Health Department Lay-offs & the Board of Health

Effective February 27, the Mayor laid off both direct service employees in Amesbury's Health Department--Health Agent and Public Health Nurse--as part of 18 positions eliminated to re-balance the current year's budget. As has been reported in local newspapers, this action has caused some concern among residents and members of the Board of Health.

I have talked with BOH members, members of the community, and MA Dept. of Public Health officials about this situation. Whether from the newspaper reporting, the BOH's meeting earlier this month (3/5) or the Mayor's own statements, I think there has been some basic information, perspective and analysis missing. At the 3/5 BOH meeting, I only heard one Board member really talk through the actual BOH responsibilities.

Here's my own take in a nutshell, based on the information that I've gathered:

The Board of Health's responsibilities are broad and it is the Town's responsibility to give it the resources it need to meet them. In my opinion, most of those responsibilities can be met by contracting for services rather than employing permanent staff. Responsibility for giving the BOH the tools it needs lies with the Mayor to design, the Council to fund and the BOH to approve.

This issue has rightly been a matter for the Mayor (as chief executive) and the Board of Health (as the responsible party) to work out together what is the most cost-effective way for Amesbury to meet this obligations and protect the public health of Amesbury's residents. Ultimately, the BOH is 'on the line' for maintaining public health in Amesbury, and they will decide that they do (or don't) have the tools they need from the Mayor and the Council to do their job.

For me, the key to this entire discussion is answering the basic question: what are the responsibilities of the Board of Health?

Local Boards of Health are empowered by Massachusetts law to oversee important elements of public health on the local level. CLICK HERE to read an overview of local BOH duties. Almost all of the BOH's duties are inspectional in nature: Sanitary Code enforcement for dwellings and restaurants, enforcement of Title V code for spectic systems, garbage/trash disposal, pool/beach water quality sampling, camps/mobile home park licensing, smoking/public space restrictions. These are the services that I think lend themselves to be purchased by the Town on an as-needed basis (contract) from professionals.

A tougher question is about having a public health nurse. Health care and disease control responsibilities include receiving and transferring reports of communicable diseases, as well as providing for anti-rabies vaccination and other vaccinations if necessary in the opinion of the BOH. These responsibilities are specific and limited. They do not extend to the provision of any direct health care. According to a 3/21 Newburyport Daily News article on this issue, the public health nurse's responsibilities have included "health screenings, blood pressure checks [and] medication reviews."

While I do not question at all the general value of such services, especially for Amesbury's older or low-income citizens, I do question if it is part of municipal government's role to provide health care (beyond disease surveillance and basic vaccinations). I work in the field of health care and services for very low income households, so I definitely get the important role of community-based health care and referral services in supporting public health. Based on the information that I've received from the MA Department of Public Health, however, I'm not sure I see a big role for the Town in actually providing health care services.

My concern is that we are mixing what we must do with what we can also do in terms of public health. We must make sure that we comply with MA general law's public health provisions. We may also make policy decisions to provide additional care or support to the community. (An example, we must provide basic levels of policing; we may also pay to have force members specially trained to focus on domestic violence in our community. We must keep our library doors open a certain number of hours a week; we may provide literacy classes at the library at taxpayer expense.)

For the moment, this issue is in the hands of the Mayor and the BOH to work out, in the context of the Mayor's recent cuts. It will come before the Council soon, however, as part of the 2010 budget. That budget will contain monies to pay for Amesbury's public health needs. At that point, the Council will have a role in this issue. I will have plenty of questions for both the Mayor AND the BOH, as part of the budget process, centered on the thoughts and concerns above.

In the end, there are two questions two answer. First, what are the basic responsibilities of the BOH and what tools does it need to achieve them? Second, are there additional services and objectives above and beyond those basics that the Town and BOH would like to have in place? Only after the first question is answered should we even begin to discuss the second question. I think that the two questions have been mixed together in the discussions to date, however.