Whether you live in a major city or the smallest town, your local board of health has statutory responsibility to address infectious diseases – like COVID-19 – through investigating known and suspected cases, recommending and enforcing quarantine and isolation (both voluntary and involuntary), making testing recommendations, reporting to state public health officials, and enforcing regulations around reopening. In this moment of crisis, we are relying on our local public health departments to protect us by coordinating with local hospitals and clinics, emergency response units, and law enforcement.
The difficulty that we face in Massachusetts is the inconsistency in capacity and quality of local public health departments. This is a problem that MPHA has been raising for years. It is why we helped found the Coalition for Local Public Health several years ago and have vigorously supported passage of the SAPHE Act. The municipal approach to public health in our state – through the 351 cities and towns – means that there is substantial inefficiency and variability in service delivery. In particular, many small towns lack staff and instead rely entirely on volunteer boards of health. As a result they lack the capacity to meet the new demands being placed on them as a result of the current epidemic.
Our Immediate Response
To address this crisis, MPHA is now playing a critical coordination role, connecting the state’s COVID-19 Command Center with local public health departments and districts. Together with our partners in the Coalition for Local Public Health, we have developed a network of seven Crisis Affiliates, who are collectively responsible for supporting and directing state resources to struggling local health departments in 227 municipalities. These Crisis Affiliates include regional planning organizations and existing public health umbrella groups. In addition, MPHA is also supporting the 15 existing Health Districts (collections of municipalities which had previously come together to share public health responsibilities) through troubleshooting and information sharing.
MPHA is also helping to ramp up our state’s capacity for contact tracing – that is, documenting and informing everyone who has had known contact with someone with a positive test for COVID-19.
Early in the pandemic, we partnered with the public health programs at nine colleges and universities (Northeastern, Boston University, Tufts, Harvard, UMass Lowell, UMass Amherst, Simmons University, Regis College, and the Mass College of Pharmacy and Health Sciences) to recruit students, faculty, and alumni as volunteer contact tracers. Nearly 2,000 volunteers registered through what is now called the Academic Public Health Volunteer Corps, and hundreds of volunteers have been matched with dozens of Massachusetts communities.
Shortly afterwards, the Commonwealth launched its Community Tracing Collaborative (CTC), a statewide initiative to hire and train full-time contact tracers and case investigators under the leadership of the nonprofit organization Partners in Health. MPHA is collaborating with the State’s COVID-19 Command Center to ensure that the contact tracing efforts of local health departments are integrated with CTC, and that this important investment in contact tracing also builds local public health capacity for the future.
A Proposal to Transform the Local Public Health System
Despite the dedication of our state’s local health staff and volunteers, the Commonwealth’s decentralized approach to delivering public health services leads to extreme variability in protections across municipalities — and this puts the entire state at risk. Now is the time to move rapidly to transform our local public health system to adequately protect public health and safety during the remainder of the COVID-19 crisis and to meet future threats to public health.
The goals for a stronger system have already been outlined in the consensus recommendations of the Special Commission on Local and Regional Health. In order to accelerate progress toward these goals, the state should move quickly to:
- Adopt Universal Minimum Public Health Standards,
- Ensure a Qualified Workforce,
- Expand Services through Cross-Jurisdictional Sharing, and
- Establish Sustainable State Funding.
MPHA and our partners in the Coalition for Local Public Health are working with local public health staff, municipal leaders, legislators, and state officials to advance these proposed changes. The time has come to create a public health system that provides every resident of Massachusetts with high-quality public health protections.
Additional resources for local health departments can be found at the following websites:
- Community Tracing Collaborative Webinar
- Community Tracing Collaborative Information Page
- COVID-19 Information for Local Health Departments
- Massachusetts Association of Health Boards
- Massachusetts Health Officers Association
- Massachusetts Association of Public Health Nurses
If you are a local Health Department staff member or volunteer needing assistance, please contact Kristina Kimani at email@example.com.