The 70th anniversary of the law that enabled the state to treat chronically ill individuals at Lemuel Shattuck Hospital seems like an apt time to consider how our understanding of public health has changed, and how pressing the need for access to health care remains. Chapter 770 of the Acts of 1949 formalized the City of Boston and the Commonwealth’s agreement to transfer “up to 15 acres of…Franklin Park...Any land conveyed under this act shall, from and after such conveyance be held for the state department of public health, which is hereby authorized and directed to construct on such land a six-hundred bed hospital for the care of persons suffering from chronic disease, including a nurse’s home, outpatient department and other facilities.”
Policymakers then understood a general link between poverty and chronic disease incidence, which is why they agreed to build a public teaching hospital and outpatient facilities offering affordable diagnosis and rehabilitation services in the Commonwealth’s biggest city. Since then, diabetes and addiction have overtaken tuberculosis as public health threats, but the poverty-health link is clearer than ever now. We see our poorest neighbors often struggling with multiple chronic conditions (infectious and otherwise) that are impossible to treat when their housing is unstable or nonexistent. The infectious diseases that incubate among economically fragile, homeless and very sick populations rarely stay there, as San Diego and other cities have learned to their chagrin. I and others worked with state agencies in 2018 to meet your request for more transparent planning. I’ve spent the last year following the work of the Shattuck Hospital’s Community Advisory Board and neighbors to define a new service model that will ready the campus for another century of public health shifts. Those conversations between the state’s Executive Office of Health & Human Services, the Department of Public Health, and Department of Capital Asset Management and Maintenance, and the City of Boston’s Departments of Neighborhood Development and Health and Human Services and your neighbors are informed by links between poverty, housing and health. At almost every neighborhood meeting I attend with you, and in others across districts, the most common questions raised are: how anyone can afford to continue living here?