Who is a member?
Our members are the local governments of Massachusetts and their elected and appointed leadership.
The Honorable Joanne Comerford, Senate Chair
The Honorable John Mahoney, House Chair
Joint Committee on Public Health
State House, Boston
Dear Senator Comerford, Representative Mahoney, and Distinguished Members of the Committee,
On behalf of cities and towns across the Commonwealth, the Massachusetts Municipal Association is writing to express our serious concerns with H. 5045 and S. 2922, An Act Relative to Accelerating Improvements to the Local and Regional Public Health System to Address Disparities in the Delivery of Public Health Services.
When the Special Commission on Local and Regional Public Health finalized its report in June of 2019, titled “Blueprint for Public Health Excellence: Recommendations for Improved Effectiveness and Efficiency of Local Public Health Protections (“Blueprint”), one of their key findings was that most local boards of health were unable to keep up with a growing list of duties. Of course, this finding was pre-pandemic. Their duties and importance have now grown exponentially. In an era of global pandemics, we understand the desirability of local public health performance standards more than ever. However, with no understanding of the costs associated with such mandated minimum performance standards, and no identified dedicated state-funding source, the responsibility to support these mandates would be a new burden placed on the backs of cities and towns as a significant new unfunded mandate.
The “Blueprint” contemplated a realistic two-step process to improve the local public health system (page 30). The first step was to transition local boards of health into compliance with existing statutes and regulations. The second was to help local boards of health build capacity in readiness to meet a minimum set of standards known as the Foundational Public Health Services. Using the pandemic as a backdrop, these bills are now seeking to fast-track the transformation of local boards of health, by mandating that they meet a minimum set of performance standards now. The “Blueprint” warned that, “To push them to upgrade to Foundational Public Health Services (FPHS) – without first developing the readiness and capacity to do so – will just intensify the crisis for these struggling cities and towns – and widen the gap between them and the small number of well-funded and supported health departments that will be able to implement the new standards” (page 71). This legislation does not heed this warning.
To date, no study has been conducted regarding the cost necessary for municipalities in Massachusetts to meet existing standards, nor is there any analysis of what it would take for them to achieve the foundational public health service standards. The data included in the “Blueprint” indicate some municipalities are providing such a very basic level of services that the cost to bring municipalities up to meet these standards has the potential to be enormous. For example, over 70% of local public health departments do not have enough staff to comply with current statutory and regulatory duties and 80% of local public health department representatives agreed that they do not have the capacity to provide the most essential public health services to their citizens (page 33). Without a dedicated state-funding source, there is no way municipalities would be able to meet the mandates of these bills on their own.
Local health budgets vary widely by municipality and are subject to the competing demands of other municipal departments and funding needs. If these bills pass, municipalities would be mandated to devote an unknown amount of additional funds each year in order to meet these mandates. Because local revenues are capped by Proposition 2½, cities and towns cannot absorb new funding mandates without reducing other expenditures on essential public safety, education or other critical services. Further, without a dedicated source of state funding, it would be unclear from year to year if necessary funding from the state would be available to match contributions from municipalities. Expanding department staffing capacity to meet any minimum standards would require long-range goal-setting and planning that would only work if dedicated state funds can be guaranteed. Short-staffed departments cannot hire the permanent professional employees necessary to meet and maintain minimum performance standards without knowing if reliable state assistance will be provided from year to year to maintain those hires. Moreover, the non-public-health aspects of municipal budgets are already facing severe shortfalls due to the pandemic. The mandates in this legislation would worsen an already dire fiscal situation, and force further budget cuts in other important departments.
Local boards of health and health departments are the “boots on the ground” for the Commonwealth. If municipalities are mandated to meet expanding minimum performance standards, the Department of Public Health and Department of Environmental Protection must be required to rise up to deliver increased training and technical assistance to municipalities, and provide a platform to analyze the data collected from each board of health. The Commonwealth serves to benefit greatly from increased standards, increased training, and data collection by local boards of health, and the DPH and DEP are and should remain vital partners to local boards of health. These bills do not identify any additional roles for DPH and DEP, nor are state agencies directed to support data collection and analysis. Any legislation should identify further ways in which DPH and DEP and all state agencies can partner with and support local boards of health.
The MMA supports the vision of a 21st century model for local boards of health and agrees that this is a vital aspirational goal to achieve for the health and safety of all residents of the Commonwealth. However, these bills omit necessary steps detailed in the comprehensive “Blueprint,” and would have the ironic impact of overburdening local boards of health and harming municipal finances, instead of improving capacity and finances at such a critical time. We respectfully request that you and your colleagues conduct a thorough analysis of the sweeping unfunded mandates in these bills, and secure a guaranteed full-funding revenue source before advancing these measures out of committee.
The MMA looks forward to working closely with the committee in the further review and development of these bills. If you have any questions, please do not hesitate to have your office contact me or MMA Senior Legislative Analyst Brittney Franklin at 617-426-7272 at any time.
Thank you very much.
Geoffrey C. Beckwith
MMA Executive Director & CEO