Getting to the Root Causes: Public Health in 2018

By Robyn Alie, Manager, MMS Health Policy and Public Health

In 2017, Massachusetts ranked high among the 50 states on education (#1), health care (#2), and public health (#5). But according to the same source — US News & World Report in June — the Commonwealth underperformed on other criteria that affect health: 40th for mental health, 47th in affordability, 41st in disability employment, and 40th for racial income gap.

Root Causes

Social determinants such as these are increasingly recognized as powerful drivers of health outcomes — more important than medical care, studies suggest. They have become a focus in the state’s efforts to improve health outcomes and address health care costs. Throughout 2017, CMS has piloted the section 1115 waiver project for MassHealth — with the active support of the MMS — to establish accountable care organizations (ACOs) that are addressing social determinants of health in their patient populations. Pilot ACOs have been working with behavioral health and community health partners. The goal of this care coordination is to reduce ED utilization and health care costs, and improve patient experience and health outcomes. Pilot projects wrap up in December 2017, and a full roll out of the waiver project is slated for 2018.

Opioid Crisis

At the same time, the opioid epidemic remains a crisis for Massachusetts. In 2016, 2,107 people died from opioid-related overdoses, more than triple the number of five years earlier. In August, the DPH reported a 5 percent decline in overdose deaths for the first half of 2017, compared to the first half of 2016. Opioid prescriptions had fallen 28 percent since the first quarter of 2015. The MMS will remain actively engaged in this issue, focusing in 2018 on prevention and treatment of opioid use disorder by addressing the treatment of chronic pain, supporting physicians as providers of medication-assisted treatment, and broadening access to naloxone.

Climate Urgency

This year saw a series of devastating weather events, including multiple hurricanes resulting in the loss of American lives, property, and infrastructure. It also saw significant budget cuts to environmental agencies, including the EPA, and the US announcement of its intent to withdraw from the Paris climate agreement to reduce emissions. In May, the MMS adopted policy to initiate a three-year communications campaign to raise public awareness of the link between the environment and human health; the campaign is slated to launch in 2018.

Vital Signs asked local public health leaders to anticipate the pressing concerns for 2018


Sandro Galea, MD, DrPH“Perhaps the most clear epidemic today that matters to all of us in Massachusetts is the opioid epidemic. It is hard not to focus on this and the potential it has to shape health in the Commonwealth for generations to come. Physician attention to this issue can make an enormous difference. And yet one cannot help but feel that Massachusetts can also be proactive, can think about health in 2020 and 2030, not simply focus on what is urgent today. To do so, the state needs to focus on the drivers of health, the economic, cultural, and social factors. Physicians have an important voice, and if they apply that to articulating a set of priorities that creates the healthiest state, it can go a long way.”

Sandro Galea, MD, DrPH; dean, Boston University School of Public Health


Steven Ringer, MD, PhD“The ongoing opioid problem will remain a prime area of concern and active work in public health, as will evolving patterns in disease caused by familiar and novel pathogens. It seems that we cannot shy away from societal and social determinants of health, and we will have to grapple directly with issues of disparities in health care and the role of society in providing for the disadvantaged.”

Steven Ringer, MD, PhD; chair, MMS Committee on Public Health


Jessica Collins“We know that social determinants of health — basic human needs such as lack of affordable housing, transportation barriers, limited access to well-paying jobs, and exposure to violence — contribute to poor health outcomes, drive up health care costs, and create deep health inequities across race and income. We have a window of opportunity now to take an aggressive approach to these inequities as part of Massachusetts health care transformation. It’s essential that health care and public health work together — in collaboration with consumer advocates, social services, and community organizations — to ensure that prevention and equity are at the center our health care systems of the future.”

Jessica Collins; president, Massachusetts Public Health Association 


Heather Alker, MD, MPH“We want to raise awareness of the human health threats impacted by climate change. Recent natural disasters have directly shown us this link but letting patients know that environmental conditions exacerbate many common diseases could benefit us all.”

Heather Alker, MD, MPH; chair, MMS Committee on Environmental and Occupational Health


Kathryn Brodowski, MD, MPH“As part of the MassHealth restructuring effort, ACOs are being encouraged to address social determinants of health. We recommend providers adopt the Hunger Vital Sign™ to screen for food insecurity and connect patients to needed resources. The Flexible Services Program may be one potential avenue to create clinical-community linkages to address needs that are identified.”

Kathryn Brodowski, MD, MPH; director of public health and research, Greater Boston Food Bank

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