A "2.0" bill, set to be filed Wednesday would dedicate state funding to city and town health departments -- something Massachusetts is alone in not doing already, lawmakers said -- for planning, technical assistance and operations.
It would also order the state Department of Public Health to create a single, uniform system for local departments to collect and report health data, incentivize regional cooperation among municipal health offices, and implement some minimum standards of operation in local health departments.
Republican Rep. Hannah Kane and Democratic Rep. Denise Garlick, who were authors on the first bill, plan to file the new legislation on Wednesday alongside Sen. Jo Comerford.
Kane said that the first pass "provided a roadmap" to address public health challenges, but said that the past six months of COVID-19 have proved that it is not enough.
"Given the pandemic's ability to both visualize and make real for all people the critical role of public health and the devastating outcome when it's not adequately financed or staffed, it is clear to all of us now that we need to accelerate our work," she said. "We cannot move slowly and build."
"The pandemic has laid bare all the inequities that many of us had already realized existed, and it's important to note these inequities were not formed during this pandemic, but in all the days leading to it," Kane added. "The Massachusetts decentralized model has led to inadequate and inconsistent public health protections, and our state is one of the only to not provide dedicated state funding to local public health departments."
The bill does not set a minimum funding amount. If approved, the state Department of Public Health would create a funding formula, subject to appropriation, for state dollars to flow to health departments based on population and equity factors, according to a copy of the bill text provided by Comerford's office.
While several supporters pointed to the pandemic as evidence that another legislative update is necessary, they stressed that many of the problems it highlighted in health infrastructure have long existed.
Because of the decentralized system, neighboring towns can have vastly different health resources available even as their populations -- and any communicable diseases they might carry -- mingle and interact.
"Without the standards that (the bill) lays out, we will continue to see inequities in public health protections across municipalities," said Kristina Kimani, assistant policy director for the Massachusetts Public Health Association. "Our current decentralized approach to delivering health services leads to extreme variability across municipalities, we know that viruses and other communicable diseases do not respect municipal boundaries, and this in turn puts the entire state at risk."
The effects are even more acute for already-vulnerable people, speakers said, with structural issues such as funding and staffing disparities contributing to disparate health outcomes among people of color.
"Over the past several months, we have seen the remarkable work of our local public health workforce, and we've also seen the ineffectiveness of the structure in which they are working," said Sigalle Reiss, president of the Massachusetts Health Officers Association. "There are huge gaps in these capabilities between communities, which only exacerbate the equity concerns with COVID, other infectious diseases and public health services."
The new bill, Reiss said, would "strategically add capabilities to close these gaps."
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