2021 Indicators Report: Understanding PA’s public health infrastructure

WILKES-BARRE — As part of the 2021 Indicators Report, compiled by The Institute for Public Policy & Economic Development at Wilkes University, The Institute’s Health & Health Care Task Force examined public health.

Executive Director Terri Ooms said, “Given the circumstances of the pandemic, it seemed as though an understanding of the system in PA is warranted. Sadly, public health across America, has become part of partisan politics, however its roots are based in medicine and science. “Ooms said according to the Institute of Medicine, the three core functions of public health are — assessment, policy development, and assurance.

“Federal, state, and local authorities play a role in performing these core functions and delivering essential health services,” Ooms said. “Although states have primary responsibility for implementing public health, the structure and roles of state and local departments of health vary by state.

Ooms explained that the Pennsylvania public health system is a mixed structure with three different authorities primarily responsible for public health matters: the state Department of Health, county and municipal health departments, and local health authorities.

There are currently six county health departments and four municipal health departments, which cover 41 percent of Pennsylvania’s population. In the remaining 61 counties and municipalities that do not have a local health department, public health services are provided by a combination of various governmental agencies and other non-governmental organizations.

According to the nonprofit Trust for America’s Health, less than 3 percent of the estimated $3.6 trillion the United States spends annually on health is directed toward public health and prevention.

Pa.’s public health system

In Pennsylvania, Ooms said there are three different authorities responsible for public health matters: the Department of Health (DOH), county and municipal health departments and local health authorities. The PA DOH was established in 1905, and operates under the current mission “to promote healthy behaviors, prevent injury and disease, and to assure the safe delivery of quality health care for all people in Pennsylvania” and vision of “a healthy Pennsylvania for all.”

The Pennsylvania Local Health Administrative Law — (Act 315) enacted in 1951 — authorized the creation of single-county or joint county departments of health to improve local health administration throughout the state. Act 315 provides funding for local health departments in counties and municipalities that meet the requirements.

“For decades, state funding rates under Act 315 were stable at $6 per capita,” Ooms said. “The Law was amended by Act 12 in 1976 to add support for environmental health initiatives, and provided $1.50 per capita to local health departments for these services. Local health departments are also funded through state and federal grants, and local funding from counties and municipalities is required to cover a portion of the costs.”

The current structure of the PA DOH consists of the following 16 distinct bureaus:

The Bureau of Community Health Systems operates as the public health implementation arm responsible for operating a network of state health centers and supporting public health programs throughout the state through six health district offices.

There are three district administrators covering all six health districts; each district administrator is assigned to two health districts. The Lackawanna and Luzerne County region falls under the Northeast District office, which also includes Wyoming, Susquehanna, Wayne, Pike, Monroe, Carbon, Lehigh, and Northampton Counties.

The district administrator covering the Northeast District also has oversight of the Southeast District.

In addition, the DOH includes five offices focused on health care-associated infections, health research, equity, and resources and services, and prescription drug monitoring.

Ooms said the local public health infrastructure in PA currently consists of six county health departments, four municipal health departments, and a network of state clinics in the remainder of the state. The county and municipal health departments (CMHDs) cover 41 percent of Pennsylvania’s population at a local level. Part of the local region is served by the Wilkes-Barre City Health Department and state health centers located in Lackawanna County (Scranton) and Luzerne County (Wilkes-Barre).

The county and municipal health departments in Pennsylvania are located in more urban, populated areas. Local health departments are paid a per capita rate by the state to provide a set of mandated public health services.

“It would be difficult for counties and municipalities in less populated rural areas to establish local health departments and provide the required services with the level of per capita financing that is currently in place,” Ooms said.

In the remaining 61 counties and municipalities that do not have a local health department, public health services are provided by a combination of various governmental agencies and other non-governmental organizations.

Public health services are implemented either through a municipal board of health or through the Department of Health’s six district health offices and health centers.

The Department of Environmental Protection provides environmental public health services, and the Department of Agriculture conducts restaurant inspections in counties and municipalities that lack certified inspectors. The Commonwealth Response Coordination Center, housed within PEMA (Pennsylvania Emergency Management Agency) also plays a role during public health disaster declarations.

Although the Department of Human Services is separate from the Department of Health, it also provides services related to public health, including overseeing the state’s health information exchange and Medical Assistance programs.