Massachusetts House Passes Legislation to Establish an Effective and Equitable Local Public Health System

Today, the Massachusetts House of Representatives passed legislation designed to strengthen local and regional public health and ensure that every resident has access to foundational public health services, regardless of where they live, through the Department of Public Health’s (DPH) State Action for Public Health Excellence (SAPHE) program established by the Legislature in 2020.

Across the Commonwealth, there are hundreds of local public health boards with varying degrees of expertise and bandwidth depending on the size and wealth of the community in which they are located and are tasked with functions as diverse as restaurant inspection, sanitary code enforcement, emergency preparedness, and disease control. This legislation builds on the 2019 recommendations of the Special Commission on Local and Regional Public Health and the SAPHE 1.0 legislation passed in early 2020 by establishing a statewide standard for those boards and the services that they provide; dedicating state funding; creating a uniform data collection and reporting system; providing training and technical assistance to public health professionals to meet educational and credentialing standards; and establishing more effective and efficient methods of delivery for public health services.

“Over the last two years, the pandemic has highlighted the importance of public health services, and the regional and racial inequity that exists within our public health infrastructure,” said House Speaker Ronald J. Mariano (D-Quincy). “I’m incredibly proud of the steps taken in this legislation, in addition to funding that was previously allocated by the Legislature to support the Commonwealth’s public health infrastructure, to ensure that every resident of Massachusetts has access to sufficient public health services regardless of the size or wealth of the community that they live in. Whether public health boards are inspecting restaurants and drinking water, or responding to a disease outbreak such as COVID-19, the work they do is of great importance. I want to thank Chairs Lawn, Decker, and Garlick, Representative Kane, and all my colleagues in the House, for working diligently to improve and expand public health services in Massachusetts.”

“SAPHE 2.0 affirms and extends the House’s commitment under the leadership of Speaker Mariano to the health of all residents of the Commonwealth,” said Representative John Lawn (D-Watertown), House Chair of the Joint Committee on Health Care Financing. “Local boards of health worked courageously on the front line of Massachusetts’ response to the COVID-19 public health emergency. The policy solutions in this legislation will empower our public health infrastructure and workforce to respond effectively, efficiently, and equitably to any future public health challenges.”

“This is landmark legislation that recognizes the critical role that local boards of health serve in our communities, from developing a rapid response to a pandemic that helps to slow the spread with vaccinations, testing, and contact tracing, to ensuring that our water, our restaurants, and the air we breathe are safe,” said Representative Marjorie C. Decker (D-Cambridge), House Chair of the Joint Committee on Public Health. “This bill ensures greater equity for all 351 cities and towns in Massachusetts. A robust local public health response is our greatest strength and ensures a healthier Commonwealth.”

Specifically, An Act relative to accelerating improvements to the local and regional public health system to address disparities in the delivery of public health services seeks to strengthen local and reginal public health in six main ways:

Establishes minimum public health standards for every community

  • Clarifies that the SAPHE program should provide every resident with foundational public health services, including services to improve racial and health equity; assist boards of health to adopt practices that improve the delivery of services; develop state-wide standards for services; and provide resources for boards of health, including workforce credentialing standards and professional development
  • Requires boards of health to comply with the standards for local foundational public health services including inspections, epidemiology and communicable disease investigation and reporting; permitting and other local public health responsibilities; workforce education, training, and credentialing; and contributing required data
  • Allows boards of health to comply with standards either individually or through cross-jurisdictional sharing of public health services
  • Requires the standards foundational public health services developed by the SAPHE program to be consistent with the recommendations of the June 2019 report of the special commission

Provides training and technical assistance to public health professionals to meet educational and credentialing standards

  • Mandates that DPH, with the Department of Environmental Protection (DEP), provide no cost public health educational and training opportunities and technical assistance to municipal and regional public health officials and staff

Dedicates state funding

  • Requires DPH to provide funds to boards of health for grants and technical assistance to municipalities with limited operational capacity; competitive grants to increase the delivery of services across three or more municipalities; non-competitive funding to ensure all residents of the state receive foundational public health services that meet or exceed the required standards

Creates a uniform data collection and reporting system

  • Mandates that DPH and DEP develop systems to increase standardization of public health reporting and systems to measure standard responsibilities of boards of health. This data should be made public where feasible under privacy requirements
  • Authorizes DPH to coordinate affected boards of health and share data, if there is an outbreak of disease or other public health situation that impacts more than one board
  • Requires DPH and DEP to biennially report on the impact of the SAPHE program and the status of local public health systems and their ability to meet the requirements of this act
  • If DPH and DEP determine a failure to meet the standards constitutes a threat to public health, they must notify the appropriate board of health and request that the board take action. DPH may restrict future funding if the actions are not sufficient to protect public health

Establishes more effective and efficient methods of delivery for public health services

  • Requires DPH to hold public hearings to identify ways to improve the efficiency and effectiveness of the delivery of local public health services, and to report to the Legislature with an analysis of needs, opportunities, challenges, timeline, and cost analysis for the implementation of the SAPHE program
  • Revives and extends the Special Commission on Local and Regional Public Health and requires them to review the changes made in this act to the SAPHE program and available funding

“The Legislature has focused on public health in a comprehensive, deliberative process since 2015 with the establishment of a Special Commission,” said Representative Denise Garlick (D-Needham), Chair of the House Committee on Bills in the Third Reading and lead sponsor of the bill. “The Special Commission’s 2019 report exposed the fractures in local public health, and the covid public health crisis only magnified those inequities. With the work accomplished by SAPHE 1.0 and the substantial investments made by the House and Senate in annual budgets and ARPA, SAPHE 2.0 provides the tools and direction to move local and regional public health forward. The passage of this legislation is the result of the extraordinary efforts of the frontline public health workers, advocates, experts and the legislative and executive branches working together to positively impact the lives of every resident in our Commonwealth.”

“I am grateful to all who helped champion this legislation and I greatly appreciate the Speaker, the Minority Leader, Chair Michlewitz, Chair Decker, Chair Lawn and Chair Driscoll for their commitment and support in bringing this transformational legislation forward. My legislative colleague and friend Chair Garlick has been a terrific partner, working together to implement the unanimous recommendations of the Special Commission on Local and Regional Public Health that will significantly strengthen our local public health system, ensuring it is more equitable, efficient and effective. SAPHE 2.0 is about good government – the efficient delivery of services, promoting health and thereby reducing our healthcare costs,” said Representative Hannah Kane (R-Shrewsbury), lead sponsor of the bill.

The 25-member Special Commission on Local and Regional Public Health was established in 2016 and found that many of Massachusetts’ 351 individual boards of health are often unable to meet statutory requirements and lack the capacity to meet rigorous national public health standards. In response, the commission developed recommendations, known as the Blueprint for Public Health Excellence, which served as the basis for SAPHE 1.0 to encourage regional collaboration and planning.

In December 2021, the Legislature approved over $200 million in American Rescue Plan Act and FY21 surplus funding to support local and regional public health infrastructure. The FY23 budget signed today includes $15 million for grants to support ocal and regional boards of health, furthering the Legislature’s continued efforts to build upon the successful State Action for Public Health Excellence (SAPHE) Program.

An Act relative to accelerating improvements to the local and regional public health system to address disparities in the delivery of public health services (H.5104) passed the House of Representatives 153-0. It now goes to the Senate for their consideration.