When Robbie Goldstein took the reins as the state’s new public health commissioner in April, he brought national experience dealing with the public health crisis of our time. As senior adviser to Rochelle Walensky, director of the Centers for Disease Control and Prevention, Goldstein was at the center of the country’s public health response to the COVID pandemic. 

Walensky had been a mentor to Goldstein at Massachusetts General Hospital, where both previously worked as infectious disease physicians. In a conversation on this week’s episode of The Codcast, Goldstein picked up on a favorite axiom of Walensky’s in talking about their work together at the CDC. 

“We would say to each other almost on a daily basis, hard things are hard – and we can do hard things,” he told Codcast hosts John McDonough of Harvard’s school of public health and Paul Hattis of the Lown Institute.

Goldstein returned repeatedly to the idea that many public health issues are complex and not given to simple solutions, but that progress nonetheless can be made with focused effort.  

He said the pandemic exposed the poor state of public health readiness nationally to deal with a problem of that scale. “What I wish we knew back then was the importance of preparedness in our emergency response infrastructure. I think it is reasonable to say that we entered 2020 with a pretty weak, anemic preparedness infrastructure in this country,” Goldstein said. Massachusetts “was likely better than much of the rest of the country,” he said. “But even here, we were not as prepared as we should be.” 

One way the state can be more prepared for such a crisis in the future is by better coordinating the work of local public health departments. That’s the aim of pending legislation, dubbed State Action for Public Health Excellence Act, which Goldstein voiced support for. The bill would set uniform credentialing standards for those working local public health departments, and would support more efforts at shared services among local departments, many of which are tiny offices  in small Massachusetts towns. It would build on a grant program the state established in 2020 to move public health programs in the same direction. 

“The first version was an enormous step,” Goldstein said of the grant program. “This is another enormous step forward to support local public health,” he said of the pending legislation. “If we provide adequate resources and now we provide people with a rubric to judge themselves and the technical assistance, the training, the support that they need to get them there, we will see a real transformation of local public health.” 

Goldstein defended the public health-focused effort to deal with the seemingly intractable problems in the area of Massachusetts Avenue and Melnea Cass Boulevard in Boston. 

“There seems to be very little, if any, progress that’s been made in resolving that,” said McDonough, who pointed to a recent Boston Globe commentary piece suggesting the situation represents a failure of the public health approach. 

Goldstein acknowledged the persistence of the problems with drug overdoses and a homeless population at the encampment there, but he pushed back against the claim that the public health-oriented approach that’s been in place has failed. 

“We have to remember the counterfactual,” he said. “I think public health has done a tremendous amount at Mass. and Cass and to address substance use and homelessness across the Commonwealth. What is hard to quantify, what’s hard to understand is … how much bigger would the devastation have been had we not been at the table and had we not had public health outreach workers on the street at Mass and Cass, had we not had an engagement center in the South End to bring people in to get them recovery services to make sure that those who wanted treatment beds had treatment beds available?”