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Bouquets and Brickbats for Massachusetts Public Health

Posted by John McDonough  December 9, 2013 07:58 PM

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Two new reports, out today from the Robert Wood Johnson Foundation, put Massachusetts in different lights -- one really nice, and another pretty bad. Let's look!

First, RWJF released this report today "The Massachusetts Prevention and Wellness Trust: An MA H&W Fund.jpgInnovative Approach to Prevention as a Component of Health Care Reform." The report reviews the substance and process behind the creation, in 2012, of the new four-year $60 million Trust, created as an element of that year's major health care cost containment law. Nicely done, attractive, readable, and informative.

Written by former MA Public Health Commissioner John Auerbach, an ardent advocate for the creation of the Trust, it describes the broad coalition of folks who came together starting in 2011 to push for the Trust's creation, and describes the political process involved in setting it up. In connection with the report's release, RWJF also posted today an informative interview with Auerbach and Cheryl Bartlett, his successor as DPH Commissioner:

NPH: Was there a model for the Trust fund?

Auerbach: I would say it was an innovative idea, however, there were examples of efforts that were helpful in coming up with the model. The Affordable Care Act's Public Health and Prevention Trust, for example, allocated hundreds of millions of dollars to community transformation grants.

Bartlett: We did ROI analysis projections for how many preventable hospitalizations we needed to achieve the target cost savings of $60 million over four years. We provided information to the Advisory Board on the top 13 most-preventable health conditions and risk factors that have evidence-based strategies with measurable outcomes and cost savings. Each advisory board member prioritized the list and we came out with the four conditions we're using for the Trust. Applicants for grants were required to choose at least two of the four conditions and design a collaborative approach for community-clinical linkages to support care coordination and health promotion at a local level.

Creation of the Trust is a great accomplishment for public health in Massachusetts and, perhaps, an encouragement for other states to follow this lead, as Massachusetts followed the lead set by the Public Health and Prevention Trust in Title IV of the Affordable Care Act.

All is not so lovely, though, when it comes to prevention and public health in Massachusetts, especially when the topic is tobacco and smoking prevention. As luck would have it, another RWJF report dropped out of the sky just as I was writing this post: "Broken Promises to our Children: the 1998 State Tobacco Settlement 15 Years Later."

The report "finds that states continue to spend only a miniscule portion of their tobacco revenues to fight tobacco use. The states have also failed to reverse deep cuts to tobacco prevention and cessation programs that have undermined the nation?s efforts to reduce tobacco use."

Oh oh. Where does Massachusetts stand?

Fiscal Year 2014 Funding for Smoking Prevention: $4 million
Funding Level recommended by U.S. Centers for Disease Control & Prevention: $90 million
Percent of CDC recommended level actually funded: 4.4%
State Rank: 36 lowest out of 51

Come on, Massachusetts. We have one of the nation's highest tobacco tax rates, and we're 14th from the bottom when it comes to helping people quit.

We can do better.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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