120: Supporting Public Health Authority

Margret Cooke, Massachusetts Commissioner of Public Health, examines the value of public health authority when responding to a public health emergency; Alison Beam, Pennsylvania’s former acting Secretary of Health, says the response forced by...

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Margret Cooke, Massachusetts Commissioner of Public Health, examines the value of public health authority when responding to a public health emergency; Alison Beam, Pennsylvania’s former acting Secretary of Health, says the response forced by COVID-19 has improved services for people living with intellectual and developmental disabilities in her state; and Richard Hamburg, Executive Director of the Safe States Alliance, shares the findings of a report that examines the pandemic’s impact on injury and prevention violence programs.

ASTHO Health Policy Prospectus: Maintaining Public Health’s Legal Authority to Prevent Disease Spread

ASTHO Webpage: Public Health Review Podcast

Safe States Alliance Report: Crisis Amidst COVID-19 – The State of Injury and Violence Prevention in Health Departments and Hospitals

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This is Public Health Review Morning Edition for Wednesday, February 16th, 2022. I'm Robert Johnson. 
Now, today's news from the Association of State and Territorial Health Officials. 

Until the pandemic, public health authority was a largely unfamiliar concept to most Americans; but like everything else, COVID-19 changed that. The resulting debate over if or when to use legal authority to manage a public health emergency has brought new attention to the topic. 
ASTHO has identified public health authority as one of its top 10 policy issues to watch this year. Massachusetts commissioner of public health Margret Cooke examines the value of this important tool in today's morning conversation. 
How does public health authority help when you need to respond to a public health crisis? 
Well in Massachusetts, once the governor declares that an emergency exists which is detrimental to public health, the commissioner of public health can take an action to maintain the public health and to prevent disease. 
So, the key to responding to a crisis is that this can occur extremely quickly—much faster than, say, if you had to promulgate a regulation, and clearly much faster than statutory change. This quickness, it provides flexibility in responding to crises that need an immediate response or in responding to a crisis. such as COVID, which is constantly changing and needs quick-changing actions to be taken. 
And I think the second benefit to using public health authority—at least how it's constructed in Massachusetts—is the broadness with which its powers can be applied. As long as it's used to maintain public health and prevent disease, there's an argument that it's within the scope of what our law was designed to address.
So, for instance, during the COVID pandemic, we've used it for a broad range of things—everything from requiring healthcare facilities to report specific racial and ethnic data to creating special grocery shopping hours for high risk individuals, and to mandating that longterm care facility staff obtain COVID vaccinations. 
Do you have any examples—other than COVID—examples where you've used authority like this to try to address a challenge or a problem? 
Sure. We've had a public health emergency statute in Massachusetts since 1965, and we've used it sparingly but in a variety of different ways. And the obvious example, as you just mentioned, is our current crisis with COVID-19; but we've used it in the past to bring water to a city whose public reservoir was contaminated, we declared a public health emergency with respect to the opioid crisis, and most recently, right before COVID-19, we used our statute in 2019 to declare a public health emergency with respect to vaping and EVALI disease. 
The pandemic has generated a lot of discussion about public health authority. A lot of people are thinking about that, talking about it. 
How do you communicate the importance of the tool when you're talking to your key stakeholders? 
I don't think there's any doubt that there's always been attention between individual liberty and the government's power to protect public health by restricting their behaviors. We've seen this in the past with things like seatbelt laws, banning indoor smoking, and just recently COVID-related restrictions on large gatherings. 
But I think the public's reaction to these types of restrictions provides an immediate and kind of automatic response or a check and balance, and it needs to be taken into careful consideration when we think about using the powers of the public health emergency and we need to weigh that against its effectiveness. So, it's a tool that we really think should be used sparingly and in situations where no other tool would be effective; and that's really because the risk in challenging it could result in restrictions that would endanger the public health flexibility in responding to emergent threats, both on a pandemic scale and also on more localized emergencies. 
So, as an agency, that's something that we're always trying to emphasize with our stakeholders, the tension between these two issues and what tools already exist that we could use to address public health and what actions are already authorized that could immediately be utilized without calling upon the broad powers of a public health emergency. 
You can read the new policy brief about public health authority using the link in the show notes. 
Tomorrow, we'll conclude our look at the ASTHO policy series with a discussion focused on mental health.

Programs and services for people living with intellectual and developmental disabilities changed during the pandemic; in Pennsylvania, that meant a move to more individualized care. Alison Beam, former Pennsylvania acting secretary of health, says the response forced by COVID-19 has made her state support of the IDD community better. 
I think not just the program, but it also makes us stronger as a state government because we have to remember who we serve every day; and having a reminder that maybe a population that isn't in the traditional wheelhouse of our Department of Health, nonetheless we have counterparts over at our Department of Human Services that we need to be lockstep with and thinking about them at all times when we're moving forward with progressing the health of the commonwealth. 
This puts them front and center, and I think those are legacies that hopefully stretch far beyond the COVID-19 pandemic. 
Hear the full conversation with former Pennsylvania acting secretary of health Alison Beam on a new episode of the Public Health Review Podcast. It's available now everywhere you stream audio. 

Finally today, a report by the Safe States Alliance provides a look at how the pandemic has impacted injury and violence prevention programs in health departments and hospitals. Richard Hamburg is the organization's executive director. 
COVID-19 has exacerbated workforce burnout; and being a member of and chairing the ASTHO Affiliate Council, we're hearing the same thing from all of our partner organizations. 
It's also exposing and intensifying technology inequities. It's catalyzing interest in addressing those inequities with upstream approaches to public health. 
And, finally, injury and violence prevention professionals are eager for support to prepare for future emergencies and address the root causes of injury and violence prevention. 
You can read the report using the link in the show notes. 

That'll do it for today's newscast. 

Be sure to join us again tomorrow morning for more ASTHO news and information. 

I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day. 

Margret Cooke JD

Commissioner, Massachusetts Department of Public Health

Alison Beam JD

Former Acting Secretary of Health, Pennsylvania Department of Health

Richard Hamburg MPA

Executive Director, Safe States Alliance