‘We Need to Train People Differently’.

Kathleen MacVarish Associate Professor of the Practice, Environmental Health
Breakfast: Special K Protein and a big cup of Starbucks coffee
Hometown: Baldwin, New York (“The south shore of Long Island.”)
Extracurricular: “All things outdoors—hiking, mountain biking, muddy obstacle course racing, cross-country skiing…”
You recently received the Robert C. Periello Memorial Award/Sanitarian of the Year from the Massachusetts Environmental Health Association. What is a sanitarian?
Sanitarians include the people who work in state and local health departments looking at air, water, soil, food, solid waste, hazardous waste, that type of thing. A lot of people don’t like the title, because it brings up sanitation and garbage collectors, so while Massachusetts has a board of registration for sanitarians, which I chair, the National Environmental Health Association has the same credential but call it a registered environmental health specialist.
What led you to become a registered sanitarian?
I started out as a food inspector in Brooklyn. That’s where I became very interested in rats—Harold [Cox, director of the Activist Lab] likes to tease me about that, but I actually like pest control.
I didn’t even realize that that was public health. My bachelor’s degree is in food science, and I thought of myself as a regulator. Then I moved to California and got a job at the Orange County health department. California is one of the states that requires all of their county health inspectors to be registered sanitarians. That meant I had to learn more about things like housing, drinking water, and waste water. It took a while for me to figure out that regulators were actually part of the whole public health system.
Why does California require that credential? Does Massachusetts?
Not every state has that requirement—I would say it’s about half and half. In Massachusetts it’s optional: We have a board, but you don’t have to have that credential to work in the health department. What that has actually done is create a training gap, or a training problem.
For example, for food safety, if you have someone coming in to do your food inspections and they haven’t been trained, how good is the inspection? That’s a pretty complex regulatory area, and the code is as thick as a telephone book. It’s not a simple thing to read or interpret. You really want standardization of inspectors, and the industry actually would like standardized inspectors as well, because it’s hard when you’re a chain and you get one inspection report in one town and a completely different one in another.
Why don’t all states just make it a requirement?
If it were mandatory, there’s a cost associated with it. It might also be difficult for some areas to hire registered people, like in western Massachusetts, where they just don’t have that many. How are they going to staff a health department? It’s something I think we need to bite the bullet and do, and maybe we can grandfather in existing people, but it would be a hurdle.
What brought you to SPH and the Activist Lab?
I was a health inspector for about 20 years, and what I learned over time is that the best way to get people to comply with the regulations is to educate them, and to work with them. That’s not how I was trained as a food inspector. We were coming in and saying, “Do this, this, and this,” and if they didn’t they got fined. It was very antagonistic. There was no collaboration.
As I got more experienced I thought, “Wow, I wish I had been trained differently!” How I had been trained wasn’t very effective. I was definitely filling out the forms right and I was finding all the violations, but I wasn’t getting positive change.
It just made sense to me: We need to train people differently.
After 20 years of doing inspections, I was ready for a change. By then I had moved to Massachusetts and was working in Milton, and I met Anne [Fidler, assistant dean for public health practice]. I called her up one day and I said, “Anne, I can’t do another pigeon complaint investigation!”
There happened to be an opening at SPH to manage the HRSA-supported New England Public Health Training Center Training Center. I started here as a manager of that program, but it really evolved. We got more training grants. I got more interested in the production of training, but always with this idea that we have to train people the right way, that it shouldn’t be an antagonistic relationship with the people being regulated, but a partnership.
How does your work in the Activist Lab address this training gap?
Because the credential is optional, there’s no standard training program that our environmental health professionals have to go through in Massachusetts in order to do the work. So, what we’ve been able to do here in the Activist Lab is actually come up with a uniform training program so that anyone can get up to a base level of knowledge. It doesn’t necessarily prepare you for the credential, but it prepares you for the work.
We now have three training centers here at the lab. One is funded by the Department of Public Health for the Massachusetts local workforce, where we took all of the programs areas that all of the boards of health are responsible for and developed an online, self-paced training for each area. They’re available 24/7, 365, and you don’t have to take a day off from work and travel. You get a certificate completion. You get contact hours, and the contact hours satisfy continuing education for certain types of credentials including sanitarian. They’re also free, so it really is a win-win.
For the more complex areas like food, onsite waste water, and housing inspections, we took it a step further and have what we call performance-level training. Some of that is online, and some of it is in the classroom and in the field. We have a group of experienced inspectors who volunteer to be field trainers, and they supervise the trainees.
High-quality training is expensive, but we’ve been fortunate to have these grants. Anne Fidler is actually leading a big charge to try to get our HRSA grant re-funded, because that has really helped support the work that we’re doing with the Department of Public Health.
Really, we’re trying to come up with a uniform curriculum so people can take what they need, when they need it.
How do you feel about receiving this award?
It’s an honor to be nominated by my peers, people I’ve worked with for literally decades, and to know they respect and really appreciate the work. I also have to plug my team here: I get the award, but it’s because of all these people who I have the privilege of working with in the lab and who make it happen.
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