As federal policies and funding streams continue to evolve, the implications for Massachusetts’ public health system – and the safety net that supports our communities - are coming into sharper focus.

At a time when our collective work and access to basic needs is facing mounting pressure, United Way brought together state and local leaders for a dialogue to explore how federal changes are affecting social determinants of health and community well-being across our region, and what leaders can do now to respond.  United Way convened public health experts for the conversation at The NonProfit Center, including Massachusetts Public Health Commissioner Robert Goldstein, Horizons for Homeless Children President and CEO Kate Barrand, Massachusetts Public Health Alliance Deputy Director Oami Amarasingham and Ann Hwang, President of the Atrius Health Equity Foundation. 

“Approximately 80 percent of what determines our health is not what happens hospitals and care settings, but what happens in our homes or in the communities where we live,” said John Madondo, President of UnitedHealthCare of Massachusetts and Board Chair of United Way of Massachusetts Bay.  
 
“Economic mobility and the health of a community are one.” said Marty Martinez, the former public health leader who is now President and CEO at UWMB.  “They are inseparable.  And that means you also can’t separate housing, access to childcare and jobs, and education from public health either.  Addressing the social determinants of health –housing stability, food security, economic mobility and education opportunity – will lead to better outcomes for people and for entire communities.” 

The risks are real.  Medicaid eligibility changes are expected to impact access to health care coverage for an estimated 200,000 people. New work requirements for SNAP food assistance are estimated to impact 100,000 people in Massachusetts. Immigration policies are creating widespread fear for families who are afraid to go to the doctor or to send their children to school. The safety net, already frayed, is systemically being dismantled by federal policy shifts. 

“This is a lot more than a moment,” Martinez said.  “But we have to focus on both the crisis at hand and advancing the progress we need to continue to make.”  

“Throughout history, public health has gone through ‘boom and bust’ cycles,” said Robert Goldstein, Commissioner of the Department of Public Health. “Investments have been made over the years in the infrastructure of public health – data systems that track diseases, training infrastructure, community health networks  – and we are at the precipice of the federal government about to turn it all off. This infrastructure is the backbone of our ability to respond to whatever crisis is next.” 

“There is a crisis in the caregiver community as well as a crisis in the community,” 
said Kate Barrand, President and CEO at Horizons for Homeless Children.   “There is a crisis facing the families we are serving, but also those who are the ones serving the families.  We are experiencing the highest incidents of teachers starting to leave because of the stress.”  

The state and local leaders brought together by United Way noted that while they track a wide range of data sets, they are monitoring leading indicators such as life expectancy, opioid-related deaths and maternal health.  DPH Commissioner Goldstein noted that the state is continuing to disaggregate the data to look for trends among specific populations and communities to ensure a focus remains on equity. 

“We have to make sure we don’t lose sight of the long-term impacts,” said Oami Amarasingham. Deputy Director at the Massachusetts Public Health Alliance. “The impacts of this short-term crisis will create long-term damage to the health of children and adults.  Hunger, housing instability, lack of health care are adverse childhood experiences that are associated with bad long-term health outcomes.” 

As these pressures mount, leaders noted the role that philanthropy can play as a critical lever for both short-term relief and investing in what comes next. As gaps in the safety net widen, philanthropy is increasingly stepping in when others cannot. 

“Philanthropy can fund initiatives that others are not in a position to fund,” said Ann Hwang, President at Atrius Health Equity Foundation.  “We must balance immediate needs with the long-term systems change we will need in the future.” 

The conversation surfaced concrete suggestions for taking actions: 

What’s the number one thing we can do? 
 
“Don’t be discouraged,” said Commissioner Goldstein. “Over our 250-year history, our state has had its ups and downs, but we always continue to make progress. We have been a shining light for the nation, and we have a lot to be proud of in Massachusetts.  We can build on that. We can rely on that.” 

As Marty Martinez closed out the conversation, “It’s hard to think of a way out, but there is a way forward.”