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In 1799, Paul Revere was appointed chairman of the Board of Health in Boston, the first local health board in the Commonwealth, and was given broad authority to control environmental contamination and deadly epidemics. More than 200 years later, today’s health boards, while charged with many more responsibilities, have much the same purpose: to provide for the public’s health and safety.
“Local boards of health in Massachusetts are entrusted with providing safe drinking water, food inspections in restaurants, and making sure proper regulations are passed so the community as a whole is safe and healthy,” says Christopher Quinn, M.D., president of the Massachusetts Association of Health Boards (MAHB).
Dr. Quinn, who is also Director of Occupational Health Services at Sturdy Memorial Hospital in Attleboro, Mass. and a physician with the Attleboro Health Department, and Cheryl Sbarra, Esq., staff attorney for MAHB, joined host B. Dale Magee, M.D. in the July episode of Physician Focus to discuss how local boards of health operate and their importance to local communities.
“The Massachusetts legislature,” says Ms. Sbarra, “gave local boards of health the obligation and the authority to protect the public health, safety, and welfare, very similar to powers given to police and fire departments. They pass local regulations, and they pass them just like a town meeting or city council would pass an ordinance.”
Who are these people who sit on boards of health? They are local residents and come from all walks of life. There are no specific requirements or special skills that are needed, just a desire to contribute to a healthy community. In cities, members are appointed; in towns, they may be either elected or appointed. All benefit from the training programs MAHB conducts annually for board members.
“People serve for a variety of reasons,” says Dr. Quinn. “They may get involved because they have a particular skill set or because of a particular issue they want to get involved with.”
Each community in the state has a board of health (or health department) and their responsibilities for public health are similar, yet smaller communities are faced perhaps with more formidable tasks because of fewer resources and personnel.
“In rural areas,” says Ms. Sbarra, “boards of health may have one full-time position or even a half-time person, but they have the same obligations as a full-fledged department. There are lots of challenges for smaller boards of health.”
While the work of health boards remains invisible to many residents, the successes of the boards over the years are many. Dr. Quinn and Ms. Sbarra cite their work with food inspection, septic systems, clean water, and especially tobacco control. The boards began tobacco control efforts some 20 years ago, and, says Ms. Sbarra, “they have been the heroes in changing social norms surrounding tobacco in Massachusetts.”
Among the biggest challenges boards face is the balancing act between regulating individual rights and safeguarding public health. Vaccinations, fluoridation, and the lifestyles of some individuals that may threaten neighbors (such as hoarding) are examples of the areas that have created tension and controversy at times. “We tread very delicately here,” says Dr. Quinn. “We look not just at the individual, but we have to look at how other people are affected.”
Both physician and attorney agree that just because boards possess the legal authority to regulate individual behavior, it doesn’t mean they should do so. They still should engage in a balancing act. “The goal of enforcement efforts of boards of health,” says Ms. Sbarra, “is compliance, not punishment. We’re not there to fine you or put you in jail; we’re there to get compliance, however we can, and it needs to be reasonable.”
As boards continue to provide a host of essential services and enforce regulations covering critical areas such as housing and sanitary conditions, hazardous and solid waste, and food and water, new issues, such as e-cigarettes and all-hazards preparedness, emerge demanding attention.
Despite the challenges, Dr. Quinn and Ms. Sbarra agree that boards should be proud to let people know about their important work. People need to know, they say, what boards of health do, and – perhaps most important - citizens need to think about how safe they are in the community because of their work.
View the video above for more discussion, including further conversation about the balancing act of boards in deciding between the rights of individual behavior and public health and safety, how boards of health work with other municipal agencies and community groups, and the challenge of providing services for disparate populations within a community.
Text:
MMS/Richard Gulla
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