AMHERST – The Massachusetts Health Policy Forum at Brandeis University and the University of Massachusetts Amherst (UMass) hosted a free virtual forum on Jan. 26 to examine the latest legislative recommendations and propose action steps to support a statewide local public health system. The forum was titled, “Massachusetts Local Public Health Infrastructure: Protecting Public Health and Preparing for the Next Pandemic.”

The focus was discussing key components and information on why a statewide local public health system was not only needed in the commonwealth, but also to create one that can adequately respond to the public health needs of all communities in the state.

A special commission on local and regional public health was convened in 2016 to investigate and develop recommendations for improving the 351 departments that make up the local public health system in Massachusetts. This has branched out to now where work on this research has been done by a team of professors and students at UMass in collaboration with the State Health Policy Forum group.

The forum opened with comments made by state Sen. Jo Comerford who said she was happy to be shining a light on a health infrastructure focused on equity.

“We see public health leaders in communities stretched thinner and thinner,” Comerford said. “One critical way to transform these inequities is to invest in local and regional infrastructure.”

Comerford also spoke in favor of proposed legislation SAPHE (State Action for Public Health Excellence) 2.0, which would further provide support to increase the efficiency and effectiveness of the local public health system in the state by most notably allocating state funds to boards of health.
The bill would have the Department of Public Health work with stakeholders and members of the special commission to create minimum local public health performance standards that include workforce training and credentialing, standards for reporting date through a unified public health reporting system, and minimum performance standards in areas such as inspections and permitting.

This work comes in response to seeing SAPHE 1.0 play out and making improvements from that initial starting point. SAPHE 1.0 was the first step toward increasing the efficiency and effectiveness of local public health services.

This legislation established a State Action for Public Health Excellence program to encourage higher performance standards for boards of health, increase cross-jurisdictional service sharing, improve data reporting and analysis, establish workforce standards, and to create professional development opportunities. SAPHE 1.0 also created a new grant program to support collaboration across municipalities to deliver public health services, or for planning and capacity building in regional collaboration, with a specified proportion of grants going to lower-income municipalities.

Now with SAPHE 2.0, three parallel funding streams to help support local public health systems will be provided. The grant-based system created in SAPHE 1.0 will be continued with the goal of competitive grants incentivizing service sharing. With that being said, the grant program will also be expanded to include need-based grants, with priority given to towns and cities in need of urgent help.

Non-competitive funding to help ensure that all municipalities are able to reach local standards will also be included. This funding will be distributed using a formula based on population, levels of cross-jurisdictional sharing and sociodemographic data. Two hundred million in federal funds from the American Rescue Plan Act (ARPA) received by the commonwealth has been allocated to supply funding for SAPHE 2.0.

UMass Master of Public Health candidates Juliana Sopko and Parker Sweet gave a presentation on the SAPHE bills, how to bring a public health standard to the state, and their research on the state’s health system as a whole.

Sweet explained how a goal of health standardization was to make sure the 351 public health departments across the state are equipped consistently with minimum services that everyone is guaranteed. He suggested that the state could mandate accreditation like done in Ohio or dedicate state resources. He added that the success of both ideas hinges on the success level of the state.
Sweet went on to discuss how shared service district reporting has worked in other states and how it creates an increased ability to receive grants. This would be a part of SAPHE 2.0.

“I want to present one interesting figure from Ohio who regionalized,” Sweet said. “They’ve seen a 13 percent decrease in per capita spending on the local health system.”

Sopko and Sweet then went though the five themes of their goals. The first theme was the balance of cross jurisdictional sharing and governance, which is focused on bringing strong municipal representation to the table as each town and city knows their own best.

The second theme was grant based funding and inequity with the focus on assisting rural departments in maintaining staff levels. Sweet explained that grant funding mechanisms can actually exasperate smaller departments like rural ones who typically can run into staffing problems.

The third theme was for robust data collection that Sopko called “imperative” to being able to easily share and access this information at the same time. The fourth theme was workforce standards and credentials and has been a focus with the lack of a pipeline in many communities for local public health.

The final theme trying to be addressed in this work is inequity within public health systems. With funding in the past coming based on a tax base has left some public health departments stuck in the past while others have continued to grow. Each theme’s slide in the presentation had a quote from their reports shown to give a comment on each theme.

“The funding mechanism that comes from tax base is just inherently regressive and limits the power of putting positive resources in place for any city or town and that translates into your zip code being the dictator of whether you have good services of bad services,” the quote said for the final theme.
Following their presentation, the forum opened up to Dr. Anna Maria Siega-Riz, dean of the UMass Amherst School of Public Health and Health Sciences. Siega-Riz led the forum as moderator and led discussions for the panel.

Dr. Sarah Goff, associate professor in the Department of Health Policy and Management in the School of Public Health and Health Sciences at UMass, was another panel member. Dr. Goff also works as a health services researcher and practicing pediatrician and internist, with her research broadly seeking to address issues of quality and equity in the U.S. health care system with a focus on health and health care for women and children.

State Rep. Denise Garlick, who represents the 13th Norfolk District, comprised of Needham, Dover and Medfield, and is also a registered nurse and a past president of the Massachusetts Nurses Association, joined the panel. Garlick currently sits as the Chair of Bills in Third Reading, which is the final committee legislation must pass before it can be engrossed. She has worked with State Sen. Comerford on SAPHE 2.0. When Garlick spoke to the panel she shared some of her own experiences as a nurse and the focus of public health within some departments.

“In my education there was no real focus on public health at all. Massachusetts has many residents who fail to see public health,” Garlick said. “What we see [after COVID-19] in the public now is rising awareness of local public health.”

Garlick added that since her time on the Board of Health in 2004 she has thought about the disparity between communities and has been making efforts since then to get to this point. She also added that the pandemic brought public health to the forefront and passing legislation like this has become even more important since before the pandemic started as it will help everyone if another event like this is to happen.

Siega-Riz brought forth the question of what were some of the biggest concerns facing local health departments and how SAPHE would address some of these challenges and put us in a better place for the next pandemic.

Damon Chaplin, a senior administrator with a background in public health and business administration the last 20 years has had plenty of public and private leadership experience, from local and state government program and policy development to regulatory agencies, said equity and funding comes back to staffing.

“Our biggest challenge is staffing. The pandemic showed us our lack of staffing and support. We were taking grant staff and any staff we could find,” Chaplin said. “One thing that came to mind is what often happens in programs is weaker ones get cut. Cycles show the ones not being valued get cut. We have to add back to the four functions and systems of public health and safe lay a foundation for sustained funding for local public health from the state.”

Craig Andrade, associate dean of practice of the Boston University of Public Health, added that some challenges being faced reflect margins between communities.

“I came from a marginalized community. Often times not everyone is at the table and understanding the needs of other minorities. Understanding what their needs are compared to majority are missed and we’ve seen that and continue to see that,” Andrade said. “There are cracks in our structure that suggest a significant challenge. Inequity has been here for decades and centuries in Mass.”

Pheobe Walker, director of community services at the Franklin Regional Council of Governments and appointee of the governor to the Special Commission on Local and Regional Public Health, also spoke on the forum and broke down the main goals of the bill. Walker said that the bill is attempting to create state wide standards.

“We want a set value to bring us close to what other states are doing with qualifications and met performance standards,” Walker said.

“We have to move from a culture of treatment to a culture of prevention and wellness,” Chaplin added in passing this law to better protect citizens, especially if another pandemic were to arise.“Public health saves lives. Embrace the mantra and understanding. Public health is the glue that makes this all work.”

To review the work done and information about panelists in the forum, visit heller.brandeis.edu where you can read the issue brief and speaker bios, as well as the agenda of the project. SAPHE 2.0 will continue to be reviewed by the state.