A coalition of local officials, advocates and lawmakers unveiled legislation Wednesday that aims to accelerate improvements to the state’s decentralized public health system, which has faced increasing strain during the coronavirus pandemic.
The proposal, which has not yet been filed, would again direct the state Department of Public Health to set minimum public health standards across the 351 municipal health agencies in Massachusetts. The bill would set a timeline for communities to reach those standards.
The standards would aim to standardize the responsibilities for and expectations of health agents that are tasked with inspecting restaurants, enforcing tobacco regulations, tracking EEE infections and, most recently, a growing list of testing and enforcement measures in response to COVID-19, according to coalition members.
The bill would also offer incentives to municipalities to share services, require a dedicated stream of revenue for public health departments and direct DPH to create a uniform data collecting and reporting system for health officials across the commonwealth.
“Our state has a local public health system that is based in hundreds of different municipalities, with no source of state funding and no minimum standards for staffing,” Kristina Kimani, assistant policy director at the Massachusetts Public Health Association, told MassLive. “As a result, there are many communities – both large and small – who have inadequate staffing. And there are dozens of small communities with no public health staff at all.”
“Given what we have experienced during this pandemic, we have a moral obligation to our residents to take meaningful action now,” she added. “Every Massachusetts resident deserves adequate local public health protections – regardless of their ZIP Code.”
The MPHA is part of the coalition to push for the bill unveiled Wednesday. Rep. Hannah Kane, a Shrewsbury Republican, and Rep. Denise Garlick, a Needham Democrat, are the lead sponsors in the House. Sen. Jo Comerford, a Northampton Democrat, is the sponsor in the Senate.
Gov. Charlie Baker signed into law a proposal in April to boost public health standards into law in April; the bill was proposed in 2019, well before the pandemic. The “State Action for Public Health Excellence” law requires DPH to create minimum standards for public health services for the commonwealth, including workforce standards.
The SAPHE law also required DPH to provide public health training to local officials at least four times a year and created a grant program to help boards of health improve their services. After the law took effect, the Baker administration announced health officials in 79 cities and towns will receive grant funding over the next two years to improve data sharing and work on air quality, online inspection scheduling, nursing services and other projects.
Yet the public health system remains fractured and increasingly burdened as local health officials scramble to respond to COVID-19 and the state’s ever-changing guidelines. Health officials have juggled their usual responsibilities with COVID-19 testing and isolation measures, responses to complaints against businesses during the non-essential business closures and the phased reopening and answering flurries of questions from business leaders, local officials and residents about the state’s COVID-19 guidelines.
The latest bill, called the “Statewide Accelerated Public Health for Every Community Act,” has been dubbed SAPHE 2.0. It aims aims to accelerate the overhaul of the state’s fractured public health system, coalition members say.
“The COVID-19 pandemic put a spotlight on our local public health system,” Kimani said. “We saw the incredible hard work and dedication of our local public health workers, and we also saw the inefficiency and ineffectiveness of the structure they work in.”
The proposal would establish uniform standards across local boards of health across the commonwealth, including credentialing standards for health officials and training. This aims to accelerate the provision in the original SAPHE law that calls on DPH to develop minimum standards for public health services in consultation with local and regional officials.
The bill also requires that boards of health increase their capacity to meet the standards, including through service sharing agreements or regional health departments. Worcester’s Division of Public Health, for example, serves as the lead agency of the Central Massachusetts Regional Public Health Alliance that represents Grafton, Holden, Leicester, Millbury, Shrewsbury and West Boylston, in addition to Worcester Worcester.
The alliance works together on community health campaigns, environmental health, emergency preparedness, nursing and epidemiology. The alliance has also coordinated on sorting through complaints about COVID-19 compliance and enforcing Baker’s executive orders.
The provision directing DPH to create a uniform data collection and reporting system calls upon the state agency to implement a way to collect data on a broad set of issues that boards of health address. Health officials do submit COVID-19 data through MAVEN, the Massachusetts Virtual Epidemiologic Network, but local health officials do not have a uniform way to collect, track and share data on other work they’re doing.
The bill also contains a provision to create a dedicated funding source for boards of health, like public schools and libraries do. The provision comes as the state is looking for new revenue for fear of a major spending gap, but coalition members say having a dedicated funding source could have helped the state save money in its response to the coronavirus pandemic.
One example local health officials and Comerford noted was the Contact Tracing Collaborative with Partners in Health, which still required help from local public health officials.
“We had no ability to do anything but that was because we didn’t have a public health infrastructure that could take it,” said Comerford, adding COVID-19 contact tracing efforts weren’t fast or efficient enough. “Had we had a structure we could invest in, we could have bolstered that structure, strengthened it, turned that money toward our local boards of health.”
The bill drew input from local health officials from across the state, from Phoebe Walker, director of Community Services for the Franklin Regional Council of Governments, to Damon Chaplin, director of the New Bedford Health Department.
Chaplin raised concerns in July that the southeastern Massachusetts city was seeing an undercount of coronavirus cases, particularly among Latino and Black residents who worry about surprise bills in the mail even though COVID-19 tests are supposed to be covered by insurance.
“It’s come to life because of the lived experience and expertise of local and regional public health officials,” said Comerford, who is also chair of the Senate’s COVID-19 working group. “That’s not always how this works.”