By Sam Drysdale
BU News Service
Legislation to accelerate improvements in the state’s decentralized public health system would address inequities between municipal health departments that have been further exacerbated by the COVID-19 pandemic, supporters say.
The Statewide Accelerated Public Health for Every Community Act, or SAPHE 2.0, would establish minimum public health standards, offer municipalities incentives to share resources, create a system for uniform data collection and reporting, and dedicate state funding to local health departments.
The bill is an expansion of legislation signed into law at the end of April to improve local boards of health through grant-based incentives.
Currently, Massachusetts has a decentralized structure with 351 separate health boards, one for each municipality in the commonwealth. With no dedicated state funding, budgets usually fall on the shoulders of individual cities and towns.
The current system promotes inequity, New Bedford Health Director Damon Chaplin, who serves as a co-chair of the SAPHE 2.0 Coalition, told BU News Service.
“The system is based on property taxes,” he said. “Most health departments are underfunded, and because they are underfunded, they do not have the staffing to support community outreach.”
Bill sponsors Sen. Jo Comerford, D-Northampton; Rep. Hannah Kane, R-Shrewsbury; and Rep. Denise Garlick, D-Needham proposes state funding for local boards health to help supplement municipal funding.
In an online rally on Sept. 30., Kane said the COVID-19 crisis was the “devastating and unfortunately illustrative example needed to galvanize people,” to accelerate public health reform.
Chaplin told the rally that the decentralized structure puts the entire state at risk.
“Because viruses do not respect municipal borders, the extreme variability of protections provided across municipal health departments increases the potential for harm to all communities,” he said.
Legislators are also proposing a standard reporting system for public health data, which, according to Chaplin, will provide access to accurate data that will help local health departments make informed decisions.
Chaplin highlighted to the Bu News Service that the current system disadvantages people of color, especially in light of how research has shown the disproportionate effects of COVID-19 on Black communities. He said this is tied to the rise in coronavirus cases in gateway cities, such as New Bedford.
“We see that there is this health disparity around COVID in gateway cities — specifically those that have high numbers of Hispanics and Blacks,” he said.
If passed, the bill would also create incentives for cross-jurisdictional sharing.
There are currently 15 groups of two or more municipalities organized into public health districts or other formal arrangements for sharing services. These districts serve about 1.5 million Massachusetts residents — about 23 percent of the population — but few are in Southeastern Massachusetts.
SAPHE 2.0 proposes the consideration of cross-jurisdictional sharing in determining local boards of health’s funding.
The Massachusetts Public Health Association hopes to see some parts of SAPHE 2.0 included in the budget for the fiscal year 2021.
Garlick, a Needham Democrat who is one of the lead sponsors in the House, told the rally that the bill is especially important in this current moment.
“To have this legislation now gives us the ability to talk about our principles, talk about why this is necessary and to talk about how public health is the infrastructure of the safety net of our communities,” she said.
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