When many people think about a career in public health, their minds immediately think of the federal government and its response to national health emergencies such as the coronavirus pandemic or other natural disasters like hurricanes.

But while the federal government plays an important role in promoting public health, it’s also important to remember that most of public health is handled at the state, county, and local/city/municipal levels. After all, public health is all about serving specific communities. This means that the public health programs and initiatives must be tailored to specific communities if they are going to be successful.

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However many resources the federal government has, it would be impractical to think that it would be equipped to handle local health challenges on its own. This is why most federal resources are disseminated through state and local entities for more efficiency.

With this in mind, it might be helpful to discuss the public health challenges Boston is currently facing, specifically, so that local aspiring public health professionals will have a better sense of the kinds of programs and initiatives they are likely to work on once they begin their careers.

Public Health Challenges in the Greater Boston Area

Massachusetts generally has better public health resources than most states, meaning more attention to these issues, and, in turn, more jobs. Also, while Boston has its share of challenges it’s generally better off than the poorer communities such as Chelsea, Brockton, Lawrence. Massachusetts is also an interesting state in that it has very rural areas (e.g., Western Mass) that are often under-resourced and need more attention.

As a major metropolitan area, Boston can expect to face many of the same challenges as other large cities such as New York City. Likewise, the public health challenges in a city like Boston will of course be different from the challenges faced by more rural parts of the country. Below is a look at some of the most pressing public health challenges being faced in the Greater Boston area.

1. Hunger

Hunger and food insecurity are among the most common and detrimental public health challenges for large cities, including Boston.

According to a report conducted by The Greater Boston Food Bank in 2018, hunger and food insecurity cost the state of Massachusetts a total of roughly $2.4 billion annually, with one out of every 10 households (or roughly 700,000 people) unable to afford enough food. The study also found correlations between food insecurity and other major health issues. These conditions, and their associated costs, include:

  • Rheumatology Diseases: $76.9 million
  • Obesity: $132.7 million
  • Mental Health Conditions: $223.3 million
  • Type Two Diabetes: $251.1 million
  • Special Education: $520.3 million
  • Pulmonary Diseases: $572.6 million
  • Poor General Health: $635.4 million

The report also included a number of recommendations to state and federal policymakers to reduce hunger throughout the state, including:

  • Increasing Massachusetts Emergency Food Assistance Program (MEFAP) funding
  • Creating a common application for MassHealth and SNAP
  • Mandating high-poverty schools serve breakfast after the bell
  • Improving access to federal child nutrition assistance programs administered by the state
  • Increasing funding for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in the state budget

2. Homelessness and Addiction

In October of 2021, the city of Boston declared homelessness as a public health crisis. The declaration was spurred by a rise in homelessness in the greater Boston area, which has led to the development of tent encampments in some locations.

Because these encampments lack basic infrastructure (such as plumbing and trash disposal), rodent populations in those areas have grown and subsequently led to a rise in rodent-borne diseases such as Leptospirosis.

This declaration was made with the intent to establish a centralized system to process interventions for those who need shelter or addiction services, as well as kick off the process of gradually reducing, and eventually eliminating, these encampments.

3. Access to Healthcare

In 2016, the Boston Public Health Commission (BPHC) conducted a study to assess how accessible healthcare was to residents throughout Boston.

The report, titled the “Boston Healthcare Access Report (2017),” found that even though the city of Boston has adequate healthcare infrastructure and resources, vulnerable communities still experience barriers to accessing care. This was especially true amongst immigrants and non-English speaking members of the community. Significant gaps in coverage exist especially in areas related to dental care, behavioral health, and substance use.

What this report fails to touch on, however, is that these issues are far more prevalent and devastating to communities outside of the Boston metropolitan area. Access to primary, and especially specialty, care is becoming scarce in rural areas that don’t have resources similar to its city counterparts.

The study does make a total of 19 recommendations for ways to improve access to healthcare throughout the city, but we can also look at these recommendations for smaller communities as well. These are grouped in the following areas:

  • Data standardization, collection, and sharing
  • Policy and budget advocacy
  • Workforce development, recruitment, and retention
  • Opportunities to Advance Health Equity / Address Social Determinants of Health
  • Capacity Building / Coordinated Response to Emerging Public Health Issues
  • Patient Education and Resources
  • Immigrant Rights Education for Staff
  • Expand HelpSteps
  • Health Insurance Outreach Events

The Role of Public Health Professionals

As you can see, the city of Boston has been facing a number of public health challenges even before COVID-19 began stressing our healthcare system. It’s the role of public health professionals—community health workers, health educators, public health researchers, policy assistants/associates, etc.—to address these and other public health challenges to enable Boston and its residents to be as healthy as possible.

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