Advocate says there aren't enough resources for public health protection

Mar. 9--Coronavirus headlines dominate the public's attention. Worldwide cases exceed 105,000, with more than 3,500 deaths, including 19 in the U.S., and the World Health Organization urged governments to "pull out all the stops" to fight the disease.

The headlines put a spotlight on an existing problem in Massachusetts, according to one public health advocate -- not enough funding for local public health departments to tackle big public health issues, like coronavirus, and smaller ones, including restaurant inspections that protect the public against food-borne illness.

"Headlines (about coronavirus) recognize that it's time for investment (in local public health)," said Carlene Pavlos, executive director of the Massachusetts Public Health Association.

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In the Bay State, it's a story of haves and have nots when it comes to public health. Much of the disparity comes down to population. Bigger communities have room in their budgets to carve out money for public health, while smaller communities often don't have that luxury.

"Incredible disparities," is how Pavlos described the inequity landscape.

Massachusetts is the only state in the country that has individual public health departments in each city and town, according to a June 2019 report by the Special Commission on Local and Regional Public Health. That translates to 351 separate departments.

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Local public health departments also don't receive direct funding from the state. They must rely on local budgets and grants to meet their needs, unlike many states that have county and regional public health structures.

Smaller communities in Massachusetts feel the money pinch, including Ashland.

It has two full-time employees, a director and administrative assistant, in its public health department that serves a population of 17,000. Part-time staff includes a public health nurse that works 10 hours weekly, food inspector and tobacco control officer. The department's total budget for this fiscal year, which ends June 30, is roughly $230,000.

"We are left on our own to a large degree to fund public health priorities identified locally and by the state," said Ashland Town Manager Michael Herbert.

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Of the 105 Massachusetts towns with fewer than 5,000 residents, more than 75% don't have full-time public health staff, and 58% don't have public health inspectors, according to last year's report by the Special Commission on Local and Regional Public Health.

Those numbers make it nearly impossible for smaller communities to meet a host of public health requirements, including: food safety in restaurants and public kitchens; preventing the spread of communicable disease; enforcing tobacco and lead regulations; responding to reports of housing code violations; proper installation of septic systems; and monitoring water quality at public swimming pools and beaches.

Staffing cuts over the years at the state Department of Public Health resulted in dumping many of those responsibilities into the lap of local public health departments, according to Jim White, Natick's public health director.

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Sam Wong, Framingham's public health director, said he's thankful for his 16-member staff, but he still wishes for more resources.

Wong manages five health inspectors for a city of roughly 70,000 residents. They spend roughly half their time dealing with housing issues, including landlord-tenant disputes, a responsibility mandated by the state that takes time away from addressing other public health issues.

If there was more money to go around, Wong said he could hire more staff to better handle the myriad public health responsibilities set by the state, including restaurant and septic system inspections.

"I totally agree with Sam," that time spent on housing issues detracts from other important responsibilities, said White, who has three inspectors in Natick for 32,000 residents. "I'm blessed with three, but it's probably not enough."

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A pending bill at the statehouse calls for $1.7 million in state funding to ensure local public health workers have access to essential training; creation of grant programs so towns can share public health resources; and brings local departments more in line with 21st Century public health standards.

The bill is sitting in the Senate Ways and Means Committee after receiving support from House lawmakers and the Joint Committee on Public Health.

"We have very real public health concerns in Massachusetts," said state Sen. Becca Rausch, D-Needham, a bill co-sponsor who sits of the Joint Committee on Public Health. "I hope the bill will come to the floor, and I hope we can pass it."

Passage doesn't guarantee there will be money in next fiscal year's state budget to fund it.

Map of coronavirus cases and deaths in the US

Pavlos supports the bill's emphasis on sharing resources, adding it is imperative that $500,000 in this fiscal year's state DPH budget, primarily used for grants and local sharing of resources, also appears in that agency's budget for next year.

If coronavirus has taught us anything, Pavlos said it serves as a reminder that long-term investments must be made in local public health in order to safeguard residents.

"When you have a potential public health disease outbreak, local public health is critical to local public health response," Pavlos said.

Total cases, deaths, and recoveries by country

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Henry Schwan is the health reporter for the Daily News. Follow Henry on Twitter @henrymetrowest. He can be reached at [email protected] or 508-626-3964.

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