Local health departments in Massachusetts have a limited ability to deliver on their statutory requirements in the areas of housing code violations and restaurant and septic system inspections, lack workforce standards, and face inequities in funding, according to a new special commission report.
The State House News Service reports that Massachusetts Public Health Commissioner Monica Bharel, who chaired the Special Commission on Local and Regional Health, visits Beacon Hill today (7) to release a summary of the report and the commission’s recommendations. She will be joined by lawmakers and representatives from the Massachusetts Municipal Association, the Massachusetts Taxpayers Foundations, and local health departments.
The report acknowledges the unique nature of the state’s decentralized system of 351 boards of health, local agencies charged with ensuring the wellbeing of residents in public, in restaurants, at schools, in their homes and at work. Each city and town must fund its own board of health and their budgets, “often bare bones, are the sole responsibility of individual cities and towns with no dedicated state funding,” the report said.
Many local health departments struggle to meet traditional mandates to deal with communicable diseases, food safety, housing, sewage, and environmental hazards. But the report said the responsibilities of local health agencies are expanding and adding more stress.
“But in the 21st century, their list of duties has ballooned to include protecting the environment, planning for natural and manmade disasters, preventing new insect and tick-borne diseases, reducing substance addiction, reducing the prevalence of chronic diseases, and improving mental health. The Commonwealth’s local public health system has mostly been unable to keep up with these new demands,” the commission found.
The inability of local departments to keep up with rigorous national health standards and expanding state and local mandates comes while policymakers are searching for ways to reduce the cost of health care. The special commission report said well-resourced local health departments can be part of the health care cost solution.
“If local health departments can forestall just one in 1000 preventable hospitalizations in Massachusetts, it would represent a savings of hundreds of thousands of dollars,” the report said. “If they can, by educating the public and providing opportunities to eat right and exercise, steer those at risk for chronic diseases to healthier paths, the savings could be millions more.”
The commission recommends that Massachusetts allow local health departments to join together to form comprehensive public health districts, enter into formal shared services agreements and otherwise arrange to share health services across municipal lines.
Resource sharing would help boards of health “strengthen the service delivery capabilities of local public health departments, take advantage of economies of scale, and coordinate planning,” the report said.
The report also recommends raising the standards for local health departments as a way to improve performance, and establishing education and training standards for local public health officials and expanding professional development opportunities.
Reps. Hannah Kane and Denise Garlick and Sen. Jason Lewis plan to use the report to call for passage of legislation (H 1935/S 1294) creating an incentive grant program to support community-driven regional collaborations to share services and meet higher standards.
“Every day about 200 lives begin in Massachusetts. Another 150 end,” the report said. “Between those two bookmarks, there is no other entity more important to ensuring the health and wellbeing of residents than their local boards of health.”
