Member Spotlight: Boston Public Health Commission Executive Director Monica Valdes Lupi Discusses the Evolution of Local Health Departments’ Role in Public Health and Her Path to Leadership

Interview by Taylarr Lopez, Communications Specialist, NACCHO

NACCHO’s Member Spotlight series features interviews with local health department leaders and staff about their careers in public health. This interview features Monica Valdes Lupi, JD, MPH, Executive Director of the Boston Public Health Commission (MA). She is also a member of NACCHO’s Board of Directors. Below, she shares what led her to become Executive Director of the Boston Public Health Commission and steps her department is taking to prepare for the future.

Tell us about your career path in public health.

I’ve been involved in public health probably when I didn’t know what I was doing would fall under public health! In college, I volunteered with different community-based organizations that provided afterschool tutoring for children whose first language was not English and health education and support for migrant farm workers. I continued working with migrant farmworkers throughout law school and that was really my first immersion in public health and health policy, since I was able to help clients access health, employment and educational resources. I went on to get my MPH with a concentration in health law and began working for the Massachusetts League of Community Health Centers which is the primary care association for our state.

Working with our health centers was a great training ground for learning about the connections between primary care and public health. Our patients’ health was driven by the communities in which they lived, and so the services they received to deal with these external drivers or social determinants was in large part funded by the Boston Public Health Commission (BPHC)– the local health department for the City of Boston. My work on cultural competency for the health centers led me to collaborating with the BPHC and this is where my career in governmental public health all started in 2001. I worked under the leadership of John Auerbach and Barbara Ferrer and worked my way up from serving as a senior health policy manager to becoming the first Chief of Staff. In 2007, I moved onto the Massachusetts Department of Public Health as the chief of staff and then as the Deputy Commissioner under John until 2012. It was an exciting opportunity where I was able to lead efforts to scale health equity and health and clinical partnerships from a local to state level while collaborating with other state agencies in implementing health reform and payment transformation. In 2013, I moved to Virginia with my family and joined the Association of State and Territorial Health Officials (ASTHO) where I led developing its health systems transformation portfolio. It’s been an adventure being able to work at the local, state, and national levels on so many important public health priorities. Returning to BPHC as the Executive Director in 2016 feels like my career has come full circle to where things all began, and it really has been a privilege to serve alongside colleagues and community partners that I’ve grown up with in public health.

What are some of the highlights of your career in public health? What makes the work that you do worthwhile?

Being at the forefront of nationally recognized health equity activities at the local, state, and national levels has definitely been one of my career highlights. I was involved in health disparity conversations seventeen years ago and to see the evolution of our work across the nation has been really exciting. Another career highlight would be our work in Massachusetts on the early stages of implementing health reform and forging partnerships with our state Medicaid agency (MassHealth). We were able to successfully get comprehensive tobacco cessation coverage for our MassHealth clients and showed that every $1 invested in this benefit led to an average savings of $3.12 in cardiovascular-related hospitalization expenditures. On average, these savings were recouped within slightly more than a year after the benefits were used.

I think the reason why many of us work in governmental public health, is because we want to make sure we’re empowering our communities by developing policy changes and investing resources that support on the ground efforts to achieve optimal health.

What challenges are you or your health department currently facing?

I think many of us are grappling with the opioid epidemic. This is not a new issue for us in Boston, and several of our services around addictions-related prevention, treatment, and recovery support have been recognized as best practices. However, with fentanyl in the mix, we’re challenged in keeping pace with non-fatal and fatal overdoses. Additionally, we have new partners in this fight with our first responders in Boston EMS, the police and fire departments. We’re working to leverage resources and expertise across our city agencies, health care system, community-based organizations and philanthropy to tackle the epidemic.

Another challenge for us is adapting to the new accountable care organizations that that have been rolled in out statewide. We’re currently involved as a community provider to support long term behavioral support services, and so it’s important for us to understanding new payment mechanisms and how to communicate these benefit changes to both our clients and staff. Many local health departments are in this same space and trying to determine how to leverage momentum in health delivery reform to sustain and make investments in public health programs that improve population health.

What is the biggest change you’ve seen in public health since you’ve started in this field?

The social determinants of health have become part of our everyday language in public health and beyond. Local health departments across the nation are working to braid funding and optimize policy levers in housing, education, and public safety to improve the health of the diverse communities that we all serve. I also think that the role of Chief Health Strategist and Public Health 3.0 have pushed both local and state health officials to re-frame the way that we do our work, especially when it comes to cultivating strategic partnerships, harnessing the power of messaging and the narrative for health, and using data for action.

How are you positioning yourself and/or your health department for the future?

We recently received public health accreditation which I think is an example of one way that we’re preparing for the future. Creating a culture of learning through our accreditation activities has truly transformed the way that we approach all our work at BPHC. As a health department, we envision a thriving city where all residents live healthy, fulfilling lives free of racism, poverty, violence and other systems of oppression — that all residents have equitable opportunities and resources that lead to optimal health and well-being.  Our strategic priority on advancing health equity has been an important driver across all our efforts as it’s provided a new framework for integrating equity in our day-to-day practice. The foundation of this priority is built on cross-sectoral collaboration, social determinants of health, and community engagement. A colleague and I are part of the Kresge Foundation’s Emerging Leaders in Public Health program which has given us an opportunity to accelerate these efforts.

How long have you been a member of NACCHO and what value do you find in belonging?

I’ve been a NACCHO member since I returned to BPHC in 2016 and have also been actively involved in the Big Cities Health Coalition where I’ve co-led two different working groups focused on health equity and safe consumption sites. Last year, I joined the NACCHO Board as an At-Large member and it’s been a really great way of learning more about NACCHO and the breadth and scope of its services and resources and the ways that we can support local health departments on the ground.

NACCHO provides its members with so many different opportunities for peer-to-peer learning. While all public health is local, we often don’t need to reinvent the wheel when trying to figure out how to address a specific public health challenge or issue. There’s valuable expertise among NACCHO’s members and the organization has played a vital role in sharing best practices, connecting its members, and advocating for critical public health resources at the national level.

What do you enjoy doing in your time away from work?

While work consumes much of my time even when I’m not in the office, my husband, Louis, and kids, Niko and Elie, keep me grounded and remind me of what’s really important in life. In my “off” time, I serve as a Lyft driver for Niko and Elie shuttling them back and forth for hockey games and practices and riding lessons. This has increased exponentially now that we’re back in Boston where it feels like there’s an ice-skating rink at every turn! In warmer weather, you’ll find me at the beach on the Cape where our time is dictated by the changing of the tides and we go between surf-casting and clamming.

For more interviews in the series, visit NACCHO Voice Member Spotlight.