BOSTON — Nearly a year after the state poured millions of dollars into modernizing the state’s public health system, leaders in the field — including those who oversee collaboration between some 14 communities in Hampshire County and all 26 Franklin County communities — are lauding the advances they’ve made with the state support.
“For decades, small rural towns, especially in western Massachusetts and in our region, have operated with boards of health that were either volunteer-based or provided a small stipend,” Merridith O’Leary, commissioner of Northampton’s Department of Health & Human Services, told a panel of lawmakers led by Sen. Jo Comerford on Tuesday. “With strong support from my mayor (Gina-Louise Sciarra) and the DHHS leadership team, we have worked to make sure the stability and equity we maintain in Northampton extends to surrounding Hampshire County towns we serve. … Smaller towns could simply not provide these services on their own.”
This work has been accomplished thanks to the new program called SAPHE 2.0, or the Statewide Accelerated Public Health for Every Community, that was wrapped inside an expansive $4 billion economic development bond bill signed into law last November by Gov. Maura Healey. The overall goal of SAPHE 2.0, filed by Comerford and state Rep. Hannah Kane, aims to modernize public health in the state.
SAPHE 2.0 creates minimum public health standards for every Massachusetts community, which previously did not exist; dedicates state funding to support local boards of health and health departments; ensures workers hold the necessary credentials; provides training; and creates a uniform data collection and reporting system to be used across cities and towns.
“This is such a game-changer and so transformative,” Comerford said in an interview about SAPHE 2.0. “We thought it was really important that we make sure our colleagues understand what is happening because we went from a state that had 351 completely different ways of approaching public health and resourcing public health to a state with public health standards, training credentials and plans, data collection and a commitment on the part of the state to fund some of this.”
Tuesday’s presentation welcomed Sam Wong, director of the state’s Office of Local and Regional Health, who emphasized the importance of shared health services.
“What makes Massachusetts exceedingly unique is that we have one of the most decentralized [public health] systems,” he said.
He explained Massachusetts’ public health system is considered an outlier. There are more local public health jurisdictions than any other state, with sharing of services among municipalities historically limited.
SAPHE 2.0 aims to address that challenge and encourage more collaboration across municipal lines. More than 90% of Massachusetts municipalities are leveraging Public Health Excellence (PHE) grants, totaling $26.2 million to 322 municipalities, to meet established performance standards, expand capacity and deliver more equitable local public health services.
SAPHE 2.0’s birth is part of a four-year process dating back to the COVID-19 pandemic. In response to the pandemic, the state created SAPHE 1.0 in April 2020 to help preserve public health. A year later, the American Rescue Plan Act (ARPA) was signed into law and designated $200 million in funds, fueling the push for SAPHE 2.0. Finally, the bill created a pathway for SAPHE 2.0 to provide equitable public health services across the state.
Roughly $1.8 million went into health services in Franklin County through grants to the Foothills Health District, the Valley Health Regional Collaborative, the North Quabbin Health Collaborative and the Cooperative Public Health Service, according to Franklin Regional Council of Governments Director of Community Health Phoebe Walker.
“Until this grant program was created, Massachusetts was one of the only states in the country that didn’t provide state funding toward local public health,” Walker said. “If you’re only funding public health protections out of property taxes, and you don’t have a lot of property tax revenue, then it’s hard to pay for the same kind of service that’s happening in Wellesley, for instance.”
One of the most positive impacts the grants had for Franklin County, Health District Program Manager Randy Crochier said, is funding of public health nurses in the area — a position that small towns like Gill would likely not be able to fund out of the town budget.
Crochier recounted meeting with a public health nurse in Franklin County who, thanks to the program, was able to become trained in the state’s SHINE (Serving the Health Insurance Needs of Everyone) program, allowing her to help a resident living on a limited income find health insurance with a “very, very” low copay.
“[PHE grant funding] has professionalized and legitimized public health, and it is working hard to make it so that your ZIP code no longer determines the level of public health protection that you get,” Crochier said. “[The nurse] met with a person on a limited income yesterday who gets not quite $1,800 a month to live off of, and the insurance they were looking at was almost $190 a month with high, high deductibles. As a SHINE counselor, the nurse was able to find an insurance that was free, with very, very low copays, thus allowing this person to actually continue to live a reasonable life.”
Walker also explained that in the event of an infectious disease outbreak, rural communities’ access to a public health nurse can help slow or stop the spread of a communicable disease.
A prime example of a shared services team is the Northampton-based Hampshire Public Health Shared Services Collaborative (HPHSSC), which O’Leary oversees out of DHHS. O’Leary shared how the collaborative boosts resources for rural towns in Hampshire County, while her counterparts from central Massachusetts and the Greater Boston area also lauded the program.
Formed in 2022, the HPHSSC consists of 14 Hampshire County communities that pool resources, functions and expertise. These towns include Northampton, Amherst, Easthampton, Hadley, Granby, many hilltowns and more.
Some of these shared services include blood pressure clinics, vaccine information, Narcan distribution and a variety of health education programs. One education program includes a space at the University of Massachusetts Amherst that offers training services to local public health officials.
“At a time when public health across the nation faces chronic underfunding, erosion in trust and growing division, this program (SAPHE 2.0) instead brought resilience, equity and unity to the 14 very different communities in western Massachusetts,” O’Leary said.
Ahead of future budgeting seasons, Comerford hoped the presentation would show her colleagues the importance of public health funding, a field whose work often goes unnoticed. Next fiscal year, $34 million in federal funding will expire for Massachusetts public health investments.
“It’s really the precursor to the conversation I know we’re going to have to have in fiscal year 27 budget [planning],” she said. “[The Department of Public Health] has also pushed through a lot of work. The amount of work was so significant and the gains made were so significant that Rep. Kane and I thought it was important that we update our colleagues so that they could understand the truly transformational efforts.”
Comerford said there is already talk of running a SAPHE 3.0, to keep pushing the needle forward toward tackling public health goals.
“I’m really proud of the leadership of western Massachusetts in really ensuring the true fulfillment of this moment,” Comerford said, “because there is no end of positive return for us in the commonwealth and we just got started.”