This is the third and last article providing information on the LWV Delaware County Health Department Study. On January 29, 2009 the League of Women Voters of Central Delaware County will conduct a consensus meeting on the issue of establishing a Delaware County Health Department. The League will need everyone’s viewpoint to reach consensus on this important issue. What is Public Health?
The art and science of safeguarding and improving community health through organized community effort involving prevention of disease, control of communicable disease, application of sanitary measures, health education and monitoring of environmental hazards.
—American Public Health Association Current Public Health Laws and Structure in Delaware County
Pennsylvania has one of the most confusing arrays of public health regulations, with the state Department of Health having overall authority. The State Department of Health County office in Chester and the PA Department of Health (PADOH) regional office in Reading** cover Delaware County. This state health center is the largest in Pennsylvania outside of the regional offices. Most counties in Pennsylvania have staffs of 2 - 4 public health workers. At times during its history the Delaware County Health Center has had increased staff primarily due to large-scale infectious disease outbreaks such as the syphilis outbreak in the 1980’s. This increase in staff was the result of pulling staff from the other county health offices and regional offices.
** The Southeast District Office in Reading provides all other public health nurses, consultants and educators, but shares its resources with the other counties in this region. Everything from maternal/child health, diabetes, chronic disease, epidemiology research (position vacant) and communicable diseases etc., is handled regionally with communication handled locally.NOTE
: The Montgomery County Health Department and the Chester County Health Department have over 120 employees each.
The current staff of the PADOH County health center is composed of the following:
- One Community Health Nurse Supervisor
- One Immunization Nurse Consultant
- One Community Health Nurse
- One Sexually Transmitted Disease (STD) Public Health Program Representative
- One Tuberculosis (TB) Outreach Public Health Assistant
- One TB Registry Clerk/Clerk-typist
- One Clerk-typist
- Two part-time Community Health Nurse Assistants
- One HIV Nurse-Consultant. (recently hired)
- Two Community Health Nurse positions remain vacant
The Delaware County Department of Intercommunity Health, with a staff of four, has no legal authority or qualified staff to perform public health services or to monitor public health, and acts as liaison for the county and information resource only.
Delaware County has 49 municipalities with several different state classifications for municipalities; thus some municipalities, such as the city of Chester, have a small health department. These health departments, however, do not operate or receive significant federal or state funding since, according to PA Act 315 and the federal government, they do not meet needed qualifications. They can perform basic inspections of restaurants, pools, schools, etc., and handle some health and environmental nuisance issues. They generally do not have a public health nurse on staff, nor do they have a lab or public clinic or epidemiologist. Several Delaware County townships employ part-time health officers, certified by the state, to perform inspections of restaurants and pools, and to handle basic reporting to the state. Nine municipalities in Delaware County are not large enough even to employ a part-time inspector and instead have to rely on the Pennsylvania Department of Agriculture and the Pennsylvania Department of Health to perform needed public health services. The State Department of Environmental Protection provides environmental services for the county.
The six county health departments, including Bucks, Montgomery, Chester and Philadelphia counties, fall under PA ACT 315. The following information is from the “Feasibility Study: Establishing a Department of Public Health in Lancaster County Presented to United Way of Lancaster County by Drexel University School of Public Health April 29, 2005.”
Act 315 authorizes the creation, establishment, and administration of single-county or joint-county Departments of Health in Pennsylvania. The minimum program requirements for local departments of health include:
- Communicable disease control including Tuberculosis and Sexually Transmitted Diseases,
- Public Health Laboratory Services,
- Public Health Education,
- Environmental Health Services,
- Public Health Statistics,
- Maternal and Child Health Services,
- Public Health Nursing Services, and
- Chronic Disease Control.
The commonwealth will pay an additional annual grant, through Act 12, for Environmental services that include but are not limited to:
- Air and noise pollution control,
- Restaurant and wholesale food inspection,
- Rodent and vector control,
- Water and sewage inspection,
- Housing code enforcement, and
- Other similar services in addition to other local health grants for Public Health services.
Administrative requirements include:
- Annual Program Plan, and
- Merit system requirements for personnel administration.
Required personnel include: Act 537
- County health director,
- Full time physician (if not the health director can request a waiver to no less than half time),
- Director of Public Health nursing, and
- Director of Environmental Health Services.
One other major source of state-funded public health activity is available under Act 537, the Pennsylvania Sewage Facilities Act. Under Act 537 municipalities with certified Sewage Enforcement Officers can receive state funding for 85 percent of the costs of administering the requirements of the Act. County health departments can also utilize this money.
Other Areas of Concern
Our committee has found some interesting facts on public health in Delaware County:
- Delaware County, with a population of over 550,000 people, is the largest county in Pennsylvania and the largest county in the United States without a county-based health department.
- Delaware County has diverse populations including the poorest city in the state—the city of Chester.
The health statistics for the city of Chester alone may be argument enough for a county health department. For example:
- The city of Chester has the highest infant mortality rate and the lowest infant birth weight in Pennsylvania.
- Chester has among the highest overall mortality rate, adjusted for age, in the state. The cancer incidence rates for leukemia, all cancers combined, as well as cancers of the prostate, lung, trachea, and bronchus are significantly elevated above the state average and rates in surrounding counties.
- It has twice the national average of childhood asthma, with 1 in 5 children having the disease.
- It has the highest blood lead levels for children in the state.
- Currently the city of Chester is highly affected by an eighty percent increase in gonorrhea cases.
The current system for public health in Delaware County has several complex layers with ultimate authority resting with separate state agencies: the Pennsylvania Department of Health, the Department of Agriculture and the Department of Environmental Protection. The surrounding counties utilize state and federal funding, which brought taxpayer dollars directly back into their counties and, at the same time, eliminated the bureaucracy of dozens of different municipalities doing varying degrees of public health. These counties also managed to centralize communication and disease reporting and expand other public health services.
Pennsylvania ranks last nationally among all states in the size of its public health workforce per capita. Pennsylvania would need more than a doubling of the current workforce to achieve even the national average. Given the example of the gonorrhea and syphilis outbreaks, one wonders how the state would handle multiple infectious disease outbreaks in multiple counties without health departments. Indeed, how would Delaware County handle such a situation? Survey
This month the committee has mailed a survey to the local municipalities on specific questions regarding public health services in their community. We hope to share this information and even more with you at the January 29, 2009 consensus meeting. Please bring this article and the other two VOTER articles on public health (“Update on the County Health Department Issue” in the September 2008 issue and “Economic Arguments For and Against a Public Health Department in Delaware County” in the November 2008 issue) to this meeting. You will receive other material to give you the information needed to discuss the pros and cons of creating a Delaware County Health Department.