Pa. counties with their own health departments see benefits, new research shows

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When the COVID-19 pandemic hit five years ago, epidemiologist Becky Dawson realized the impact of not having a local health department.

Dawson, a biology professor at Allegheny College in Crawford County, said that when national officials kept instructing people to listen to local health officials about the spread of COVID-19 in their area, she and other Crawford County residents didn’t have any.

“We weren’t sure who to be listening to,” Dawson said. “We didn’t know where to go for data.”

She said local officials did the best they could. One county commissioner runs an ambulance service, so he set up data collection on COVID-19 cases. Once the vaccine was available, a community hospital promoted it.

Public health departments investigate and respond to outbreaks of infectious diseases, inspect restaurants, and collect all kinds of health data.

More than 50 counties in Pennsylvania do not have local health departments.

Dawson and other researchers just published a study showing counties that do have them tend to have more primary care doctors, more people getting vaccinated, and lower infant mortality rates, among other health measures.

“When we do public health the way that public health is supposed to be done at the local level, we actually do see a huge impact.”

People who live in counties without a health department can turn to the state health department for some of the services that a local department would provide. The researchers also emphasize that all the local health departments in Pennsylvania are in urban counties, and the rural communities without health departments already lack access to health care, compared to urban communities.

These findings do not surprise Jennifer Kolker, a professor of health management and policy at Drexel University.

“I don’t think we need a whole lot more research. I think the research is out there that health departments do good and improve health. I think the question about why we don’t have health departments in Pennsylvania is not a research question. It’s a political question, and it’s a funding question,” she said.

In the early 2000s, community groups in four counties without health departments hired Kolker and other researchers to survey residents to see what they thought about their county adding their own health departments.

Kolker found that people were often skeptical of creating a health department because: it would mean creating a government agency funded by taxes, there was no immediate health crisis, and they saw some routine health department work like restaurant inspections as unnecessary.

“We heard from people in some counties saying, ‘We don’t need a health department. If restaurants aren’t safe, people will get sick, and then word will get around, and they just won’t eat there.’ That came from a county commissioner,” Kolker recalled.

But some counties in Pennsylvania without health departments still want to form them. In 2022, Delaware County established a health department, making it the first county to do so in Pennsylvania in more than 35 years. They did it mostly with state, federal, and grant funding, said Rosemarie Halt, chair of the county’s board of health.

“It really is a huge success story in the fact that we were able to build this without a lot of money coming directly from the county.”

She said county residents had been talking about having their own health department for more than a decade, but support from local, state, and federal officials in the past few years finally made it happen.

The Delaware County Health Department has since been able to better address issues like chronic diseases, mental health, and maternal and infant care, said department director Lora Siegmann Werner. For instance, they worked with local school districts to vaccinate the children who were missing mandated vaccines for school. They also set up kiosks so residents can easily buy tests for diseases like COVID-19 and flu, as well as first aid kits and feminine hygiene products.

Northampton County executive Lamont McClure said they had some informal discussions two years ago, and may set up a working group again in the coming weeks.

“It’s a complicated issue because I think if we asked a poll question, for example, I think you would probably see broad support for the establishment of a county health bureau … to help with tuberculosis, HIV, AIDS, maternal health care,” he said. “The devil is in the details. I don’t know that there is a great hunger for the establishment of another government bureaucracy.”