Lessons Learned: The Varied Responses of Massachusetts' Local Health Departments During the COVID-19 Pandemic. Issue 4 (July 2022)

• Record Type: Journal Article
• Authors: Mauzy, Steven; Putney, Kimberly; Baroni, Emily; Dey, Andrew; Elangovan, Kavya; Ji, Grace; McHale, Samantha; Prabha, Gargi; Sarkisova, Natalya; Granger, Stephanie; Black, Kristin; Lindenmayer, Joann
• Is Part Of: Journal of public health management and practice. Volume 28:Issue 4(2022)
• Page Start: 344
• Page End: 352
• Publication Date: 2022-07
• Subjects: COVID-19 -- local public health -- resiliency; Public health administration -- United States -- Periodicals; 253.6
• DOI: 10.1097/PHH.0000000000001547
• Languages: English
• ISSNs: 1078-4659

Abstract

Abstract : Context: Massachusetts' decentralized public health model holds tightly to its founding principle of home rule and a board of health system established in 1799. Consequently, Massachusetts has more local health departments (n = 351) than any other state. During COVID-19, each health department, steeped in centuries of independence, launched its own response to the pandemic. Objectives: To analyze local public health resources and responses to COVID-19. Design: Semistructured interviews and a survey gathered quantitative and qualitative information about communities' responses and resources before and during the pandemic. Municipality demographics (American Community Survey) served as a proxy for community health literacy. We tracked the frequency and content of local board of health meetings using minutes and agendas; we rated the quality of COVID-19 communications on town Web sites. Setting: The first 6 months of the COVID-19 pandemic in Massachusetts: March-August 2020. Participants: Health directors and agents in 10 south-central Massachusetts municipalities, identified as the point of contact by the Academic Public Health Corps. Main Outcome Measures: We measured municipality resources using self-reported budgets, staffing levels, and demographic-based estimates of community health literacy. We identified COVID-19 responses through communities' self-reported efforts, information on town Web sites, and meeting minutes and agendas. Results: Municipalities excelled in communicating with residents, local businesses, and neighboring towns but lacked the staffing and funding for an efficient and coordinated response. On average, municipal budgets ranged from $5 to $16 per capita, and COVID-19 consumed 75% of health department staff time. All respondents noted extreme workload increases. While municipal Web sites received high scores for Accurate Information, other categories (Navigability; Timeliness; Information Present) were less than 50%. Conclusions: Increased support for regionalization and sustained public health funding would improve local health responses during complex emergencies in states with local public health administration.