The COVID-19 pandemic has laid bare yawning inequities in the way people live and die in Massachusetts.
Now the Massachusetts Public Health Association, a nonprofit that advocates for health equity, is surveying candidates for governor and asking them to explain, in writing, their specific plans to address longstanding socioeconomic disparities.
Even before the coronavirus tore through low-income communities, hitting hardest among people of color, state data showed that those groups typically faced higher rates of asthma, diabetes, inadequate prenatal care, infant mortality, and other poor health outcomes.
In response, the association is calling for the next governor to elevate the state’s health commissioner to a Cabinet-level position so public health receives greater consideration in policy decisions.
“We have all come to understand that housing policy, transportation . . . agriculture and food policy, labor and criminal legal policy all impact health outcomes, and have been major contributors to health inequities,” said Carlene Pavlos, the association’s executive director.
The state’s public health department is part of the massive Executive Office of Health and Human Services, the state’s largest executive-level office with 12 agencies, along with the Medicaid office.
The Globe asked five health leaders, including two former state public health commissioners, for suggestions on how the next administration can help reduce disparities. Here’s what they said:
Dr. Howard Koh, former Massachusetts health commissioner (1997–2003), now a professor at the Harvard T.H. Chan School of Public Health
“Health is much more than what happens to you in the doctor’s office,” Koh said. “Health is shaped by where people live, labor, learn, play, and pray.”
Koh supports elevating the state’s health commissioner to a Cabinet level, saying it will bring the person who best understands health issues directly to the governor’s ear. Koh points to Boston Mayor Michelle Wu, who boosted Dr. Bisola Ojikutu, the city’s health commissioner, to a Cabinet-level role as one of her first appointments. Ojikutu’s experience as a physician, health equity researcher, and community advocate has been crucial in crafting a comprehensive response to the drug, housing, and crime crisis along the intersection of Massachusetts Avenue and Melnea Cass Boulevard, he said.
Koh also said the next administration must dramatically improve health data collection. The Baker administration recently unveiled Massachusetts Data Hub, a user-friendly search tool to browse state data, but much of that information is outdated.
“That doesn’t sound exciting to many people,” Koh said. “But unless you have reliable, timely data, it’s really difficult to make any informed policy decisions and demonstrate that you are making progress.”
Dr. Joseph Betancourt, senior vice president for equity and community health at Massachusetts General Hospital
Massachusetts health leaders have proposed “countless interventions to address disparities, but the graveyard they lie in is large,” Betancourt said. What’s needed is a dedicated stream of resources through the health care financing system to make such efforts sustainable, he said.
“Something is funded by a grant, and you demonstrate impact, but when you try to integrate it, it’s not covered by insurance,” he said.
Betancourt is a member of a new initiative, the Health Equity Compact, composed of Black and Latino health care and business leaders, that aims to combat racial and ethnic disparities in Massachusetts. The compact is drafting legislation, which will attempt to address disparities.
But some of the legislation, if successful, will still need state regulations to be enforced.
“We will need to work with the governor and we hope the [new] governor will make this [compact] a signature initiative of any platform,” Betancourt said.
Dr. Lauren Smith, chief health equity and strategy officer for the CDC Foundation and former medical director and interim Massachusetts health commissioner (2007-2013)
Smith declined to comment on the proposal to elevate the health commissioner’s position, but said a new governor will need to address what she calls the “wrong pocket problem.”
For example, she said, health commissioners understand food deserts — areas where it is difficult to buy affordable or good-quality fresh food. But health commissioners don’t have authority over zoning, economic development, or related activities that could result in more supermarkets in neighborhoods without one.
“Is that [money and priority] even in the budget for agencies responsible for thinking about zoning regulations?” Smith said. “The money is in the wrong pocket; it’s with the folks who have the influence or authority but may not be thinking about” food deserts.
Smith also said health equity is often cast as a moral issue. Instead, the state’s next governor needs to think of it in terms of economic preparedness.
“If a significant portion of our neighbors and workforce have a predictable but chronic disease that limits their ability to work and shortens their life, that’s a competitiveness issue,” she said. “If we have folks on the sidelines because of preventable inequities, we are hampering ourselves.”
Timothy McDonald, vice president, Massachusetts Health Officers Association
McDonald said boosting the health commissioner to a Cabinet position makes sense.
“When you have to funnel [proposals] up through an assistant Cabinet secretary or secretary, not everything will get through,” McDonald said. “Also, if the governor has questions and you are not there making the argument . . .there is less expertise to bear on the subject.”
McDonald said the new administration should champion proposals to fix a fractured system for funding public health in Massachusetts. Each community has its own health department, which relies on local property taxes for much of its budget. That means wealthier communities typically receive better health services, such as restaurant, pool, and beach inspections, flu vaccination clinics, and follow-up on sanitation complaints.
McDonald said a new administration should ensure that state spending on public health is awarded in a more “needs-based way,” much the way the state’s School Building Authority awards money for new schools based on a community’s ability to pay; lower-income communities receive more funding.
“That’s how it should be if we are ever going to get closer to an equitable system,” McDonald said.
Michael Curry, chief executive, League of Community Health Centers
Curry cited a phenomenon known as the “weathering effect.” Parents who are used to a high prevalence of asthma in their children, for instance, rate the severity of their illness as a 4 or 5 out of a scale of 10. But health care experts assess their symptoms, which are often the result of poor housing conditions, at twice that level.
“They are so used to their children being sick and missing school it becomes normalized,” Curry said. “We are asking the next governor of Massachusetts to not be willing to accept it’s a tale of two states when it comes to access to healthy lives and life expectancy.”
Curry also said the next governor should target money and other resources to “hot spots,” low-income neighborhoods and communities of color that suffer chronically high diabetes and cancer rates, to help increase such health screenings, in much the same way the Baker administration targeted extra resources to boost vaccination rates in the 20 cities and towns hardest hit by COVID-19.
Curry said the health association’s survey of candidates for governor will prompt them to focus on these issues and capture their pledges in writing.
“If you want to get commitments,” Curry said, “get them on the campaign trail.”