Department of Public Health
Thomas Carbone, Director of Public Health
36 Bartlet St.
Andover, MA 01810
Thursday, April 6, 2017
Contact: John Guilfoil
Email: [email protected]
Andover Public Health Op-Ed: The Future of Public Health
The following is an op-ed from Andover Director of Public Health Thomas Carbone:
In many ways, local public health practice has changed very little in the past 50 years. In Massachusetts, every city and town has a Board of Health or Health Commission as required by statute. Some boards of health are appointed, like Andover’s, and some are elected. Some boards of selectmen sit as the board of health, and some cities have a sole commissioner. There are even some regional boards of health, but very few. Public health is a very local issue, addressed by local resources, yet those health issues rarely are contained by municipal boundaries.
In Massachusetts, smaller health departments are very environmentally centric and enforce the state’s sanitary and environmental codes because they are mandated requirements. Unfortunately, due to budgetary restraints, the community health aspect of their work often gets driven to the sidelines. As a result, there is a varied landscape of health promotion opportunities, depending on the means and priorities of each community.
Health departments need to evolve with the times. For example, a booming economy often results in increased housing development, or the opening of new restaurants, which increases demand on staff for review of plans or proposals. During a recession, public health staff may need to expand enforcement actions due to an increase in complaints, or a decrease in preventive property maintenance.
There are always new diseases emerging that require additional attention. Prior to 1995, it was rare to see rabies in wild animals in Massachusetts, but a surge in raccoon rabies that year embedded the disease here. In 2000, we saw the rise of West Nile Virus as it infected the mosquito population. In 2009, we experienced Pandemic Influenza (H1N1), and recently our attention has been focused on the Ebola and Zika viruses. Each of these emerging diseases has presented different challenges to public health.
The public health sector has renewed its focus on health promotion and disease prevention programs, with the idea that it is less expensive to prevent an illness than it is to treat an illness. Some examples include smoking cessation and the reduction of tobacco containing products, cancer screenings, vaccination clinics, blood pressure and cholesterol screenings, concussion prevention programs, and personal protection from mosquitos and ticks.
Many communities are now reviewing the local health resources available to their residents. Nationally, there is a Public Health Accreditation Board that provides benchmarks for communities to strive toward. Andover will be hosting a Merrimack College Masters in Public Health candidate to start that review, with the intention of developing a roadmap to accreditation. Currently, the only Massachusetts community that has attained PHAB Accreditation is the City of Worcester.
Many practitioners see regionalization as a way to meet the PHAB standards and the needs of their communities. Andover already works within regional collaborations for tobacco control, emergency planning and Medical Reserve Corps operations and we hope to see further regional work in other health promotion activities.
In August of 2016, Governor Charlie Baker signed a legislative bill establishing a special commission on local and regional health. This commission will be reviewing how local public health is addressed, and will hopefully make recommendations on how to strengthen the local health system.
With federal resources diminishing, it is expected that states and municipalities will need to shoulder the burden of environmental stewardship and protecting the most vulnerable people in local communities. Local health will need to be flexible in its service delivery, and must develop new models for financing and operations. This is something that will be done locally, regionally and statewide.
As Dr. Leana Wen, Health Commissioner of Baltimore, Maryland says: “Public Health saved your life today. You just didn’t know it.” Public health leaders will be working to ensure that this statement remains true.