The Critical Work of Boards of Health

Much of their work remains invisible to most residents, yet that work is critically important and affects all citizens across the Commonwealth. For more than 200 years, in fact — ever since 1799, when Paul Revere (yes, that Paul Revere) was appointed chairman of the nation’s first board of health in Boston to control the “filth and offal” that were causing illness in the community — local boards of health have had one goal: to provide for the public’s health and safety.
As the local board of health is one of most significant agencies in the community, here’s some basic information on how they work: what their responsibilities are, who sits on them, and some of the challenges they face.
Acting as the local arms of the state Department of Public Health and the Department of Environmental Protection, boards of health have been given the obligation and legal authority by the state Legislature to protect public health, similar to powers given to police and fire departments. Boards can pass local regulations, just as a town meeting or city council would pass a bylaw or ordinance, and enforce a variety of policies regarding basic health needs.
Consider just some of the major responsibilities of local boards of health (and thus the many ways they keep us healthy and safe). Boards conduct restaurant and food inspections, engage in mosquito control, and report cases of diseases such as measles, mumps, West Nile virus, rabies, and other infectious diseases. They inspect pools and beaches, operate health clinics offering vaccinations against the flu and pneumonia, and take on lead-poisoning prevention efforts. They are entrusted with providing safe drinking water, enforcing sanitary and housing codes, and controlling air pollution and hazardous and solid waste.
Tobacco control, another major concern of health boards, has been one of their biggest success stories over the years. Local boards began tobacco-control efforts more than 20 years ago, and those efforts have dramatically changed attitudes toward tobacco, resulting in huge declines in smoking rates among all ages.
So who are these people who protect us? Those who sit on boards of health are local residents who come from all walks of life. While certain skills are desirable, such as those of physicians and nurses, no specific requirements are needed, just a desire to contribute to a healthy community, and citizen participation is encouraged. In larger cities, members are appointed; in towns, they may be either elected or appointed. All of those who participate benefit from the training programs that the Mass. Assoc. of Health Boards conducts for board members around the state.
Every community in the state has a board of health (though some call it a health department, and some may operate regionally), and while their responsibilities are similar, smaller communities are faced with more formidable tasks and bigger challenges because of fewer resources and personnel. In rural areas, for example, boards of health may have one full-time position or even a half-time person, but they have the same obligations as larger departments. In carrying out their duties, all boards work as needed with other municipal agencies, such as police and fire departments, as well as state agencies.
One of the biggest challenges boards face is the balancing act between regulating individual rights and safeguarding public health. Vaccinations, fluoridation, and the lifestyles of some individuals that may threaten neighbors (such as hoarding) are examples of issues that have created tension and controversy at times between boards and citizens. Boards should act with caution and prudence in this area, looking not just at the individual, but how other people and the larger community are affected. While boards possess the legal authority to regulate individual behavior, the goal of enforcement efforts is compliance, not punishment.
As health boards routinely provide essential services and enforce regulations, new issues continue to emerge, requiring additional attention. Among those are e-cigarettes, all-hazards preparedness, and the arrival of new residents. One of the biggest challenges facing boards today, for example, is providing services for disparate populations within a community, such as refugees and immigrants, whose cultures, customs, and primary languages may be different.  No matter where you live, local boards of health play a vital role in your community. –
Dr. Christopher Quinn is president of the Mass. Assoc. of Health Boards (MAHB) and director of Occupational Health at Sturdy Memorial Hospital in Attleboro. Cheryl Sbarra, Esq. is staff attorney for the MAHB. This article is a public service of the Mass. Medical Society.