Public Health: The Year Ahead

Focus on Opioid Abuse, Preparedness, and End of Life

BY ROBYN ALIE
MMS PUBLIC HEALTH MANAGER

The year 2014 began with rising numbers of deaths from suspected opioid overdoses in communities around the state, prompting Massachusetts Gov. Deval Patrick to declare a public health emergency in March.

In August, an international public health emergency was declared by the World Health Organization, as the death toll from Ebola virus mounted in Africa. After the first cases were diagnosed in the United States, we saw tension between public health experts and politicians, with some states attempting to impose mandatory quarantines. Massachusetts’ response, led by the DPH, has focused on preparing health care workers, hospitals, laboratories, and emergency responders for the possibility of a local case.

Meanwhile, efforts to combat existing public health threats, such as vaccine-preventable diseases, violence, and chronic disease, continue. Working toward reducing health care disparities and ensuring that the health care needs of vulnerable populations are met will also continue to be a focus of public health efforts statewide.

Progress toward better integration of primary care, mental health and substance abuse services, and development of a “robust community system” to provide preventive behavioral health services to avoid the need for more acute care where possible, as recommended by a 2014 DPH analysis of statewide behavioral health resources and utilization, will be significant.

MMS’s Public Health Leadership Forum, scheduled for April 8, 2015, will examine the status of efforts to reduce opioid abuse, and explore how the health care community and the state can contribute to greater success.

On Beacon Hill, Governor-elect Charlie Baker will take office in 2015. He has stated that the opioid crisis and health care cost will be top priorities. He has announced the appointment of former Department of Mental Health Commissioner, Marylou Sudders, as Secretary for Health and Human Services.

What Will 2015 Bring?

Vital Signs asked five committee chairs what they expect in the year to come. 

Vital Signs December 2014 - Steve Ringer, MD
Steve Ringer, MD

“There’s the massive question of opioid use and addiction in Massachusetts and how that interdigitates with the whole health care system. The question goes beyond the drugs, but what happens to people who are addicted to drugs, how are they cared for, what things are available to them, and what’s not… We were focused on infectious diseases before the Ebola crisis, thinking about the diseases we faced, whether it was Chikungunya or H1N1, and thinking about a public health strategy in terms of evaluation and prevention. With Ebola, we see the inter-relationship between public health and disaster planning. And it raises issues of what are the rights and responsibilities of public health. What are the limits of what the government can do? At what point do individual rights get superseded? That’s a persistent issue.”

— Steve Ringer, M.D., Chair, Committee on Public Health 

Vital Signs December 2014 - Paul Biddinger, MD
Paul Biddinger, MD

“With the transition from frenzied planning and extreme anxiety to more long-term and sustained planning, we need to consider what Ebola and, before that, other emerging infections like MERS and SARS mean for our health care system. I believe that we will continue to see more zoonoses and emerging infections, with some that are very serious. We need to think about what it takes to invest in preparing for that threat, both in the health system and in public health infrastructure. Do we need to invest more? I think so.”

— Paul Biddinger, M.D., Chair, MMS Committee on Preparedness

Vital Signs December 2014 - Sushama Scalera, MD
Sushama Scalera, MD

“Ebola will likely continue to be more of a political and social issue in our country than a deadly disease. Yet, there are many public health threats that are far more frightening than Ebola. Influenza is more contagious and still claims half a million lives per year. The death toll from Tuberculosis was 1.5 million last year. The high rates of drug-resistant strains leave treatment options in the developing world limited. In parts of the United States, child vaccination rates against deadly diseases like mumps and measles have dropped below those of developing countries.”

— Sushama Scalera, M.D., Chair, Committee on Global Medicine

Vital Signs December 2014, Dense Rollinson
Denise Rollinson, MD

“Let’s continue to encourage healthy food choices at work and in our schools, and support the use of bikes. And encourage everyone to get a flu shot!”

— Denise Rollinson, M.D., Chair, Committee on Nutrition and Physical Activity


Vital Signs December 2014, Eric Reines
Eric Reines, MD

“In the later stages of life, what’s important are comfort, dignity, love, and peace. In September, the Institute of Medicine released ‘Dying in America,’ which takes head-on … the false accusations that there would be death panels if doctors were paid to discuss advance care directives. That political fallout still distracts the public and politicians from the real issues: that people are suffering and need appropriate care for their suffering. ”

— Eric Reines, M.D., Chair, Committee on Geriatric Medicine

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