Q&A with Monica Bharel, 2015 Commencement Speaker.

Thrust headlong into one of the most vexing public health problems to hit Massachusetts in decades, Monica Bharel knew she would need to hit the ground running as the state’s new commissioner of the Massachusetts Department of Public Health.

Being in the middle of a crisis is not an unusual position for Bharel, who has more than 20 years as a physician behind her, practicing in neighborhood health centers, city hospitals, the Veterans Administration, university hospitals, and nonprofit organizations. Most of that time was spent serving some of Boston’s least fortunate as chief medical officer of Boston Healthcare for the Homeless, which dispenses care to more than 12,000 patients each year.

Ahead of her are new challenges running a department that regulates nearly all health care facilities in the state, from major hospitals to storefront clinics. Its budget of $565 million funds more than 100 programs that address a spectrum of problems ranging from infectious diseases to substance abuse. But the daunting issue of opioid addiction—and the increasing frequency of overdoses—may prove to be Bharel’s toughest challenge.

In 2014, more than 1,000 people died of drug overdoses in Massachusetts, with eastern Massachusetts and parts of Rhode Island among the worst cluster of overdose deaths in the nation. Heroin and prescription painkillers such as fentanyl—about 20 times more powerful than heroin—have been implicated in many of the deaths, which are continuing mostly unabated into 2015.

Governor Charlie Baker has made curbing the overdose spike one of the top issues of his first six months in office and has made Bharel a key part of his administration’s effort. She has previously served in multiple policy creation and advisory roles, including a gubernatorial appointment to the Behavioral Health and Primary Care Integration Task Force by former Governor Deval Patrick.

Bharel has been a faculty member at Harvard Medical School, the School of Medicine, and the Harvard T.H. Chan School of Public Health, and received her MPH from the Harvard T.H. Chan School of Public Health with a concentration in health care policy and management. She earned her medical degree from the School of Medicine and completed internal medicine residencies at Boston Medical Center.

Throughout her career, she has kept a steady focus on the mission of serving the underserved, telling a 2014 interviewer, “I have always subscribed to the idea that you can judge the greatness of a nation by how it treats its weakest members.”

Q: With two decades as a physician, what are some of the major public health challenges that you have seen emerge over time?

A: In my clinic I have been fortunate enough to work with some very vulnerable populations who have had limited access to healthcare. My main priority has been around working towards health equity, and eliminating healthcare disparities so we could all live at the same level of good health.

I think one of the things that have been wonderful to see in terms of healthcare specifically as the first component of healthcare is being able to access healthcare—so to have insurance. In Massachusetts—and now with the country following us—we have been very lucky to have most individuals insured.

Q: You’ve said that your time at Boston Healthcare for the Homeless gave you a much greater sense of some of the issues of healthcare equity and access. Are there any additional proposals or initiatives coming through the pipeline that can further those aims?

A: When you work with individuals who are having experiences of homelessness, it really spotlights the issue of health equity. When individuals have to focus on first where we are going to receive our next meal or find a safe place to sleep at night, it is very difficult to prioritize some basic medical needs unless it is an emergency.

Things like taking care of your diabetes, making sure that you are taking medication for your high blood pressure, or getting your preventative care screenings can really become overbearing challenges. At Boston Healthcare for the Homeless we took a systematic look at those individuals. We tried to take the care to the communities where they live and stay, in order to decrease as many barriers as possible. Individuals could get the healthcare they need and get closer to health equity because things like place really matter—where individuals are, what their surroundings are, and what their living conditions are.

Here now, I am so grateful to have the opportunity to be with the Department of Public Health because it is really a chance to take that knowledge of the importance of people’s socioeconomic status and their location, race, sex, geographically where they live—to take the information and raise awareness around it.

Q: How are you hoping to use that to raise awareness?

A: In order to do something, first there is awareness followed by action. One of the things that I am very focused on here at the Department of Public Health is looking at data in new and improved ways. So we collect a lot of different data sources at DPH, but I really want to be able to look at those in a way that highlights what kind of disparities and public issues there are, and where they are.

Q: How much of a factor was opioid addiction in some of the issues that you saw at Boston Healthcare for the Homeless?

A: The current crisis of opioid addiction is affecting all communities, and it is affecting all of us. It affects our friends, our neighbors, our patients and does not really discriminate by geography, age, or household income. So it is really a problem that we want to address head on in Massachusetts.

In terms of my work with the Boston Healthcare for the Homeless, there were individuals whom I worked with who were not only suffering from the problem of substance abuse disorder but many also had issues with mental health as well as having concurrent medical illnesses. There were individuals who were dealing with all three of those components together and were trying to navigate the medical system. Honestly, part of our role was helping them coordinate their care because there are so many different silos under which we get healthcare provided to us. So part of what I am motivated to do now is to think across those silos about a holistic way to help individuals who are suffering from substance abuse disorders.

Q: So with the declaration of a public health emergency around opioid addiction, does that make it the Commonwealth’s most pressing public health issue?

A: Well, the opioid epidemic is a critical public health issue. The governor has put together a working group to address the opioid crisis; I sit on that working group, and I am an active member. We have gone all across the state and listened to over a thousand different individuals give their stories and suggestions of what we need to do as a state. In the next month or so, we will be coming out with recommendations and ideas for implementing some of those because we have to do something about this now.

Q: In terms of that group and its potential influence on policy, are there any initiatives that came out of those listening tour that you feel really have some merit and are worth pursuing?

A: When I think about the opioid use issue, I think about it in the structure of prevention, intervention, treatment, and recovery. In those four buckets there is crime prevention and making sure that our young people understand how crippling the addiction can be, as well as secondary prevention where if people are using opioids, we help them stop or explain the dangers of opioid use.

In interventions and treatment, we need to make sure that we have access to the appropriate types of treatment. Every individual is different—to me, opioid use is just like any other medical disease such as diabetes or heart disease, where different interventions are needed for different individuals. So there have to be many different options, whether it is medication-assisted treatment or other opportunities.

Of course, then there is recovery to make sure that when people are no longer using, they have the support that they need around them in a community where they can thrive in recovery.

Q: What can SPH graduates look forward to as they begin—or further—their public health careers? What are some of the issues they are going to be tackling, and what are some of the pressing public health concerns they will need to address?

A: I am really excited to have an opportunity to speak to the graduating class. I find welcoming my new public health colleagues into the field one of the most inspiring and important things that I can do. Ideally, they should be proud of the work they are doing—they should be proud, but not yet satisfied.

To me, the key message to them is that the key health outcomes that we monitor vary too much by socioeconomic status, geography location, race, and sex. I would really like them to work with me together on solutions to improve, decrease, and really eliminate health disparities and increase health equity.