Today DPH Interim Commissioner Lauren Smith, MD, MPH had the honor of addressing the Joint Hearing of the House and Senate Committees on Ways and Means, in support of Governor Patrick's proposed FY 2014 budget. Dr. Smith's prepared testimony appears below:
Honorable Chairs and Members of the Committee, thank you for the opportunity to provide testimony today on the funding allocated in the Governor’s Fiscal Year (FY) 2014 budget for the programs and services administered by the Department of Public Health. My name is Dr. Lauren Smith and I am the Interim Commissioner of the Department.
The mission of the Massachusetts Department of Public Health is to prevent illness, injury, and premature death, to assure access to high quality public health and health care services, and to promote wellness and health equity for all people in the Commonwealth. None of these programs and initiatives are possible without the support of necessary tax revenues. I am proud to support the Governor’s revenue proposal because, I believe, it will create growth and opportunity throughout the whole Commonwealth.
We envision a Commonwealth in which all people enjoy optimal health. Massachusetts ranks among the healthiest of states according to comparative analyses, but we face numerous challenges, including chronic and infectious disease, substance abuse, violence, preventable hospitalizations, and health disparities.
We strive to accomplish our mission by:
- Providing outcome-driven, evidence-based programs to promote wellness, prevent and control disease and disability through the management of state and federal resources;
- Developing, implementing, promoting, and enforcing policies to assure that the conditions under which people live are most conducive to health and enable people to make healthy choices for themselves and their families;
- Operating four public health hospitals, the Hinton State Laboratory Institute, and the State Office of Pharmacy Services;
- Collecting, maintaining, and publishing vital records and health statistics;
- Licensing, certifying, and/or accrediting hospitals, clinics, laboratories, and thousands of health professionals;
- Interpreting and enforcing public health law;
- Providing surveillance of chronic diseases, occupational hazards, injuries, behavioral risks, and other public health indicators;
- Providing 24/7 coverage to detect, prevent, and resolve infectious, environmental, and bio-terrorism threats to the health of the public.
Nearly 3,000 DPH staff work at more than a dozen different locations across the Commonwealth. Their duties are diverse: doctors, nurses, and other health providers care for patients at the four public health hospitals; epidemiologists track diseases and investigate clusters of illness; inspectors protect the public by enforcing public health laws; administrators provide guidance to more than 700 community-based agencies that receive funding from the Department; educators and outreach workers enroll clients in WIC and Early Intervention; and laboratory workers identify and track strains of illness across the state.
This is a substantial mission and last spring, along with other EOHHS agencies, our senior leadership team established a Departmental strategic plan, aligned with the strategic goals of the Secretariat and the Patrick-Murray Administration, to codify and strengthen our vision for this agency. Our identified goals were:
1) Support the success of health care reform by ensuring that public health is involved in promoting wellness and access to high quality care while reducing the growth of health care costs;
2) Reduce health disparities by promoting health equity;
3) Promote wellness and reduce chronic disease;
4) Strengthen local and state public health systems to prevent disease and promote health;
5) Reduce youth violence.
We are implementing plans and strategies in collaboration with state, local and community partners to accomplish these goals and improve the health of all residents of the Commonwealth.
I wanted to highlight a few of our successes in the past year.
DPH expanded evidence-based national home visiting models in 17 communities across the State (Boston, Brockton, Chelsea, Everett, Fall River, Fitchburg, Holyoke, Lawrence, Lowell, Lynn, New Bedford, North Adams/Pittsfield, Revere, Southbridge, Springfield, and Worcester). Utilizing federal funds, staff have developed a universal, one-time home visit for all new moms (regardless of income, risk, or prior birthing experience) residing in the 17 communities.
Mass in Motion, partially funded by the health promotion appropriation (4513-1111), has leveraged two Community Transformation Grants at $3 million/year for five years (Massachusetts is the only state health department to receive two); a Health Impact Assessment Grant at $175K/year for three years (one of six awards in the U.S. and the only award to a state health department); Childhood Obesity Research Demonstration Project funds of $1.7 million/year for four years (one of three in the U.S. and the only award to a state health department); as well as ongoing support at $850K/year from private partners. Mass in Motion supports community level approaches to health promotion and wellness initiatives across the Commonwealth. Mass in Motion is currently implemented in 52 cities and towns impacting 33% of the Commonwealth’s (correct?) population.
The Office of HIV/AIDS and Division of STD Prevention, in cooperation with the Bureau of Laboratory Sciences, have made Massachusetts one of the first states to adopt and implement a 4th Generation HIV diagnostic assay and related Acute HIV Infection Protocol. The transition represented a profound practice shift which was accomplished smoothly and efficiently, and enables the state for the first time to detect and respond to acute HIV infection as a priority disease intervention practice.
In partnership with the Department of Elementary and Secondary Education (DESE), North River Collaborative and Brockton Public Schools, the Bureau of Substance Abuse Services (BSAS) opened Massachusetts’ fourth Recovery High School, Independence Academy in Brockton. The school has the capacity to serve approximately 30-50 students who have been diagnosed with a substance abuse or dependence disorder. The school’s comprehensive curriculum is consistent with Massachusetts State Standards, MCAS testing protocols, and the course requirements of students’ sending school districts.
And through the efforts of both BSAS and the Bureau of Community Health and Prevention’s Office of School Based Health Centers (SBHC), all 32 MDPH funded SBHC’s have been trained in evidence based models for identifying potential substance use issues and changing behavior in youth. SBHC’s are now required to screen, provide brief interventions and collect data.
Between November 2007 and November 2012 there have been 16,618 enrollments in the statewide naloxone (Narcan) program. People who are enrolled now receive education on how to prevent, recognize and respond to an opioid overdose. As of November 30, 2012 there have already been 1,774 reported overdose reversals attributable to this program. There have also been over 200 reports of police and fire department use of naloxone to reverse opioid overdoses in our first responder pilot from 2010-2012.
The Bureau of Environmental Health (BEH) worked with industry, state, and federal officials to implement a dockside testing pilot program which allowed for shellfish harvested from closed federal waters to land in Massachusetts, be tested for paralytic shellfish poisoning toxin and, if safe, to enter the market for human consumption. The initial phase began in January 2011. In 2012, as a result of the economic benefits of the pilot, Sea Watch International completed a $3.5 million expansion project in New Bedford. Plans to extend the pilot and include other companies/vessels are underway. To date, 100 new jobs have been added to the greater-New Bedford economy.
As you well know, these successes have not come without short fallings as well. Though the Department has faced serious challenges over the course of the past year, I am here today to assure you we have learned from these challenges and have redoubled our efforts to provide the kind of high-level services and programs I have just highlighted, while protecting and enriching the lives and well-being of our Massachusetts residents. I look forward to working with each of you in accomplishing our mission to promote the health, safety and well-being of all our Commonwealth’s residents, and to fulfill our regulatory responsibilities in a way that is fair, rigorous, and worthy of the public’s trust.
Looking forward to Fiscal Year 2014, the Department – in partnership with the Patrick-Murray Administration – has placed great emphasis on maintaining, and in some key areas, increasing funding for critical programs. I am very pleased by the Governor’s support of DPH in his FY14 budget recommendations and look forward to working with you to ensure these critical supports are maintained so that we can sharply focus on what we do best – serving the Commonwealth’s 6.6 million residents.
The Governor has proposed a $548.9 million budget for DPH in FY14, representing a $32 million increase from FY13 projected spending. The Governor’s budget provides a total of $3.7 million in additional funding for new or expanded services, enhancing the Department’s ability to meet its regulatory responsibilities.
Protecting Massachusetts residents from those who would endanger the public by reason of greed or negligence is a core part of DPH’s mission. The fungal meningitis outbreak linked to the New England Compounding Center (NECC) was tragic, and the owners of NECC bear primary responsibility. However, we have acknowledged that poor judgment and missed opportunities on behalf of regulators allowed NECC to continue their willful disregard of sound practice for too long. This is not acceptable to me and we have taken swift and appropriate actions to ensure that this never happens again.
The Department’s recently completed, unannounced inspections of 40 sterile compounding pharmacies in the Commonwealth have shown us that while NECC may have been an egregious actor, there is clearly a need for more rigorous oversight of this industry. In addition to the many reforms the Administration has already taken, the Governor’s FY14 Budget directs several critical investments:
The Governor’s budget provides just over $1 million in new funding to enable the Board of Pharmacy to hire additional staff to continue the unannounced inspections of compounding pharmacies. These unannounced inspections have been, and will continue to be, a core component of enhanced oversight moving forward.
The Governor’s budget also supports more than 30 new staff positions at DPH to ensure the Department’s capacity to protect public health and safety and meet its regulatory responsibilities. These positions represent critical supports for our core regulatory functions. Your support of this recommendation is vital to the Department’s success in FY14. DPH has proposed $2.9 million in new or increased fees to offset the costs of the majority of these new positions. These investments in core regulatory functions include:
- $888K in environmental health services to support 16.5 new positions to address regulatory requirements involving food safety, radiation control, biotech waste, and other environmental threats to public health. These positions are essential to bolstering regulatory enforcement and quality assurance.
- $700K to support eight new positions to strengthen the capacity of the Bureau of Health Care Safety and Quality’s licensing, inspection and enforcement activities. These new positions will aid the Bureau in identifying potential problems affecting quality and safety before there is a crisis.
- $289K in critical operations and essential services for four legal staff to increase DPH’s ability to provide legal support involving health care and health professions licensure for ongoing legal issues.
- Finally, $190K for two critical management positions to oversee quality assurance in the Hinton State Laboratory’s operations and ongoing training in bio-safety operations. Adding these two positions is a proactive measure to ensure the highest quality across the Department’s labs, which are subject to independent inspections by national accrediting bodies.
These investments are critical for ensuring the ability of the Department to carry out its regulatory responsibilities. Again, none of these investments are possible without the support of necessary tax revenues. The Governor’s revenue proposal not only increases funding for the Department, but invests in the critically important areas of transportation and education.
A core public health tenet is that supportive infrastructure drives health improvement. A strong public transportation system allows residents to have access to healthcare providers. Other connections between health and transportation include physical activity, safety, air quality, and health equity. Extensive and robust evidence connects increased educational attainment with improved health outcomes. Funding these key investments will keep Massachusetts growing, helping our students achieve, our families prosper and our businesses compete. Funding these key investments will support public health.
One proposed source of revenue in the Governor’s budget comes from closing the sales tax loophole for soda and candy, as well as increasing the state’s tobacco tax. These key reforms will incentivize healthy behaviors and decrease use of products with adverse health consequences. This will benefit all of our Commonwealth’s children and families.
I know these are not always popular choices. But these proposals can have tremendous benefits for our Commonwealth. For starters, eliminating the sales tax loophole for soda and candy would raise an estimated $22 million in revenue in FY 14 and $53 million in FY15. Decreasing consumption of sugary foods and drinks is particularly important in light of the increasing burden of obesity in our Commonwealth and in the nation. More than half of Massachusetts adults and almost one third of high school and middle school students are overweight or obese.
In the past ten years alone, the percentage of Massachusetts adults with diabetes has almost doubled, and obesity will soon pass smoking as the leading cause of preventable death. We can make a difference – and the Governor’s proposal helps lead the way.
And this is not a leap of faith. Massachusetts would join an additional 33 other states across the country, including Connecticut, New Jersey, Maine, New York and Rhode Island in closing sales tax loopholes on soda, as well as an additional 17 states including Connecticut, New Jersey, Maine, New York and Rhode Island with regards to candy.
Raising the tobacco tax addresses another key public health priority. Tobacco use is still the number one cause of preventable death and disability in the Commonwealth. More than 9,000 Massachusetts residents die every year from the effects of tobacco – one person every hour of every day. Each year, health care expenses caused by smoking cost Massachusetts residents $3.9 billion. The Massachusetts economy loses another $1.5 billion in lost productivity. These are costs we can cut today through prevention.
The Governor’s FY14 budget proposes to increase the cigarette tax by $1 while also raising the tax on other tobacco products. Both efforts combined would generate roughly $69 million in FY14 and $166 million starting in FY15, while also lowering the use of these products among youth and adults. We know that the best incentive to stop people from smoking is financial, and that youth are particularly sensitive to price when it comes to tobacco.
I ask that you support these critically important reforms.
In summary, the Governor’s House 1 recommendations for DPH represent aggressive and timely investments in critical regulatory public health functions that enhance DPH’s ability to protect public health and safety, paired with balanced and maintained level funding for essential programs. I believe this budget lays a solid foundation for the Department in FY 2014 and I encourage you and your membership to support these recommendations.