It is now well established that the burden of the COVID-19 pandemic was not experienced evenly in Massachusetts. Certain cities, towns, or entire counties, have more COVID-19 cases and fewer people vaccinated. The communities experiencing the greater burden of COVID-19 are not random. They are also the towns that have more unemployment, less affordable housing, and limited transportation options, and towns where more persons of color live.
This is just one more example of the role that root causes — how where we live, learn, play, work, and age — can shape our health. These social and economic determinants are influenced by structural racism and have long driven health disparities in Massachusetts. The pandemic has made it even more clear that eradicating the systemic and institutional barriers to health equity should be the foundational tenet of public health.
Massachusetts can join a growing number of states that integrate health equity standards into all policies. No longer will it fall almost exclusively within the domain of the Department of Public Health, which cannot make transformational change without broad and ongoing collaboration with other state policy makers.
For example, the Health Equity at All Levels of Government (HEALING) bill, legislation proposed by State Senator Jo Comerford and State Representative Liz Miranda, embodies the public health approach that sees one’s health as affected by many societal factors and that health solutions must therefore come from all sectors of government. Their legislation, endorsed by the Massachusetts Public Health Association, builds on an established public health framework that recognizes the role of health in all policies.
Already put forth by the state-appointed Health Equity Task Force, chaired by Assaad Sayah, CEO of Cambridge Health Alliance, and Michael Curry, CEO of the Massachusetts League of Community Health Centers, is the Blueprint for Health Equity, a series of bold recommendations for new systems that prioritize equity in state government. It offers far-reaching recommendations that position Massachusetts as a health equity leader.
Health is shaped by decisions not always considered “health.” Decisions made about where to build roads or site a power plant can greatly affect health, and state-wide mechanisms such as these will bring health equity concerns to the table when those decisions are made.
To be sure, these policies and recommendations represent a paradigm shift, and at times a challenging new way to work. But our state government has done it before.
The Joint Committee on Racial Equity, Civil Rights, and Inclusion, which the Massachusetts Legislature created after last year’s nationwide racial justice protests, involves a bipartisan group working to confront structural racism and exclusion within existing institutions and policies across the Commonwealth. It provides a model for new ways to address the state’s health and social justice issues by methodically tackling a list of community-informed priorities.
The Academic Public Health Corps, a pioneering alliance formed in March 2020, links students from 13 academic institutions with local and state health officials and public health advocates. To date, 982 corps members have tackled emerging needs in 135 communities across Massachusetts and have been particularly effective in responding rapidly to COVID-19.
From our perspective, as leaders of schools and programs of public health in Massachusetts, policy enactment offers some of the most powerful and sustainable mechanisms to address public health issues. The policy approach these efforts emphasize is the need for collaboration across government, community, and academic spheres to tackle entrenched systems and to level drivers of racism and health inequities.
As members of the Association of Schools and Programs of Public Health, which encourages the academic community to address real-life policies that benefit state residents, we want to work collectively and alongside state policy makers and community stakeholders to advance the Blueprint for Health Equity recommendations. By advancing the state’s pioneering health-equity-focused recommendations, Massachusetts can make enduring positive change and lead in comprehensively addressing health, racism, and equity.
Anna Maria Siega-Riz is dean of the School of Public Health and Health Sciences at the University of Massachusetts Amherst; Michelle Williams is dean of the faculty at Harvard T.H. Chan School of Public Health; Dr. Sandro Galea is dean of the School of Public Health at Boston University; Dr. Carmen Sceppa is dean of the Bouvé College of Health Sciences at Northeastern University; and Aviva Must is dean of Public Health and Professional Degree Programs at Tufts University School of Medicine.