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Chapter 11

Health and Human Services

Public Health

Health officials in municipalities are involved in numerous and varied public health activities that may include holding vaccination clinics, inspecting food establishments and housing units, responding to nuisance complaints, dealing with unsafe or noncompliant structures and other sources of illness or disease, and permitting septic systems. Core functions of public health have evolved in many communities over time to include emergency planning, substance use prevention and mental health services, with a focus on social determinants of health and health equity. A manual from the Massachusetts Association of Health Boards outlines the statutory duties of Local Health Boards. It is important to remember that these duties do not include local regulations, bylaws and ordinances that local health boards are also required to manage.

Helpful resources available to health officials include the Massachusetts Association of Health Boards and the Massachusetts Health Officers Association.

Organization and Role of Health Board

On the local level, boards of health and/or health departments have the primary responsibility for protecting public health. Under state law,1 the Select Board acts as the board of health if the municipality has no other arrangement, or the Select Board can be authorized by Town Meeting to appoint a board of health. Most municipalities have a separate, autonomous board of health consisting of three or more elected or appointed members. Recently, municipalities have begun to share the delivery of public health services through intermunicipal municipal agreements2 or the formation of regional health districts. Municipalities may designate the manner in which health services are delivered.3

Board of health members are not required by law to have any medical or health training, although in practice many do, and some local ordinances or bylaws require that one member be a doctor or medical professional. Boards of health may appoint a physician and other staff to advise and assist them. Select Board members who serve as the board of health are authorized by law to appoint a health inspector.4 In towns with fewer than 3,000 people, this inspector may be the school physician. A town charter may provide for another method of appointment of health personnel, such as by the town manager.

Most municipalities employ a health inspector and a public health nurse either full-time, part-time, or on a contractual basis. Qualifications for a health inspector can include licensure as a registered sanitarian. Many municipalities also require that inspectors be certified health officers. A Special Commission on Local and Regional Public Health was created in 2016 to “assess the effectiveness and efficiency of municipal and regional public health systems and to make recommendations regarding how to strengthen the delivery of public health services and preventive measures.” The commission’s 2019 report, “Blueprint for Public Health Excellence: Recommendations for Improved Effectiveness and Efficiency of Local Public Health Protections,” outlines recommendations for board of health training and credentials, among other best practices.

Organization and Role of the Health Department

Boards of health may operate according to administrative and enforcement regulations of the Department of Public Health or the Massachusetts Department of Environmental Protection. The local board of health usually delegates most of its administrative, inspectional and enforcement activity to a health department comprised of paid employees, leaving policy-setting and oversight to the board.

The board’s specific legal duties5 include enforcement of the State Sanitary Code (105 CMR 400-675), which establishes minimum health standards for residential housing, day camps, swimming pools and food service establishments, among other facilities and activities. The code permits a board of health, or another health authority, to adopt rules and regulations stricter than those contained in the code.

In addition to many specific statutory jurisdictions and authorities, boards of health have extensive power to adopt and enforce any reasonable health regulation.6 Some municipalities have instituted smoking or tobacco control regulations that go beyond the state’s Clean Indoor Air Act,7 while others have set standards for noise pollution. Boards of health may issue orders declaring that an emergency exists and requiring that certain actions be taken. They may order the fluoridation of water supplies, adopt and enforce local regulations for the control of air pollution, or adopt regulations for the operation of animal stables.

Because of the range of their authority, health officials can cooperate with the Select Board to shape the standards and character of the community.

Public Health Nursing

State law8 permits boards of health to establish and maintain dental, medical and health clinics and to conduct general education campaigns relating to health matters. Many of these direct health services are aimed at adults and children who are unable to obtain private medical care. Many municipalities provide vaccination clinics, well-baby clinics, hypertension screening, and screening for blood lead poisoning, among other community health services.

The local health authority is required to notify the Department of Public Health within 24 hours of the discovery of a case of a communicable disease.9 In most communities, this is done by a public health nurse through the MAVEN reporting and tracking system. The board of health must also notify the school committee of all reported diseases that are dangerous to the public health. The Massachusetts Association for Public Health Nurses is an excellent resource.

Environmental Health

Boards of health have broad authority to regulate in environmental areas where there is a risk of adverse health consequences. Boards of health have the power to enforce state laws and regulations concerning groundwater monitoring, septic systems, underground fuel tanks and chemical storage, landfills, hazardous waste, and water supply contamination. The board of health may make and enforce regulations concerning house drainage and connection with common sewers.10 The board of health is required to approve sites for solid waste disposal facilities11 and hazardous waste facilities.12 Preliminary and definitive subdivision plans must be submitted to the board of health for approval.13 An excellent resource in this area is the Massachusetts Environmental Health Association, which provides training, educational programs, and networking for professionals in the fields of public and environmental health.

Health Nuisances

Boards of health have considerable authority to take actions in the removal of nuisances. A health nuisance is defined by law as a source of filth or a cause of sickness. State law14 gives the board of health, after a public hearing, the power to approve a business that may result in a nuisance or harm to the inhabitants, cause injury to their land, or cause offensive or dangerous odors. This permission is called a site assignment.

Boards of health are authorized to examine all nuisances that may be injurious to the public health and to destroy, remove or prevent them.15 A separate law16 gives the Select Board the same nuisance abatement powers. The Select Board may declare a burned, dilapidated or dangerous building, structure or vacant lot to be a nuisance. After holding a public hearing and giving written notice to the owner of the property or their authorized agent, the board may order the nuisance altered, disposed of or regulated. If the owner fails to comply, the town can sue for the cost of removing the building or for the cost of another solution.17

Some municipalities have nuisance bylaws or ordinances that allow them to clean up a nuisance, bill the property owner for costs, and place a lien on the property if the bill is not paid.18 As an alternative, some municipalities prefer to seek a court order against the owner requiring the cleanup at the expense of the owner, so that the municipality does not have to be responsible for any costs involved. This would require court action and thus should be discussed and coordinated with town counsel.

Health departments have become an essential part of community code enforcement teams for dealing with unsafe or blighted properties.

Sewage and Septic Systems

Septic systems, sewage treatment plants, and sewage systems are of regular concern to municipalities. Under state law,19 the Massachusetts Department of Environmental Protection regulates all disposal of sewage by sewerage and septic systems. More than 60 cities and towns in eastern and central Massachusetts are connected directly or indirectly to the Massachusetts Water Resources Authority, which is responsible for regional wastewater collection and treatment, and water supply. The MWRA can issue orders to private dischargers and municipalities violating MWRA regulations, which impose detailed and comprehensive limitations.

A separate MassDEP permit program, the Division of Water Pollution Control, regulates the construction, connections, repairs, expansions and extensions of public and private sewage treatment plants and their sewerage and discharge points.

Title 5

Boards of health are also the local enforcement agents for the State Environmental Code (310 CMR 11.00, 310 CMR 15.000), Title 5 of which establishes minimum standards for on-site sewage disposal. Title 5 governs the type of system installed, the permit procedure, the design specifications, the testing prerequisites, and the performance standards (including certain inspections during the life of the system, as with a land transfer). Each septic system requires a permit from the local board of health or its agent, following a physical inspection.

Certain provisions of Title 5 cannot be waived, but any variance requires approval of the board of health and, on review, the Massachusetts Department of Environmental Protection. For example, the MassDEP must approve the use of most alternative systems, modifications of large flow systems, and several other project types where state review is appropriate.

In addition to these statutes and regulations, municipalities have authority to promulgate their own septic system regulations.20 Many municipalities have such local septic system rules. Some municipalities have used this power to regulate package treatment plants, mounded septic systems, groundwater and soil conditions, and time-of-testing during the year.

Solid Waste

State law requires local boards of health to approve sites for solid waste disposal facilities21 and hazardous waste facilities,22 and a board of health permit is needed for the collection and transportation of garbage, or other offensive substances, through town streets.23 The day-to-day responsibility for managing trash collection, landfills, transfer stations and recycling programs, however, typically falls to the department of public works and/or the Select Board (see Chapter 9). Local boards of health also often participate in the Mercury Recovery Program and manage collection sites for mercury-containing products.

Human Services

Human services comprise a variety of publicly funded programs dedicated to improving the quality of life for town residents. Seniors, youth and families, veterans and the disability community are examples of the specific populations that may be served by local human services programs.

Human services have developed through efforts of both the public sector and private agencies. Although the tradition of local involvement is strong, most notably in health, recreation and elderly programs, many towns address community-centered problems on an as-needed basis. Examples include setting up a youth commission to serve the needs of young people and creating a council on aging to serve only the elderly. The Massachusetts Councils on Aging is an excellent nonprofit resource that provides support to municipal programs that deliver community elderly services.

Many municipalities in Massachusetts have recognized the value of an integrated approach to human services that enables community leaders to assess existing programs and plan for the future. Many municipalities have created human services departments or have appointed human services coordinators to implement this more comprehensive approach. The nonprofit Massachusetts Public Health Association aims to create health equity by addressing root causes of health and wellness across many factors including food, housing and transportation.

Components of a Human Services Program

The composition of a human services program varies from town to town, depending on community needs and values. Some municipalities offer elder transportation, while others emphasize day care. Some choose to include veterans’ affairs as part of their overall human services function, while others treat it separately. Various state statutes provide blueprints for the creation and support of local human services agencies. Municipalities also participate in the delivery of human services in indirect ways. A municipality may financially support a private mental health center, offer free space to a day care center in a municipal building, or secure state or federal funding for a community residence.24

Without infinite resources, a municipality must make choices about which services it can provide, starting with a comprehensive examination of its human services and the establishment of a committee comprising interested citizens, including representatives from agencies already serving the community. A Select Board member should serve on the committee to make sure its work coordinates with the municipality’s overall planning process.

Municipalities often perform the following functions:

  • Funding: The municipality provides financial support, or in-kind contributions, to a private organization that provides services to the local community. This might include a youth agency or a community mental health center. Many human services functions are also funded by federal and state grant programs.
  • Planning: The municipality develops policies and sets priorities by conducting needs assessments and working to coordinate human services programs that are already available. Needs assessment activities might include citizen surveys, agency questionnaires, discussions with agency directors, or community meetings.
  • Coordination: The municipality uses its influence and staff to encourage joint efforts and programs both inside and outside of government.
  • Advocacy: The municipality negotiates with state agencies and community groups on behalf of residents who need certain services.
  • Evaluation: The municipality monitors and provides planning help to human services agencies.
  • Publicity: The municipality provides information to residents about the availability of services.

Managing Human Services

In Massachusetts, municipalities have developed a variety of methods for coordinating human services activities. Although some of these involve a change in the local charter, others can be accomplished by simple administrative action. The following are some of the approaches towns use to manage human services:

  • Human services department: A department is created that incorporates all the specialized human service agencies and functions. The degree of central control varies with each town. Budgets may be submitted for individual agencies, or for the department as a whole.
  • Existing department: An existing department, usually health, recreation or community development, assumes authority over human services.
  • Human services coordinator: A staff person is assigned the task of overseeing human services, but this person has little or no line authority over existing human service agencies. The staff person may be assigned exclusively to human services or may have other responsibilities as well.
  • Collocation: All the municipality’s human service agencies are brought together into one physical location. Although there may be little or no administrative linkage, the theory is that the proximity will encourage informal contacts, referrals and cooperative planning.
  • Contracting: A nonprofit agency is hired to plan and deliver services. Under this approach, the municipality relinquishes some control in exchange for freedom from hiring and supervisory responsibilities.
  • Social worker: The municipality hires a social worker to keep in contact with vulnerable citizens and to act as both a case manager and an advocate. As needs surrounding care linkage are increasing, more municipalities are finding social workers are key members of delivering human services programs.
  • Regional approach: Contiguous communities create regional agencies, or fund existing agencies, to provide human services planning and program management.
  • Citizen commission: A citizen commission may act alone as adviser to the Select Board, or may function in conjunction with any of the other models. The goal of a commission is to give citizens a voice in policy development and priority setting.

Public Libraries

The Massachusetts Board of Library Commissioners is the agency of state government with the statutory authority and responsibility to organize, develop, coordinate, and improve library services throughout the Commonwealth.

Public libraries may be established in one of two ways. The first is by bylaw, in which case the library is owned by the town, funded with appropriations, and under the charge of an elected board of trustees. The trustees are responsible for the care, management and control of the library and all property of the town related thereto. All money raised or appropriated by the town for library purposes is to be expended by the trustees. Likewise, the trustees manage all money donated or bequeathed to the town for library purposes. The trustees may enter into agreement with the board or boards of any neighboring library or libraries to pay for common services or to manage a facility on behalf of the various municipalities that are parties to the agreement, with expenses shared as set out in the agreement.

The second way is for the town to accept a gift or bequest for the purpose of establishing a library. The gift or bequest establishes the manner in which trustees are chosen. The gift may require that the trustees be appointed by the Select Board or another specified body. When a town appropriates funds to such a library, the trustees serve as department heads when they spend the appropriated funds. Alternatively, the town could appoint an officer or board to manage and expend the appropriated funds.

MMA's Handbook for Massachusetts Select Boards: Chapter 11: Last Updated: March 23, 2024
MMA's Handbook for Massachusetts Select Boards: Last Updated: March 25, 2024
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MMA's Handbook for Massachusetts Select Boards: Chapter 11: Last Updated: March 23, 2024


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