Alumna Leads Nashua’s Push for Better Health.
When Bobbie Bagley (’02) proclaims she loves what she does, she punctuates that statement with smile so broad it erases any doubt.
Bagley is the new director of the Division of Public Health and Community Services for Nashua, NH, a city of more than 87,000 people that is facing many of the same population health challenges that vex Boston, an hour’s drive south.
Nashua is along the busy corridor between Boston and Manchester, the state’s largest city, and has been acutely hit by the opioid crisis affecting many New England cities and towns. Residents in several Nashua neighborhoods struggle with poverty, substance abuse, high rates of diabetes, and other chronic illnesses.
In announcing Bagley’s appointment in late February, Nashua Mayor Jim Donchess called her a “very charismatic and dynamic leader for the division” who, among her other tasks, would help in the city’s ongoing fight against opioid misuse.
Bagley said she plans to engage the problem with a proactive approach that is informed by her training in social and behavioral health, but with a definite tilt toward collaboration among multiple city agencies and an existing mayoral task force. Looking at problems through a public health lens “energizes” Bagley, she said, despite originally entering the health field with a patient-centered perspective.
She began her health career in 1997 as a nurse at a long-term care facility, but within a year began working as a public health nurse in the division she now leads. While working as a public health nurse and departmental manager, she taught nursing and public health at Rivier University in Nashua, where she helped establish and led the school’s new public health program as its director.
Q: When you meet students who are considering changing their focus from whatever their major may have been into public health, what do you end up saying to them?
A: The first question I usually ask people is, “What is it that they really want to do?” I found that a lot of folks do not know what public health is. My trajectory of going through school as a pre-med major, I was not learning about public health. Then I was going into nursing and learning about it just on the cusp just before I graduated. Then I was like, “Aha, there is this fantastic profession that I can apply my nursing skills at a population-based level for prevention.” That is pretty much what my interest was. You see people coming in. They are sick and they are in the hospital. How do we prevent them from getting there?
When I meet people and students at Rivier, because I still work as an adjunct, I ask, “What is it that you want to do?” Most of the time, I am meeting students that are interested in going into nursing. I ask them, why do you want to be a nurse? I want to help people. You can work at a grocery store. You can do a lot of things to help people. What is it that you really want to do? When people start telling you what they want to do, that is when I start talking about there are. You can do this as a nurse. Then there is also another profession where you can work in healthcare and health professions and have an impact on a greater population by working in prevention. That is public health.
Then I start telling them about all the different ways that you can get into public health and all the different things that you can do in public health and practice. There are some of the concepts and what the focus is. I ask a question first. What is it that you really want to do? Where do you see yourself? Do you have to be at that bedside providing direct care? Or do you see yourself preventing people from getting sick altogether or helping them maintain health? Or are you helping communities become healthier by putting certain things in place? What do you really want to do? That is a question that I usually ask. That is how I get to talk about what I love, which is public health.
Q: So, how did you end up in public health?
A: My first job in public health after graduating from Rivier University—the school where I actually ended up teaching and becoming the director for their public health programs—was here at the division. When I got out of school I worked probably for about eight months in a subacute long-term care type of facility. Once they posted a position here for public health, I beelined right over here and put in the application. Mind you, I had been a nurse for all of eight months. I was changing my profession altogether. I worked here for three years before I applied to BU to go to school to get my graduate degree.
Q: You’re in a city that is actively trying to work with the communities to alleviate multiple issues. What are some of the hurdles you’ve encountered while here?
A: Some of the biggest things that I am seeing are a lot of missed opportunities. When I first started working in public health, again, because I am so prevention oriented, you hear that we have to have the data. We need to see the numbers. I totally agree because the numbers tell the story. They let us know where the problem exists, what we need to assess, and what we need to know about our neighborhoods and about people. At the same time it makes us very reactive instead of proactively planning and doing. Based on what we know already, we know that there are certain risk factors that lead to whatever the health issue might be. It is not to say that we should not collect data. But why do I have to respond reactively to situations rather than proactively?
When I started working here as a public health nurse, one of the programs that I coordinated was our HIV prevention program. At the time, our focus was on certain target populations, injection drug users, the corrections facilities, racial and ethnic minorities, and men who had sex with men. Adolescents were not in there. We had these high rates of chlamydia. In New Hampshire we would see about 1,000 cases every year of chlamydia, so that was our expectation. This is sexually transmitted. HIV is sexually transmitted. We were not seeing a lot of HIV in the adolescent population. My focus here was why don’t we do prevention and design educational messages for adolescents and young people so that we prevent it altogether? If we know we have high rates of chlamydia and we know that it is sexually transmitted, and we know that young people, when they start engaging in sex, have multiple partners—wouldn’t we want to be proactive and do some education to prevent that?
We did not make it a target population area, and then we started to get cases of HIV in adolescents. Now we have the numbers. Now we are going to develop a program. My approach would be if we know that there are health conditions that exist or we know that there are areas that we can focus on, why not be more proactive and put certain things in place to avoid those numbers going up?
Q: Can you talk a bit more about the opioid abuse problem here and outline some of the steps that Nashua is taking to try to fight it?
A: We have increased overdoses, and not just in Nashua but in the state of New Hampshire altogether. We are ranked up there as number two as far as the numbers of death in proportion to our population. Then we are ranked as 49th with regards to having services available for individuals that need treatment, prevention, and access to recovery. We are 49th. The state of New Hampshire is one of the wealthiest states in our union in the United States, and we do not have those services available to individuals that need to have services for them.
Our mayor here is very proactive and very on top of this issue. The previous mayor was as well. Our current mayor developed the Mayor’s Opioid Task Force, which is responding to this issue right now. We have mobilized social service agencies, stakeholders that represent the hospital, our corrections facilities, our community based organizations, and people who are living with the experience because they have lost someone. They have all come together to work on addressing this issue together. Our division is taking the lead on that by providing the direction, developing strategic plans, and helping all of these players understand that the biggest impact that we are going to have is our ability to work collectively in addressing the issue.
We have had a problem with heroin since I started here back in ’97. Our focus then was on making sure that through sharing needles they did not transmit HIV infection. Then it switched to looking at hepatitis C. Funding streams changed as a result of that. Our funding was cut. We lost the ability to be able to provide licensed alcohol, drug counselors, and case management for those same individuals who were living with this disease and at risk for HIV or hepatitis C or overdose and death. Services were taken away. The individuals did not go away though. Their disease was not being dealt with, and we did not have the resources to take care of them. Now we see where we are in this trajectory. In 2015 we had over 400 deaths in the state of New Hampshire from heroin or other opioid overdose. We know that there was an increase in opioid use because of whatever reason but then misuse of the opioids themselves. There were other social circumstances, depression, and loss of jobs. Some of the research shows that if you had situation or circumstances of domestic violence you are going to have increased depression. You might be more at risk for using or misusing substances. All of those factors have led us to where we are right now.
One of our biggest issues here is getting a grip on the issue and identifying where we have gaps. Where are we not making the connections? Where do we not have the services so that these individuals will be able to get into treatment, find themselves in recovery, and then have the substance abuse counselors and case management to help them maintain their sobriety throughout the rest of their lives? This is a big complex issue, but we are ready and willing to take strides in being able to address it. That is our biggest issue right now. Then you have other issues with alcoholism. Heroin and those opioids are just one set of drugs that are being misused in our communities. We have to monitor all of those things. We think if we take a comprehensive approach of addressing this one, it will also help us address all the others as well. Then we have our ongoing challenges with our chronic diseases, accessibility to healthcare, reducing the gaps for inequities and making sure that everyone has the same opportunities for jobs, housing, and for being able to be seen by providers. We have our hands full.
Q: What were some of the other jobs that you had after leaving BU, and how have those experiences helped you?
A: When I left BU, I was working for a non-profit organization, the New Hampshire Minority Health Coalition. It was the only organization in our state that had a mission to address cultural barriers for racial and ethnic minorities.… That organization was started to focus on making sure our providers—healthcare providers, social service agencies—factored in or took into consideration diversity and the increase in racial and ethnic minority populations in our state. They made sure that when they developed their programs and when they wrote for grants or funding, they included being able to provide culturally appropriate services for those minority populations.
I went there to work part-time, and then that ended up being a full-time position for me as a program manager. Then I was actually doing some consulting work on the side for our Department of Health and Human Services as well. I was doing alcohol and tobacco work and developing their programs to make sure that they were culturally appropriate using a public health framework. I have always had that lens once I graduated from BU to make sure that we use that framework in all the work that I do. I did some work as a consultant for Department of Health and Human Services for HIV as well in developing their comprehensive plan. Then afterwards I ended up getting a call to come back here to be the manager for our community health department. I was Chief Public Health nurse and the manager for our health department here. I did that for five years.
I was asked to teach as an adjunct at Rivier, then worked full-time as a nursing instructor teaching community and public health nursing. I taught health policy and politics in families in a multi-cultural society. After about four or five years, the president of the university, Sister Paula Buley, said we can just have a public health program. Last year we developed a program – an undergraduate on-ground and online program for a bachelor’s degree and a master’s degree program which is online. I developed both of those programs and was able to get folks that are working in the profession on board as adjunct professors or part-time professors.
I travel in very small circles between Nashua and Manchester, but it is all in doing the same work. It is all with the focus on improving the health of our communities. It is all looking at how we can preserve the health of individuals. How can we improve access? How do we make things more available to vulnerable populations? How do we educate people in how to maintain their health to have the best health that they can? Once I got into nursing and public health, that has been my goal ever since. I believe we can make big strides as public health professionals by making sure people know who we are, know what we do and know what our profession is all about, so we can grow our workforce by encouraging more people to go into public health practice, and then support those people in our field.