Massachusetts has the oldest public school system in the country. We have the oldest public health system. While we led in inventing this infrastructure, it now requires modernization, especially of the links between them. Good health is foundational for learning. Across the country, schools that were able to open earlier and safely for in-person learning achieved this thanks to robust partnerships between schools and local public health offices.
The federal government’s COVID stimulus dollars provide an enormous opportunity for Massachusetts to shift how we support healthy schools and healthy communities. If we invest strategically in infrastructure at the nexus of schools and public health across the Commonwealth, with more intensive targeted investments for the schools and communities most in need, we can lay a true foundation for all communities to flourish.
In Massachusetts, the coronavirus pandemic has brought immense pain and suffering. It has brought awe-inspiring innovation. It has also spotlighted weaknesses in our infrastructure. The state has only three accredited local public health departments — Boston, Cambridge, and the Worcester Regional Health Alliance.
Schools needed, and still need, support from local public health offices to analyze and determine the context-specific implications of guidance from the Centers for Disease Control and Prevention and the US Department of Health and Human Services. Schools needed, and still need, school-based health teams, ideally anchored by a school nurse, to develop, implement, and iterate on site-specific infection prevention and control plans. Schools needed, and still need, building upgrades and new ventilation systems, to provide a healthy physical environment for learning.
We can achieve all three of these goals through smart investment of COVID relief funds.
First, the Massachusetts Department of Health and Human Services should structure disbursement criteria for municipal access to COVID funds to incentivize the formation of regional public health collaborations on the model of the Worcester Regional Health Alliance. The Alliance is a coalition of seven municipalities that has used a regional structure to build a cost-effective and labor-efficient regional public health district. The kind of technical assistance schools need is better delivered through cross-jurisdictional sharing than with every town and city acting on its own. Regional health offices are the solution to a capital intensive — yet critical — community need.
Second, the Department of Elementary and Secondary Education should structure disbursement criteria for local education agency access to COVID relief funds to incentivize pilot programs to strengthen school-based health teams through the addition of personnel, with a special focus on infection prevention and control. DPH’s Department of School Health Services should evaluate and monitor the impact of strengthened school-based health and infection prevention and control team in collaboration with the Office of Applied Statistics, Evaluation, and Technical Services (ASETS). We should seek to track the impact of these investments on the uptake of preventive health care (e.g. flu shots), Average Daily Attendance rate, annual learning loss deriving from infectious disease, and schools as vectors of disease for the community, among other potential indicators of impact. With evidence of a net positive impact of strengthened school health teams, LEAs would have a case for continued funding from the state for school-based health teams, even after the relief funds expire.
Finally, there needs to be a tighter partnership between the Massachusetts Department of Elementary and Secondary Education and the School Building Authority to facilitate strategic use of COVID relief funds statewide on behalf of building upgrades. Many districts are taking up this work on their own. Lynn had eight schools with no mechanical ventilation and is using COVID relief funds to address this.
Yet the state should do more than let each town and city fend for itself. MSBA conducted statewide surveys of school building facilities needs in 2005, 2010, and 2016. The state’s education-specific COVID stimulus funds should be used now for another statewide survey to assess buildings against healthy building standards. Such a survey could support districts in determining COVID-related facility investments while helping to identify where additional, targeted investments are needed to improve school facilities where conditions are the worst. The National Facilities Council and COVID Collaborative advise that 15 percent of education-specific COVID relief funds (excluding 20 percent for learning loss, as per the legislative mandate) should be directed to healthy school facilities.
If Massachusetts could regionalize its public health infrastructure, strengthen health teams in schools, and achieve healthy school buildings statewide, the state would equip residents with pandemic resilience and increase capacity to maintain in-person learning in adverse conditions. We would also improve our students’ learning opportunities even in non-emergency conditions by supporting their health and the health of school personnel. And, of course, a strengthened public health infrastructure would also support the health of our communities more broadly.
Healthy schools and healthy communities. That’s what these investments could deliver.
Danielle Allen is a professor at Harvard and is exploring a run for governor. On behalf of the COVID Collaborative, she led a task force on infection prevention and control in schools.