Public Health in Practice: Environmental Health.
Public Health in Practice: Environmental Health
Several members of the SPH community serve on, or collaborate with, their local board of health to help inform the public health policies and priorities that impact their communities.
COVID-19 has showcased public health in Massachusetts under a blistering light. The pandemic has made particularly clear the important roles that public health professionals play in times of crisis, including two School of Public Health faculty members: Wendy Heiger-Bernays, clinical associate professor of environmental health, and Patricia Janulewicz Lloyd, assistant professor of environmental health.
In addition to taking volunteer leadership roles in their respective towns—Heiger-Bernays as chair of the Lexington Board of Health, and Janulewicz Lloyd as an advisor on Milton’s COVID advisory committee—the professors have trained public health professionals who are responsible for implementing the policies that protect Massachusetts residents.
Much of this work goes unrecognized. Even though the work often involves punishing hours, contentious issues, and has dramatic effects on the public’s physical, mental, and economic health, little attention is paid to the roles these professionals play.
“Local public health systems in Massachusetts during a pandemic have been akin to your auto policy—you need it when you need it, you hope to never need it, and no one likes to pay for it,” says Heiger-Bernays, clinical associate professor of environmental health. “And heaven help you if it lapses just before you have an accident—or a pandemic.”
Public health in Massachusetts has its roots dating back to 1799, in a system set up by Paul Revere, who was chairman of the first Board of Health in Boston. The original boards of health (BOH) were given broad authority to control the “filth and offal” that was believed to cause epidemics. Since that time, each city and town in Massachusetts has had a local BOH.
In larger communities, like Boston, there is a Health Commission, which functions in essentially the same way as a BOH. Boards of health and health commissions set policy for health issues in their communities. Local BOH rely on public health professionals to carry out the work and, in Massachusetts, many of these professionals are SPH graduates who focused their studies in environmental health and/or epidemiology.
“Our graduates and students have brought a wonderful energy to using the best science in making the best public health decisions, even when the best science isn’t as good as you would like,” says Heiger-Bernays. “And my practice, like that of my colleague Tricia, has been invaluable in grounding the methods that we teach to prepare students to make real-life, important decisions on the public’s behalf.”
Heiger-Bernays has served on her local BOH for nearly 20 years. In non-pandemic times, the issues her BOH faces include navigating the delicate balance in discerning when residents would benefit from mental health resources rather than from a letter of housing violations and potential eviction, passing regulations to address under-age vaping, establishing programs that seek to address social justice issues, and, most timely, long-range planning for administering antidotes or vaccinations in times of pandemic.
When COVID-19 hit, Heiger-Bernays says she was fortunate that her town had a very competent health director, Kari Sasportas (SPH’07), with whom she spoke daily. From the onset of the pandemic, Heiger-Bernays said it was clear that decisions were being made across the US that did not reflect the science of basic environmental health principles about the transmission of respiratory viruses.
With SARS-CoV-2, the virus that causes COVID-19, Heiger-Bernays said too much energy was being focused on transmission through fomites — large droplets from sneezes and coughs that can land on surfaces, be touched by someone, and then be transferred to mucous membranes, such as eyes, nose, and mouth. Masks were not only discouraged, some agencies (including the CDC) stated outright that they do not work.
But researchers and practitioners in environmental health know that respiratory viruses create both small and large droplets, and the small ones travel in the air to another person’s breathing space. Heiger-Bernays’ community passed a regulation requiring masks indoors before the governor of Massachusetts did so in early May.
At the beginning of the pandemic, Heiger-Bernays convened a technical advisory group of colleagues—epidemiologists, infectious disease clinicians, a pediatrician from her BOH, public health practitioners, and MPH students Caredwen Foley and Emily Hammel—to assist in determining criteria for school closures. At issue was whether Lexington should shut its schools due to three cases of COVID-19 in adults who had been exposed at the Biogen conference, with one adult in a family with children in the public schools.
“The group needed to consider a complex matrix of factors, including the ripple effect on families whenever children are kept out of school, particularly for families where parents had no coverage for children because they needed to leave home to work,” says Heiger-Bernays. In addition, she says, children get lunches and sometimes breakfasts in school and, if they are home, food insecurity may be an issue.
While the group was convening, signs were becoming obvious that Massachusetts was going to be hit hard with this virus, said Heiger-Bernays, so the technical advisory group was unanimous that the schools should be closed. With that guidance, the Lexington BOH recommended to the School Superintendent that schools be closed, and the Superintendent coordinated with a few regional school districts to close their schools. The next day, Massachusetts Governor Charlie Baker declared a public health emergency in the Commonwealth.
SPH students Foley and Hammel prepared FAQs that explained the decision-making process and also developed materials that they shared with the schools and with the Mass Health Officers Association, the professional organization that “leads, supports, and advocates for the delivery of statutory and foundational public health services across every municipality in the Commonwealth of Massachusetts.” The association is led by Sigalle Reiss (SPH’05), director of the Norwood Health Department, who used the communication materials prepared by the students to help support practitioners in local health who were working furiously in contact tracing and infection control.
Tracking cases became a key element of COVID-19 response for Janulewicz Lloyd, who identified that need in her town of Milton. Janulewicz Lloyd had already been engaged with her town’s public school as part of a Return to School Taskforce, and Metrics Committee monitoring case numbers.
Working with the local BOH, she helped create a website that tracked cases in Milton, and assisted with the compilation of monthly and cumulative reports on case demographics in the town. EH doctoral student Jeffrey Carlson gained valuable experience helping with the project, as did Jessica Fuchs and Rinka Murakami, MPH students who are part of the Epidemiology COVID-19 Response Corps led by epidemiology professors Jennifer Weave and Eleanor Murray.
“These students continue to volunteer their time to work with me on these websites which are the only place where Milton residents can easily access information specific to COVID cases in town,” Janulewicz Lloyd said.
Vaccination has proceeded in fits and starts throughout the Commonwealth and originally included partners such as hospitals, community health clinics, and local BOH, before shifting to mass vaccination sites. The communities of Arlington, Bedford, and Lexington have partnered to provide more efficient vaccination distribution and dispensing to residents in the region. Taking the lead on this is Christine Bongiorno (SPH’05), the director of health and human services for the town of Arlington, who was trained by Heiger-Bernays.
“Partnership, communication, respect for everyone on the team, and stepping up when there is a knowledge gap is what is needed during such times, and through the training at BUSPH, our students learn these skills,” says Janulewicz Lloyd.