In Updates from Jo, The People's Blog

The following are remarks I delivered at the UMass Amherst Elaine Marieb Center for Nursing and Engineering Innovation’s first annual symposium on nursing and engineering innovation on September 13, 2022:

I am honored to join you today. 

Thank you to Professor Karen Giuliano and Professor Frank Sup for the invitation. And for your visionary leadership.

I would be terribly remiss If I didn’t begin with a huge cheer for UMass Nursing which rose to each new challenge during the COVID-19 pandemic – whether it was mass testing or mass vaccinations – with the kind of grace and grit that I have come to understand is intrinsic to the students, faculty, and staff of this program.

Not only did you keep the wider UMass community safer and healthier, you were the frontline heroes of our region – working long hours, under great duress, in an ever changing context. I can tell you without hyperbole, that during the pandemic I heard again and again, “thank God for UMass.”

I learned yesterday that you’re 1 million tests strong. Incredible.

I begin by piling on the love and thanks for your sacrifice and service. 

I also want to cheer for the Elaine Marieb Center which brought together nurses and design experts – for example –  to rapidly develop a face shield – to address critical PPE shortages. Providing solutions at a time when most of us only had questions. The value of your efforts is clear both in the application of your work and in the investments made to this program.

It’s so clear to me that the work you all do to bring people who understand on-the-ground challenges in nursing and patient care together with people trained to develop innovative engineering solutions – improves health care and saves lives.

Again. Thank you.

The opportunity to speak with you today allowed me to reflect a bit on interdisciplinary, cross-sector collaboration – between nurses and engineers, of course – and in the state legislature.

For my part, I believe that government cannot work unless people make it work. In my job, I have an avenue to write and fight for policy and budget priorities. But it is my constituents – it’s advocates, researchers, and folks on the front lines – who surface urgent, breakthrough ideas. Their ideas and input make me smarter, their experience and expertise make the policies I fight for more relevant and more successful.

That’s the secret sauce for advancing policy and budget priorities. Always synergy, collaboration, and partnership – from all affected parties, all fields of knowledge, across all manner of expertise.

But as much as my work as a legislator rests on the values we all hold in common, and despite the fact that our state’s political system is actually designed to allow for a great deal of deliberative input from all sides, too often – still – we work in silos on Beacon Hill.

And yet, like you, we look for ways to pierce the silos and bring people with varied expertise and experience together.

I’d like to share two quick examples of work to thwart a one-size-fits-all policy, talk about a policy we built from the ground up with a great deal of cross-disciplinary work, and then offer a couple of examples in the realm of health care policy.

Remember that I said that the state Legislature is built to take input. It’s what we do. We hold hearings. We meet with experts and advocates. We listen deeply to constituents.

Amid this, the pull to siloed work – fueled by deadlines, crushing workloads, pressing issues, a lack of diverse expertise central to policy making, not enough staff or organizational resources, and a pretty rigid committee structure – leads to policy that threatens to not work for the entire Commonwealth. 

Again, two quick examples:

#1: Last spring, the legislature was working on a comprehensive bill to expand access to voting. That’s of course very good. Voting is our most potent superpower after all. But the bill we were considering left out the kind of voting machines used in many western Massachusetts communities – crank wooden boxes. And it assumed that all city and town clerks worked full time – and not half or a quarter time as in many of our smaller towns. The required fixes were quick and pragmatic, but very real and important to the towns that would have been left out or unduly burdened. If it weren’t for the expertise of local Clerks who are now implementing the law, the problem would not have been identified and the fixes would never have been made.

#2: Next, a bill on bugs. Mosquitos specifically. An issue I never thought I’d tackle and knew nothing about. But a bill filed by the Administration landed in the Joint Committee on Public Health, which is the committee I chair, that basically said that the Commonwealth could spray pesticides – whatever it wanted, whenever it wanted, wherever it wanted, until the end of time. 

Environmental experts, farmers, municipalities, public health officials, constituents, and more leapt into formation to influence this policy – each bringing a sharp and unique perspective – perspectives which were sometimes in contrast, and sometimes complementary, with others’ interests. We gathered expertise from viral disease researchers, entomologists, agriculture and water supply experts and others – even people with expertise in how wind can spread aerial-sprayed pesticides. It was the Committee’s job to find a path forward because stalling out and doing nothing was not an option with EEE, West Nile, and other mosquito-borne illnesses threatening the health of Commonwealth residents. 

I have no doubt that many of you also believe that stalling out and doing nothing, as you run into difficulties, is not an option either.

So what can it look like when policy is built through collaboration, partnerships, and cross-discipline sharing?

I’ll give you one example and then two quick health care stories:

As the Commonwealth wrestled with the pandemic and its impact on K-12 education, my office was contacted by a number of experts – who reached out separately from different disciplines, almost at the same time.

We heard from architects, public health leaders, educators, caregivers, superintendents, and more – with a similar clarion call: Make school buildings healthier so that we can withstand this crisis and crises to come. It was our job to fan the synergistic sparks I talked about earlier and bring these folks together, along with school facilities experts and state agencies that build school buildings.

We were on a roll when we heard from climate experts that the same goals we had for healthy schools could also match goals for green schools. And so the group expanded to include environmental scientists and activists. 

Each time we added a new field of expertise we had to introduce them to the work, summarize what had already been said and done, and urge them to share their know-how and perspectives. Again and again and again so that we could ensure that the best ideas were being heard and seasoned by all, and that they’d rise to the top.

In the end, the whole was much greater than the sum of its parts. We passed this concept within a large climate bill – not a public health bill or an education bill as we originally thought. And now the same group of folks is implementing the law, so the interdisciplinary integration is happening all over again so that we can see the policy through.

Because I’ve learned that it’s not enough to have a good idea and get it passed. Legislators also have to see it through to implementation. 

Now two health care examples:

As you well know, the pandemic exposed ugly, rife inequities that have long been present in our Commonwealth – glaring for all to see as the contagion tore through community after community.

In Massachusetts, People of Color got sick disproportionately. And then got disproportionately sicker. Filled the hospitals disproportionately. And tragically died disproportionately.

In preparing for the current session my team and I asked ourselves what our response should be to such rife racial disparities in health outcomes. And we filed the HEALING Act – or Health Equity at All Levels of Government.

The bill is a structural response, putting health equity as a core organizing principle at the center of everything that government does.

Our legislative director and our public health fellows spoke with experts across the nation in multiple states where they were doing pieces of health equity work in wildly diverse settings. State by state, we picked up and pieced together ideas to build this pretty massive policy response. Each state had its own context, its own assumptions, its own culture. For us, the work required being willing to see and to learn from a pretty high altitude as one by one by one by one we picked up what we believe are the best ideas to build our proposed policy. We had no idea what we’d find when we set out, but in the end, we found we had a powerful, Massachusetts-centered response.

I imagine that – across the nation – nursing and engineering don’t speak with each other as a matter of course, but here at UMass Amherst, you’re doing the revolutionary work of synthesizing the best ideas from your fields of practice into something new and needed.

And finally a story about local public health and a bill titled the State Action for Local Public Health Excellence or S-A-P-H-E, SAPHE.

This is a story about a long arc of work which started with a 2017 Commission charged with addressing the fact that Massachusetts has 351 municipalities with 351 ways of tackling public health. 

In 2017, the state knew that was problematic. In 2020, as COVID hit, it went from being a problem to being a crisis – as public health protections and public health guidance changed with each zip code.

SAPHE was the creation of the widest possible range of experts – from public health experts to municipal government experts to tax experts.

Public health experts told us what other states were doing.

Local leaders told us what expertise and help they needed and how it should be delivered.

State colleagues from DPH told us what they were already doing and how this could fit in.

Researchers told us what the gold standards were for public health protections.

Fiscal conservatives told us that they wanted an upstream fix that would be sound, ethical policy and also save us loads of money in the end.

And out of these painstaking, years-long conversations came a bill, passed by both chambers. We’re now negotiating with the Governor over the final language.

Was it a linear process? Absolutely not. We kept circling back to revise and reconsider as new inputs emerged. But in the end, it’s a thing of beauty.

Much like – I know – what you’re creating.

The lesson here is: We’re all so lasered in and focused on our disciplines in the Legislature, we risk missing the possible. Defying limits and finding what’s possible is at the heart of leaping across disciplines. 

Economists read science fiction, sociologists search for metaphors found in literature, school building architects design buildings with the counsel of the students who will fill them.

When we expand to wider views, we can see new answers and new questions.

I am proud that this center is at UMass Amherst, proud and grateful that you are a driving force in what makes Massachusetts a national leader in health care innovation.

This Center – and your work – demonstrate clearly why we must continue to invest in cutting edge technology and in advances to improve patient care. And why we must never stop reaching to colleagues in wildly diverse fields. 

These must go hand in hand – and you’re blazing the trail.

Congratulations and thank you for your work. Now and in the days to come. 

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