The divide between the two cities shows the difficulty of public health reform
The divide between the two cities shows the difficulty of public health reform

Methuen officials, including Perry and Kelly Townsend, director of health, human services and inspections, say the tipping point for their The shared services agreement came in late February when Lawrence declined to continue working with Ethan Maskup, a state-funded consultant who serves as the shared services coordinator for Lawrence and Methuen.

And Lawrence has consistently failed to meet standards that would allow it to partner effectively with Methuen, Townsend said.

“It’s not fair to our community,” she said. “We need people who are well versed, or at least getting to that point.”

The failure of the shared services agreement between the two cities could cost them both.

Last year they received $582,000 in government grant money available only to municipalities in such agreements. The time to renew this grant is now, and without a functional public health partnership, the cities stand to lose about $1.7 million over the next three years, officials from both cities said.

Lawrence officials admit they struggle to maintain effective public health services because of the city’s poverty and long history of underfunding public health. city health officials outlined the inadequacy of Lawrence’s public health services at a city council meeting Tuesday, prompting Councilwoman Wendy Luzon to describe the situation as a “failure of administration.”

Lawrence is struggling to mend fences, according to City Hall, but in the meantime, Methuen is ready to move on. City officials are working with the state Department of Public Health to establish a new partnership, possibly with Haverhill, by Monday, which should allow them to remain eligible for the DPH Shared Services grant, Perry said. That would leave Lawrence without a partner and ineligible for the grant money.

The growing rift between the two cities underscores the challenges Massachusetts health officials face as they try to build a more robust, equitable public health system for the state. Unlike other states with strong county governments, public health in Massachusetts is managed by the state’s 351 municipal health departments, many of which are underfunded and understaffed. Poorer communities are much more likely to have poorer public health services.

“We have an almost uniquely fragmented, inefficient and inequitable local public health system,” said Carlene Pavlos, executive director of the Massachusetts Public Health Association.

Shared services is one solution, and two years ago the state committed $200 million to training, data management and shared services agreements. As a result, about 320 municipalities participate in shared service agreements, according to DPH, and the Legislature is considering a bill designed to encourage local public health departments to meet state performance standards.

In Lawrence and Methuen, vastly different economic conditions and financial commitments to public health became an obstacle to collaboration. Methuen spends $21.62 per resident on public health, officials said, compared to less than $2 per person in Lawrence.

Lawrence, a city of almost 90,000 are overwhelmingly Hispanic, and just under 20 percent of the population lives in poverty, according to the U.S. Census. Methuen is the smaller city with about 53,000 residents, most of whom are white and wealthier than their neighbors in Lawrence. Its median household income is nearly double that of Lawrence.

“We don’t have the resources, this department doesn’t have the resources to hire the people we need to help us improve the public health of this city,” Joel Gorn, chair of the Lawrence Board of Health, said at a city council meeting Tuesday.

Lawrence, a former mill town and one of the poorest cities in the state, is challenged by dilapidated housing that dates back to the late 19th century, serious problems with tuberculosis, homelessness and addiction, and an influx of migrants with health problems and no insurance,” said Gorn.

“The citizens of Lawrence face unsafe dining establishments, many apartments that are not up to code that are fire hazards, and public health challenges that are enormous,” Gorn added.

Mascoop presented a report on the problems it observed in Lawrence’s public health services at the city council meeting. In the report, he emphasizes that there are 400 licensed restaurants in the city, but there is no clear documentation for health inspections.

The report documented one incident in which the health department learned that trash containers were being cleaned in a school kitchen sink. Inspectors checked the containers but never set foot in the kitchen, according to his report.

Home inspections also need more transparency, Mascoop wrote. When Lawrence cites landlords for code violations, tenants and even the board of health are not notified if they appeal, Mascoop reports.

Mascoop’s report also detailed what it called mismanagement of state funding given to the city to improve public health in the wake of the COVID-19 pandemic. Lawrence had received a government grant to hire an epidemiologist to trace contacts, but instead used the money for inspectors.

Santiago Matias, chief of staff to the mayor of Lawrence, said in an interview Friday that the city still intends to hire an epidemiologist.

Peter Blanchette, interim director of Lawrence’s inspection services, which also oversees public health, said enforcement efforts must take into account that many food service businesses are run by immigrants who may not be familiar with American standards for health and safety.

“There are many things that need to be done, but they are not things that you can do overnight,” he said.

A state dashboard showed the two cities’ collaboration ranked low in DPH’s assessment of the state’s 51 shared service arrangements. Cities meet 62 percent of the state’s performance standards for services such as environmental protection, sanitation and disease control and prevention.

Mascoop was among officials in both cities trying to bridge differences between Lawrence and Methuen, but he himself became a lightning rod.

Mathias said Lawrence has placed Mascoop on leave pending an investigation into what he described as communication misunderstandings involving the city’s predominantly Latino population, though he did not provide details on what he said went wrong.

Townsend said he believed the allegation was baseless, telling Mascoop, which was formerly of Framingham director of public health, is a respected public health expert.

In an interview on Friday, Mascoop said he didn’t know what communication problems Mathias was talking about.

“I have no idea what they’re talking about,” he said.

Methuen interpreted Mascoop’s forced absence as the end of the shared services agreement, according to Perry, the city’s mayor.

“I obviously don’t understand them giving up the grant,” Perry said. “It’s a missed opportunity.”

Now, Lawrence is ready to make big changes quickly, Mathias said. The city will again work with Mascoop, separate the health department from inspection services and is trying to hire a public health director.

Townsend, however, said she met repeatedly with Lawrence representatives and, along with Gorn and Mascoop, raised the alarm for nearly a year that the shared services agreement was at risk.

“I care about the people of Lawrence, but at this point I just don’t know what we can come up with,” she said.

Jason Laughlin can be reached at [email protected]. Follow him @jasmlaughlin.

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