Photo: Mike Saunders

Practice

SPH Faculty Brief Massachusetts Legislators on State’s Public Health Priorities

The School of Public Health hosted Massachusetts state senators and representatives from the Joint Committee on Public Health for a series of faculty presentations, the second such event held since 2023.

More than a century ago, the landmark U.S. Supreme Court case Jacobson v. Massachusetts affirmed the authority of states to steward public health. Since then, state legislatures and public health agencies have held primary responsibility for enacting and enforcing laws and policies to protect the health of their citizens, while the federal government has largely played a supportive role with agencies like the Centers for Disease Control and Prevention lending expertise and financial assistance.

On April 16, nine School of Public Health faculty shared their expertise in a briefing to Massachusetts state senators and representatives from the Joint Committee on Public Health. Over the course of the two-hour briefing, the faculty from various departments across SPH delivered 15-minute presentations on a range of topics pertinent to the health of Massachusetts residents.

“Throughout history, the federal government has been a reliable partner to states in increasing resources for healthcare and public health. To have that spigot turned off without warning, I think is unique in our history,” said Nicole Huberfeld, Edward R. Utley Professor of Health Law, Policy & Management. The briefing was the second such session to be held on the BU Medical Campus since 2023.

Rep. Marjorie Decker, committee chair of house members and an instrumental force in organizing both briefings, noted that approximately 90 percent of her colleagues are new to the committee and expressed gratitude for SPH’s continued partnership.

“We’re certainly in state legislature at a time in which we’re going to struggle together…. You are probably very familiar with a lot of the cuts that have come down that will impact public health in Massachusetts but specifically also DPH,” said Decker, referring to the Trump administration’s recent termination of $11 billion in federal grants to state public health agencies, including millions for behavioral health care, disease prevention and treatment, public health workers, community health centers, and laboratory operations in Massachusetts. “We will have to use this lens in trying to figure out what we can advance, what’s feasible and what’s not, and what the consequences are and what the workarounds might be.”

While Massachusetts relies less on federal funding than many other states, the Commonwealth has frequently leveraged federal dollars for its public health agenda, including to gain its first-in-the-nation status for expanding health care coverage to nearly all citizens in 2006.

“A lot of the questions that you are trying to answer in your political lives, I imagine, are [around] what do we do without that [money]? How do we move forward if we have to fund ourselves?” said Huberfeld. She advised Decker and her colleagues aim to act in ways that will “reduce the risk of illness, injury, and death based on available evidence,” and suggested that the committee focus their energy and resources on the social determinants of health or, in other words, the upstream factors that affect a person’s health, such as their living and working conditions. Her recommendation would be echoed by several other SPH faculty presenters.

Madeleine Scammell, associate professor of environmental health, commenced the event with her presentation on the role of local public health departments; Andrew Stokes, associate professor of global health, talked about cardiovascular disease and GLP-1 medications; and Lois McCloskey, professor of community health sciences and director of the BUSPH Center of Excellence in Maternal & Child Health, and Kathryn Thompson, assistant professor of community health sciences, discussed maternal health.

Carlos Rodriguez-Diaz, chair and professor of community health sciences, warned the legislators of the potential for worsening health outcomes among the LGBTQ+ community in Massachusetts. He predicts that given the changes in policies affecting the LGBTQ+ population nationally, Massachusetts’ more progressive laws will—and likely already have—spur migration to the state. He urged incorporation of “health in all policies,” highlighting the ongoing health disparities faced by the LGBTQ+ community including higher rates of mental health issues, substance use disorder, and certain physical health problems that often stem from stigma, discrimination, and a lack of access to culturally competent healthcare. Rodriguez-Diaz highlighted two studies undertaken by his SPH colleagues to better understand and address the drivers of these inequities: The Whole Selves Project on healthy relationship building for trans and nonbinary youth and the Studying Policies’ Effects on Communities: Trends in Resilience and Undergraduate Mental Health (SPECTRUM) Study. Unfortunately, funding for both was recently terminated, he informed the legislators.

In interim Dean Michael Stein’s opening remarks, he also drew the legislators’ attention to disparities in U.S. spending priorities. “America spends $11,000 per person on medical care and $200 per person on public health,” he said, citing 2019 CDC and Health Care Cost Institute data. “That suggests that public health is [less than] one fortieth as important as medicine. We here don’t think that.”

In total, nine legislators participated in the briefing, including Sen. William J. Driscoll, Jr., chair of senate members; Rep. Sally P. Kerans, vice chair of house members; Rep. Bruce J. Ayers, Rep. Michelle L. Ciccolo; Rep. Hannah Kane (Questrom ‘93); Rep. Sean Reid; Rep. Amy Mah Sangiolo; Rep. Decker; and Rep. Montaño. Ramla Hagi, the committee research director and an incoming SPH student; Daniella Montero (SPH ‘23), a research analyst with the committee and and an SPH alum; Sarah Pierson, the legal counsel to the committee; and Ryan Telingator, the chief of staff to Rep. Decker, also joined the event. Craig Andrade, associate dean for practice and director of SPH’s Activist Lab, presided over the briefing schedule to ensure efficient use of the group’s time.

David Hamer, professor of global health and a member of the faculty of the BU Center on Emerging Infectious Diseases, called the room’s attention to the ongoing measles outbreak and other diseases of rising concern. He said that while Massachusetts is at low risk overall, given measles’ very high reproductive rate, or the number of people who can become infected through contact with one infected person in the absence of immunity, the state must maintain its immunization rates.

Public education and countering misinformation were recurring themes throughout the briefing, with many faculty emphasizing their importance.

Monica Wang, associate professor of community health sciences, closed the briefing with a presentation on communication strategies for public health. She noted that most people—even many physicians—do not know what the social determinants of health refer to and do not speak the language of public health terminology. The field should go beyond gathering facts and evidence to consider how to frame data in alignment with different audience’s values and priorities, she said. She also raised the importance of trusted messengers, providing the example of Dorothy Oliver, an Alabama retiree, whose door-to-door advocacy got her community over 95 percent vaccinated for COVID in 2021 when the overall state vaccination rate was less than 50 percent.

The prevailing narrative is “you’re responsible for your own health,” Wang said. “The work of public health and social determinants is the counter narrative, which is your environment matters, your social connections matter—your income, your housing, your education, your race and ethnicity matter. These are all different kinds of narratives that influence policy.”