In a turbulent time of budget cuts, program shifts and a heavy emphasis on bioterrorism preparedness, Massachusetts Commissioner of Public Health Christine Ferguson says the role of public health in the state needs to be redefined in the 21st century.

Appointed last January by Gov. Mitt Romney, Ferguson faces a complex set of challenges. Post-9/11 federal money is flowing to prepare for low-probability bioterrorist attacks and major disease outbreaks, while funding to combat the rising burden of common, chronic health conditions continues to lag. The state's tobacco control program--a nationally recognized model--has now been virtually eliminated. A number of screening and prevention programs initiated by the state Department of Public Health (DPH) have moved into the private sector.

Ferguson discussed "Public Health Priorities for the Commonwealth: A Discussion with the Commissioner of Public Health" at HSPH on October 1. The event was sponsored by the Harvard Center for Cancer Prevention and Global Chat, a weekly student-led forum.

The DPH is scheduling a series of hearings in Massachusetts over the next year "on what the people think the role of public health ought to be," said Ferguson. She is enlisting the deans of all the schools of public health in the Commonwealth in the redefinition effort, and she noted to the mainly student audience, "I would love to have a cadre of students helping us."

Ferguson, former director of the Department of Human Services in Rhode Island, is a lawyer with broad experience in government health financing and in health reform. A major problem in Medicaid and Medicare, Ferguson has concluded, is that the people who implement these massive programs "don't have a public health orientation," a situation she is working to change "by merging the two cultures of financing and public health."

Specifically, said the Commissioner, "we are going to take the acute and ambulatory care side of Medicaid and merge it with the public health, regulatory and rate-setting functions. It is a change that will have very large, long-term repercussions."

In addition to this public financing initiative and the redefinition of public health effort, the Commissioner listed other goals of her department:

• At the direction of Gov. Mitt Romney, she said, DPH will put together options for universal access to affordable, high-quality health care. (Recent comments from Gov. Romney's top health care advisor suggest the state does not intend to become a sole administrator of a universal health care plan. See sidebar below.)
  
  
• The state needs to build and maintain a strong emergency preparedness plan both for terrorist and natural disease crises. "Unfortunately for those of us in public health," she said, "if we had SARS or pandemic flu, and we weren't able to deal with it effectively, it would totally destroy the credibility of everything we do."
  
  
• DPH will work with specialty groups and the medical profession to develop universal standards of care and communications technologies to prevent medical errors. Ferguson said she would seek to re-invigorate a state-funded medical errors reduction center named for Betsy Lehman, the Boston Globe medical reporter who died in 1994 when accidentally given an overdose of cancer drugs.

In answer to a question about the virtual scrapping of Massachusetts' much-touted tobacco control program, Ferguson called it a "horrible situation" for the Commonwealth. She said that she hoped it could be reinstated when the economy improves, but at present, with budgets so tight, the prospect is unlikely.

"When you have a choice between funding tobacco control or covering 1,000 people in a health insurance program," she said, "that's a pretty tough choice to make."

The tobacco control funding cuts occurred prior to Ferguson's arrival in Massachusetts. She suggested that it would have been helpful if more initial data showing the program's efficacy had been available, while recognizing that it may take years for definitive data to be ready. The point is that stakeholders need to be aware that a program is showing signs of success in order for government funding to continue.

"Sometimes we are not as good as we should be at making what we do relevant to the ordinary taxpayer and ordinary legislator," she noted.