Tension between the chief executive of the Cambridge Health Alliance – who also serves as the city’s health commissioner – and city councillors became evident at a budget hearing Wednesday. The issue involved loss of funding for a Cambridge Public Health Department outreach team that goes to parks, housing developments and other sites throughout the city to tell residents about ways to stay healthy and safe during challenging situations ranging from the Covid pandemic to extreme heat caused by climate change.
Councillors strongly urged the head of the health department, chief public health officer Derrick Neal, to seek city funds to keep the Cambridge Community Corps initiative going. But Neal indicated that Health Alliance chief executive Assaad Sayah, his boss, instead wanted Neal to find money within the department’s budget, including by possibly reducing the department’s administrative staff.
It’s not the first time that Sayah has exerted control over health department staffing in opposition to councillors, who don’t have authority to oversee this particular department because of an unusual arrangement that makes the Alliance, a health care system, the city’s public health commission. Cambridge pays CHA to operate the public health department.
CHA laid off 84 employees in 2023 in a move it said was necessary to keep the money-losing safety net institution alive. Councillors wanted to save seven public health department positions and offered to pay the Alliance to keep the jobs. Sayah refused to accept city money for two of the positions, so they were cut. At the time, councillor Patty Nolan and former vice mayor Alanna Mallon wanted the council to examine the benefits and costs of the unusual arrangement; Sayah opposed the idea, saying there is no question the relationship benefits public health and the city. He reiterated the view at the Wednesday hearing. “The structure of the public health department within the city of Cambridge is absolutely unique, and I have to say it is the envy of many communities in the area and around the country,” Sayah said.
The council never looked into the relationship. councillor E. Denise Simmons, now mayor, opposed the idea two years ago, saying she didn’t understand why an examination was necessary.
Pressure to keep program
Now, Sayah apparently does not want the health department to ask for city funds to continue the outreach team, known as C3. The initiative was funded mostly by federal Covid-recovery money via the American Rescue Plan Act received by the city, and Arpa support for C3 runs out in August. When councillors asked Neal whether the health department seeks city support, he said no.
“I’ve had a conversation with Assad, and we need to make sure that we have a good balance between, quite frankly, the management level in our office and those individuals who can be outwardly facing, and we have somewhat of an imbalance when it comes to our leadership team, and could those positions be repurposed?” Neal said, apparently recounting what Sayah told him. “And Assad tells me to go find other alternative solutions, because he understands how important it is for our community to remain gainfully employed.”
Neal estimated it would cost $150,000 to $200,000 to keep C3 going. The pressure from councillors to ask the city for money increased. And a city official practically invited a request, saying the administration was talking about what will happen to C3 after the Arpa allocation ends. Matt Nelson, assistant to the city manager, said: “I think the city manager is willing to keep that conversation going with the Public Health Department, but you know, as Derrick said, there hasn’t been a formal request.”
Finally Neal agreed to ask, sort of. “I’m going to have that conversation with Assad, but we will put in a formal request,” he said.
Dawn Baxter, spokesperson for the public health department, was contacted for comment after the hearing; the response came instead from David Cecere, spokesperson for the Alliance. “Cambridge Health Alliance and the Cambridge Public Health Department aim to continue to fund the C3 outreach program with existing resources through departmental efficiencies while exploring alternative funding opportunities,” Cecere said in an email.
Councillor questions
At the Wednesday budget meeting, Nolan repeated objections she had raised in 2023, such as the fact that the Cambridge Public Health Department serves residents of communities outside Cambridge with city funds.
Nolan singled out the health department’s tuberculosis clinic, which diagnoses and treats people with the infectious disease, some of them from outside the city. “Much of that program funding is underwritten by a grant, and it’s important to remember, when it comes to TB care, that we have to have a regional approach to caring for the patients,” Neal said.
Nolan also said that after the health department laid off its director of population health initiatives in 2023 – one of the positions that was lost – a year later the Cambridge Health Alliance created a job at the health department called director of community engagement with similar responsibilities. Neal denied that, saying the two jobs were not the same.
Asked about the issue, Cecere said that after the layoffs in 2023, CHA “reshaped its population health initiative to leverage its strengths across its communities, reduce duplicative efforts and align outreach efforts with its clinical services and community health. This effort was designed in part to improve health outcomes related to chronic conditions.”
The director of community engagement post was created after the redesign of population health work, he said. “While there is some overlap with the responsibilities of the previous senior director role, this position focuses more on deepening ties with community members, partners, the city and CHA,” Cecere said.
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