Fortifying Public Health Requires Local Funding

Public health in Massachusetts has long been starved for funding. Local public health boards and their health departments play essential roles in providing basic public health services. Direct state funding is needed to expand services and improve resource sharing among the 351 local health departments in Massachusetts. The staffing and capabilities of local health departments have long been dependent on inconsistent funding from municipalities, without additional state support. Recent public health emergencies have revealed longstanding issues with the state’s public health preparedness.

Poor structural and financial support for local health departments weakens Massachusetts’ ability to respond to current and future public health crises. Increased fortification of local health will be essential amid ongoing efforts to improve health equity within the state. The current State Action for Public Health Excellence (SAPHE) bill, proposes to address these unmet needs by building on prior legislation to better balance the inequitable distribution of resources by requiring direct state funding and greater collaboration between municipalities.

Starting in 2020, Massachusetts began an optional grant program for local health departments. On their own, grants are insufficient for addressing underfunding in resource-starved communities, as the grant process can be prohibitive for understaffed health departments. Hence, we need to look for more permanent legislative solutions.

SAPHE seeks to address these issues by: (1) incentivizing shared services, (2) providing minimum standards, (3) building a state-wide public health data collection system to ensure goals are being met, and (4) guaranteeing consistent state funding. This legislation is coming before the Joint Committee on Public Health today.

In order to understand the need for funding and support for local health, we can look at two services typically handled by local health departments – disease investigation and vaccination.  Both of these services were contracted out during the Covid-19 pandemic, highlighting how increased state funding and better collaboration can benefit all Massachusetts communities.

However, almost all local health departments were excluded from Massachusetts’ Covid-19 vaccine distribution plans in favor of third-party contractors.

The state supported local pandemic efforts by contracting with Partners in Health on a project called the Community Tracing Collaborative. It gave municipalities flexibility to choose from a menu of services that could include full or partial support of their local contact tracing efforts, allowing these municipalities to continue providing day-to-day public health services to their communities. The program had a bumpy start and received criticism for its cost.  Yet, ultimately, it was well-received by many local communities. It provided support to a fractured and underfunded system, while allowing local communities to maintain agency in how they utilized this support.

Early on in the Covid-19 vaccine distribution process, the state made the decision not to use local health departments and instead contracted with private companies. This decision surprised many advocates. Massachusetts’ public health emergency preparedness plans have included local health departments in vaccine distribution since their development in response to 9/11 and the 2001 anthrax attacks. During flu season, we see such plans implemented annually through the use of municipal vaccination clinics. However, almost all local health departments were excluded from Massachusetts’ Covid-19 vaccine distribution plans in favor of third-party contractors.

This decision resulted in many local health departments not being included in the distribution of vaccines, despite being uniquely situated with the knowledge and capabilities to reach the most vulnerable populations. On May 3, 2021, the state announced that mass vaccination sites will be closing throughout Massachusetts in the coming months. What remains unclear is how this shift will impact local health. While local health has long sought to be involved in the vaccine distribution process, the failure to integrate state and local efforts early on in the pandemic response highlights the need for greater funding, support, and collaboration between the state’s executive branch, the Massachusetts Department of Public Health and local health departments.

The consequences of Massachusetts’ decades-long failure to invest in local health departments became clear during the Covid-19 pandemic. New funding streams and greater collaboration are needed. Even in non-emergency situations, local health departments need to be well-supported, as they play an integral role in maintaining healthy communities. Investment in public health, now, is an investment in the future health of our communities.

Update from the authors: The legislation received bipartisan support from members when it was before the Joint Committee on Public Health on May 10, 2021. (Discussion begins at the 8:55 mark in the recorded video.) There is more work to be done, as the Joint Committee on Public Health will likely meet again to review language of the bill.  If SAPHE is reported favorably out of committee, it can continue through the legislative process for a full vote. Support from the public in the form of outreach to your representative and senator is crucial at every step.

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