Understanding the mayor’s office from the inside

Natalie Swartz ’20 has spent the past tumultuous year serving as the fifth Harvard Presidential City of Boston Fellow in the Boston Mayor’s Office. With former Mayor Marty Walsh being tapped to become President Biden’s Secretary of Labor, and Mayor Kim Janey taking the reins, Swartz had the remarkable experience of getting to work under not one, but two mayors. And did so in a time of turmoil for the City, the region, the nation, and the world.  The Gazette recently caught up with Swartz and asked her what the experience was like.

Q&A

Natalie Swartz

Gazette: It certainly has been a year like no other — and you got to experience decision making on the frontlines.  What was the experience like?

Swartz: I studied public health in college, and I think prior to this pandemic many people didn’t know exactly what that meant. I would always explain that public health encompasses the things outside the doctor’s office that affect our health. It turns out that a global pandemic highlighted for so many people what public health means in terms of having a safe and supportive environment and access to resources and opportunities that help keep you healthy. I had always been interested in the role that local government played in public health. Throughout the pandemic people have seen so clearly the role that local government plays. I came to government to work on issues exactly like this, so it was a pretty interesting and rather remarkable convergence.

Gazette: Did you feel prepared, at least as much as anyone can be prepared, for what happened when you got to City Hall?

Swartz: I felt prepared for a lot of the frameworks that we use for thinking about how the City should respond to COVID-19. My undergraduate experience prepared me to think about how to assess which neighborhoods were going to have a disproportionate impact. Why are you seeing different outcomes in different neighborhoods? What resource and opportunities does one neighborhood have access to that might lead to different outcomes? Why are we seeing black and brown residents have disproportionate morbidity and mortality from COVID-19? Those are the kinds of questions that drove me into this job, and it’s been fascinating to get to see the people around me asking those very same questions, and to help in working towards ensuring that we work towards more equitable outcomes for everyone — no matter what neighborhood you live in.

Gazette: What types of projects were you able to work throughout the past year?

Swartz: I was fortunate in that the projects I worked on aligned with my specific interest areas of supporting people experiencing homelessness and addiction. I was part of a team with the Office of Recovery Services and Mayor’s Office of New Urban Mechanics that was thinking about how to design low threshold overnight spaces for people experiencing homelessness and people who use drugs.

I also worked on a direct cash transfer program for young people experiencing homelessness, which is something the City had never done before. As you can imagine, COVID made it a lot harder for people experiencing homelessness to access a lot of the in-person resources they used to have access to, and that of course only exacerbated the difficulties that they were facing. The Boston Resiliency Fund granted a nonprofit called More Than Words $25,000 to do direct cash transfers for young people experiencing homelessness, and I was able to help with the implementation and evaluation of that initiative. We found that young people were using the $100 payment to support their basic needs like food and transportation.

I also worked on the City’s COVID-19 City Workforce & Operations Task Force. We asked questions like how do we deliver critical services to our residents while ensuring the safety of our employees and the residents that we’re serving?

And, more recently, I have played a part in examining how the City responds to mental health crises. The Mayor’s Office is working with the Boston Police Department, Health and Human Services Cabinet, Emergency Medical Services, Boston Medical Center, and community stakeholders to determine what we can do ensure that those in need receive the safest, and best response possible. I have been really compelled by this work to bring together many agencies in the City to figure out how to improve responses for those experiencing mental health crises. It’s been tremendous to reimagine what public safety and justice and healing look like with this group. And it’s been a great experience to be part of a room where you’re bringing together stakeholders who all want to see us do better, and sometimes just having closer coordination and closer collaboration and an open line of communication can make that happen.

Gazette: When did you first become interested, and passionate about these issues?

Swartz: I’m from Los Angeles. I moved to Boston for college. Boston is the city that has shaped me in so many ways because it’s where I learned about studying social determinants of health. At Harvard I took a class by Professor David Cutler, called “The Business and Politics of Health,” and that’s where I got exposed to this whole field of studying things beyond biology that affect people’s health and to studying health equity.

I think that equity requires us to be intentional about looking at how in the past and in the present our systems disproportionately disenfranchise Black and Brown members of our community and requires us to be really intentional about improving access to resources and care and opportunity for those facing the greatest barriers.

Moving to Boston is also what exposed me to the opioid epidemic, which has been the single issue that has compelled me the most for the last six years. I have been able to witness firsthand how devastating this crisis is. There are families who are losing their loved ones because they didn’t have access to the care that they needed. I’m compelled by how stigmatized it is, and how we make it hard for people to access care, and how hard it is for families to grieve and to share what’s happened to them. The opioid epidemic exemplified what I was learning in the classroom about social determinants of health — that we might have great biomedical technology in the form of medications for opioid use disorder and yet we aren’t getting them to people. We’re not making it easy to access this life-saving treatment. The more that I have studied this issue and worked directly with people navigating both homelessness and addiction, the more I have become completely engrossed in wanting to work on these issues and passionate about how we improve care and resources for people who are facing these difficult challenges.

During my time at Harvard, I was able to work directly with people experiencing these issues as a director at the student-run Harvard Square Homeless Shelter. I also did my thesis research at the Engagement Center in Boston. It’s been an amazing experience to go from meeting and interviewing folks at the Engagement Center to working now at the City level with the people who are operating it — those who are making the decisions about how we serve the people using the space.

Gazette: As the fellowship begins to wrap up in August, what comes next for you?

Swartz: I plan on applying to medical school.  I want to be a physician working with people who have addiction. Whether that means being a psychiatrist, or if that means being a primary care doctor who puts an emphasis on providing care for patients with substance use disorders, I’m not sure yet, but I do know I’d love to do something along those lines. There is no doubt that this Fellowship confirmed for me that I want to be someone who cares for patients directly and works at a local level on improving the continuum of care available to those patients.