Massachusetts is recognized as a pioneer in public health. It was here, in 1799 in Boston, that the nation’s first local board of health was created. But now the state’s network of community health departments is stretched so thin that some are unable to provide important services, public health officials said.
Several cash-strapped communities have cut deep into local health services to save money – in at least one case eliminating the department – even as the recent swine flu outbreak underscores the importance of hands-on local expertise. The question, officials said, is whether the cuts already seen in a handful of communities are a bellwether of what is to come across the state.
“Local public health departments and boards are facing tremendous fiscal pressures and they are losing staff at a very critical time,’’ said Geoff Wilkinson, a senior policy adviser for the state’s Department of Public Health.
Consider:
- Worcester’s Public Health Department saw its $613,000 budget slashed to $24,000 and 13 of 18 staffers laid off in April. Food inspections will occur every 20 months instead of every 12 months, which was already less frequent than the twice annually required by state law. An outside agency will take over water testing.
- Amesbury closed its Health Department March 1, laying off all three staffers. The city entered into an agreement with Newburyport for nursing services and hired a private contractor to conduct food inspec tions. Salisbury voted last week to join in a three-community arrangement, in which it will also receive services from Newburyport.
- New Bedford is down to two nurses and a nurse supervisor for a population that officials say should have six nurses. “We are maxed out right now,’’ said Health Department director Marianne de Souza. Food inspections are being done under the city’s Inspectional Services Department.
- Lowell will cut four of its 25 school nurses as of July 1. A clerk is also being laid off as part of a $300,000 cut to the health agency’s $1.2 million budget.
And more bad news might be coming. The Massachusetts Legislature voted June 19 to reduce non-education local aid by up to 15 percent in the fiscal year that starts Wednesday.
“I think this summer we’ll see more significant cuts,’’ as communities come to grips with the reality of shrinking state aid, Valerie Bassett, executive director of the Massachusetts Public Health Association, said in an interview last month.
Under state law, local health departments have two mandated jobs: to monitor communicable diseases, reporting findings to state and federal health authorities; and to inspect food establishments, from restaurants to ice cream trucks, twice a year. In many towns, health officials take on additional duties as well.
Even before the most recent cuts, many health departments, which are overseen by appointed or elected boards, were unable to keep up. A 2006 state Department of Health review found that two-thirds of 218 cities and towns reporting failed to perform required food inspections. Whether that number has slipped further is not known because the review has not been updated.
Massachusetts is one of only a few states nationwide that do not provide direct public health funding beyond grants to municipalities, officials said. Unlike most parts of the country, where public health is overseen and funded at the county level, cities and towns here generally work on their own, said Bassett.
In Connecticut, for example, the state provides funding for local health services, but ties it to meeting requirements and standards, she said. In Massachusetts, the state has no standard for determining the appropriate staffing ratio for a given population and no formal consensus on what professional qualifications health directors or staffers must hold, which leads to uneven health services across the state, said Bassett and Wilkinson.
“There are amazing disparities in the kind and quality of coverage among different towns in Massachusetts,’’ said Wilkinson.
Traditionally, many Massachusetts health departments have done far more than monitor communicable diseases. They have inspected septic systems, tested water quality in wells and public swimming pools, responded to domestic violence reports, and in some towns, overseen animal control. Most also play a key role, along with fire and police departments, in emergency response management, and are responsible for pulling contaminated products from store shelves to ensure that food-borne illnesses are not spread.
In those communities that have made deep cuts in local heath services, the reductions have significant consequences.
A prime example is Worcester, where budget cuts left only two nurses. City Manager Michael V. O’Brien called the cuts “Draconian,’’ but comparable to what other city departments have sustained. The department will still perform the most essential functions, such as infectious disease monitoring, while the city is “retooling and rethinking’’ how it conducts public health, O’Brien said.
In New Bedford, the Health Department runs a beach water testing laboratory for the Buzzards Bay region and is among only a few departments statewide that routinely offer low-cost immunization clinics and employ a lead-paint inspector. These programs could be in jeopardy if cutbacks continue, de Souza said.
Since 2006, a group of academics and state and local public health leaders has been meeting to encourage municipalities to form regional partnerships. The concept would probably save money, but more importantly, could minimize service gaps in communities that rely solely on volunteers.
Mayor Thatcher W. Kezer of Amesbury said that, in light of a projected $1.2 million shortfall, partnering with Newburyport and Salisbury is a smart move that will save $85,000 next year. The city was paying full-time salaries and benefits for services with limited demand, he said.
Kezer said aligning resources will allow for more offerings such as wellness clinics. “It’s saving us money, but it isn’t just about the money,’’ Kezer said. “We’re improving the services and doing it at a much lower cost.’’
Globe correspondent Tara Ballenger contributed to this report. Christina Pazzanese can be reached at cpazzanese@globe.com.
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