As state officials set up a wide range of urgent public health projects during the pandemic — from contact tracing to testing to vaccination — they chose to contract with private organizations rather than rely on local boards of health. Those decisions were driven by a concern that the public health resources in cities and towns were too uneven and often under-resourced to handle to tasks.
But a new state law signed last week that distributed federal pandemic relief funds allocates $200 million for local boards of health, and local health officials and advocates say that investment could transform the state's public health system into an equitable and reliable resource that's equipped to meet the challenges of the next major health crisis.
"One of the results of this terrible COVID pandemic has been that state leaders have seen what our fractured, inefficient, broken local public health system means to public health," said Carlene Pavlos, executive director of the Massachusetts Public Health Association. "And the Legislature, by investing in local public health, and the governor, by his signature, is saying that we know that we need to invest in this local system — so that when the next pandemic comes, the local public health system is prepared to respond."
The funding should mean the state won't have to rely on outside contractors for "one-time infrastructure" such as contact tracing, Pavlos said.
"Instead, we will have the local system in place, with the personnel in place that have the training and credentials and expertise to carry out the essential public health functions and respond equitably to the pandemics that are yet coming at us in the future," she said.
The $200 million allocation is divided into three main categories.
The largest sum, $98.8 million, is set aside for creating a single, unified system for collecting public health data. Right now, towns use different database systems and can't easily share information.
"There's all these different software systems," said Mike Hugo, government affairs liaison for the Massachusetts Association of Health Boards. "There's two or three major ones that are being used across the state. Meanwhile, none of that data is getting reported to the state Department of Public Health. And that includes everything from restaurants to swimming pool inspections, summer camp inspections. There's no central repository of data."
Under the new system, such data would all be shared with the state and accessible to the cities and towns.
Next, $30 million is earmarked for training and professional development for the staff in local health departments.
"The idea with the workforce development is to get all of the public health workers to certain minimal standards," Hugo said. "Right now, you could have a guy or a woman that's worked for the health department as an inspector for two decades, who's never taken a single course."
Lastly, $71.1 million will go towards a four-year program to create some public health equity across the state by allowing smaller, under-resourced communities to band together to do things like hire shared public health staff.
In Rockland, Delshaune Flipp said that would be an enormous relief. As the health agent in the South Shore town of less than 20,000 that doesn't have a separate department of public works, she's juggling a wide range of responsibilities, including trash, recycling, restaurant inspections, pool inspections and housing inspections. And the town has made it through the pandemic so far without a public health nurse.
"It's just been me, calling and working till 9 o'clock at night, [and] all weekend long," Flipp said. "I was putting in 72 hours a week."
Her office has a part-time office position available at 35 hours a week, but Flipp said most people are looking for a full-time position that would include benefits.
"We don't have the money and the resources for full time," she said.
Flipp said she's hoping the new funding will allow Rockland to team up with neighboring towns to hire inspectors that the communities can share.
"Food inspectors, Title Five [septic system] inspectors. An extra part-time person in this office would be huge." she said. "You know, everything's antiquated. We need to get up and running. And the only way to do that is with funding."
The $200 million allocation for local public health actually falls $50 million below what advocates and some lawmakers had been asking for.
State Sen. Joanne Comerford said she's optimistic the remaining $50 million will come in upcoming rounds of funding. Comerford is also pushing for the state Legislature to pass a bill to solidify the policy changes suggested in the spending bill.
She argues the bill, backed by funds from the American Rescue Plan Act, wasn't specific enough about the policy changes needed to transform the state's local public health system.
"It stopped short of setting minimum public health standards, and it stopped short of saying, 'Hey, state, you're on the hook beyond ARPA,'" Comerford said.
The so-called SAPHE 2.0 bill is a "twin sister" to the spending bill that passed last week, Comerford said, and it will help both to ensure the money is spent as it was intended, and that the transformation of the public health system is lasting with commitments to ongoing state funding.
Comerford said she's optimistic the legislation will be passed in the coming months.
