The Working Group for a Delaware County Health Department

Structure of Public Health in Delaware County

Wed, 17 Aug 2011 00:00:00 -0600

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.

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.�

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.

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.

Annual Program Plan, and
Merit system requirements for personnel administration.

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.

Act 537

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

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 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.

Conclusion

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.

Editorial: Attention to county's health is overlooked

Mon, 08 Mar 2010 00:00:00 -0700

Two health studies have garnered a great deal of attention in the last month.

First, a report from the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation ranked Delaware County as the 36th healthiest county of the 67 counties in Pennsylvania. Not an encouraging position.

Examining �health factors� and �health outcomes� in nearly every county in all 50 states, the account assessed the level of a county�s overall health based on premature death rates, the number of people who self-reported being in fair or poor health, the number of days people reported being in poor physical and mental health, and the rate of low birth weight in infants.

That national study was followed by a public health analysis specific to Delaware County by the Johns Hopkins Bloomberg School of Public Health, conducted last year, courtesy of a $50,000 state grant.

The Hopkins study used 38 indicators identified in a U.S. Department of Health and Human Services agenda for promoting health and preventing disease to compare Delaware County trends with the state, nation and three comparison jurisdictions: Montgomery County, Baltimore, Md., and New Haven, Conn.

Like the first study, the Bloomberg findings indicate Delaware County lags behind in areas like smoking, preventive colorectal cancer screenings, physical activity and adults reporting fair or poor health.

A third study, the second by the Robert Wood Johnson Foundation, this time with Trust for America�s Health, did not receive as much attention.

The findings of that February study gave Pennsylvania another low ranking in health, but for a far different reason.

�Shortchanging America�s Health: A State-By-State Look at Public Health Funding in the United States,� ranked Pennsylvania 47th out of 50 states in the amount of federal funding received from the U.S. Centers for Disease Control and Prevention to support state disease and injury prevention programs in fiscal year 2009.

Federal funding that goes to states for public health varies significantly from state to state, from a low of $13.33 per person in Virginia to a high of $58.65 in Alaska.

Approximately 75 percent of CDC�s budget is distributed through grants or cooperative agreements to states and communities to support programs to prevent diseases and prepare for health disasters.

Given the economic situation, it is likely that state may cut its budget in the coming year, so Pennsylvania�s $14.86 per person in federal funding is even more damaging.

�These rankings demonstrate that health happens where we live, learn work and play. And much of what influences how healthy we are and how long we live happens outside the doctor�s office,� says RWJF President and CEO Risa Lavizzo-Mourey. �People, no matter where they live, should have the best possible opportunity to be healthy.�

Three studies indicate that is not happening in Delaware County. It ranks lower than more than half the counties in the state, falls short of similar counties around the nation and is being shortchanged in federal funding, which requires good grant writers.

Somebody here is not paying close enough attention. County council promised a thorough investigation of the Bloomberg report. Perhaps it should look at the intelligence in all three findings and determine why Delaware County falls so short in each.

Editorial: Stop playing politics with health of Delco

Mon, 22 Feb 2010 00:00:00 -0700

For decades now, Delaware County Council members have been dancing around a fundamental change when it comes to the public health of their constituents, that is, creating a county health department.

Members of the longtime all-Republican government body have invoked a well-rehearsed litany of concerns over the years for why they haven�t instituted a 20th Century concept seemingly so basic to a county with more than half a million residents. They include: A health department would create a financial burden for taxpayers; a health department is not necessary because private hospitals and the state do the job; and the county�s office of intercommunity health coordination sufficiently addresses public health issues.

At the very least this reasoning exhibits a lack of understanding of just what a county health department does. At its very worst, it hints at irresponsibility for the sake of politics.

A former Delaware County Council chairman who was a registered nurse once told a reporter that a health department would �violate the autonomy� of the county�s 49 municipalities. They rely on politically connected �health officers,� many of whom are not health care professionals. Some of them hold the paid post in more than one municipality.

In recent years, county council members have said they are studying the �feasibility� of such an agency. Apparently the existence of health departments in surrounding suburban counties isn�t testimony enough to the importance of a local public health agency in the fifth-most populated county in the state.

Perhaps the issue will be brought home to Delaware County Council members by a recent report from the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. The researchers, who examined health factors and health outcomes in almost every county in the United States, determined that neighboring Chester County is the healthiest place to live in Pennsylvania. Montgomery County County is the fifth healthiest and Bucks County is the seventh.

Delaware County came in at 36th out of 67 counties. It ranked 14th for overall health factors, but 34th for morbidity and 37th for mortality.

The last two figures aren�t surprising, considering state health data has long documented higher than average rates of morbidity in Delaware County for such illnesses as cardiopulmonary diseases in riverfront communities where residents live among industrial plants.

Whether industrial pollutants contribute to these illnesses is not known since no one has ever conducted an epidemiological study. That would be one of many tasks assigned to a county health department. It could also assist in producing such data as the health impact of inland flight patterns, information county council members themselves could have used in their recent campaign to curtail local flight patterns imposed by the Federal Aviation Administration.

In fact, epidemiology � the science of dealing with the incidence, distribution and control of a disease � is at the crux of a county health department. While the state health department carries some of this responsibility, a county health department provides a pro-active body to address issues distinctive to the county such as the high incidence of infant mortality.

In 1987, the Delaware County AIDS Network and Chester AIDS Coalition were formed by volunteers because there was no local health department to address the fact that Delaware County had and still has the third-highest number of AIDS cases in the state. Pennsylvania health officials have often had to draw resources from throughout the state to react to communicable disease crises in Delaware County.

They include an infusion of state health workers to Chester in 1989 when an estimated one out of every 75 residents had syphilis and again in 2008 when gonorrhea increased 80 percent in a year. In 1989 state health officials had to descend on Cardinal O�Hara High School in Marple when a cleaning lady died of tuberculosis and, in 1993, on Villanova University in Radnor when 60 students were hospitalized for a flu-like illness.

State health officials had to intervene when meningitis claimed the life of a 3-year-old Folcroft boy in 1993 and a 19-year-old Villanova University student in 1995. State health officials learned of the 1997 meningococcemia death of a Marcus Hook toddler in a Delaware hospital from a Daily Times reporter. More recently, Delaware County residents have had to turn to state health officials for guidance in addressing such communicable diseases as antibiotic-resistant staph infections and the H1N1 flu in schools.

Delaware County Council Chairman Jack Whelan planned last weekend to review the recommendations of a state-funded Johns Hopkins Bloomberg School of Public Health study of Delaware County health services. Delaware County Executive Director Marianne Grace noted that Philadelphia ranked last in the University of Wisconsin report�s ratings despite having a health department. But, comparing Philadelphia�s urban environment with Delaware County�s mostly suburban environment is like comparing apples with oranges. She did concede that the rankings report could be a useful starting point for any recommendations in the Johns Hopkins study.

Ten years into the 21st Century, Delaware County officials should be well beyond a starting point in implementing 20th Century solutions for preserving public health.

Editorial: Delco Suffers for Lack of Health Department

Thu, 08 May 2008 00:00:00 -0600

In 1989, Pennsylvania Health Department workers from all over the state descended upon Chester, where an estimated one out of every 75 residents had syphilis. The state health department employees had to be pulled from their other posts in Pennsylvania to try and stem the spread of the potentially deadly disease in Delaware County because there was no county-level health department.

Nineteen years later, a sickeningly similar scenario is occurring.

Cases of another sexually transmitted disease, gonorrhea, have increased 80 percent in the last year in Delaware County, most of them in the city of Chester.

State health officials are still contemplating how to respond to the epidemic but one thing is certain. They will not be assisted by county health department workers because Delaware County still does not have its own health department.

Syphilis and gonorrhea epidemics are not the only instances of when the lack of a local health department has been felt in a county that consistently clocks the third highest rate in the state for many diseases.

Last year Delaware County school administrators had to rely on the federal Centers for Disease Control and Prevention and the Pennsylvania Health Department to determine how to respond to antibiotic-resistant staph infections that surfaced in students. The fear was compounded in the community by the fact a Virginia high school student had just died of such an infection.

Meningitis has also reared its ugly head in Delaware County over the years, seriously sickening an 18-year-old food service worker in 1998 and killing a 19-year-old Villanova University student in 1995 and a 3-year-old Folcroft boy in 1993. In 1997, the state health department didn't learn of the death of a Marcus Hook toddler who died of meningococcemia at a Delaware hospital until it received an inquiry from the Daily Times.

Other communicable diseases that have caused fear among Delaware County residents who didn't know where to turn for information include tuberculosis that killed a Cardinal O'Hara High School cleaning woman in 1989 and a flu-like illness that sent 60 Villanova University students to the hospital in 1993.

In 1987, volunteers formed the Delaware County AIDS Network because of the lack of AIDS services in Delaware County, which has the third highest number of cases in Pennsylvania's 67 counties. The grassroots organization, which was dissolved in 2004 due to lack of funding, helped foster other AIDS-care outlets in the county, but not a health department.

In the last two years, county council members themselves have unwittingly highlighted a consequence derived from the lack of a health department. They have fought the flight patterns the Federal Aviation Administration has directed across the county partially on the premise that the health impact of the planes on the population is not known.

Perhaps such an impact would be evident if a county-level health department was in place to study it.

For decades, Republican candidates running for county council would respond with the same well-rehearsed speech when asked about their stance on a Delaware County health department.

They would say the county is doing just fine with paid "health officers" in the 49 municipalities, most of whom are not health professionals.

They would say the county's office of intercommunity health coordination has everything under control and that a health department would duplicate efforts, thus displaying what little understanding they had of the nature of a health department.

While office of intercommunity health coordination staff members work hard, they do not directly address the clinical needs of Delaware County residents. Just as the name of their office suggests, they coordinate the efforts of others whether it be emergency health responders, state-funded measures such as Lyme disease, West Nile and flu prevention programs or "task forces" of volunteers. The office also acts as a referral source for health clinics sponsored by local hospitals, pharmacies, even supermarkets. However, "referring" is not "doing" and the private sector has no mandate to preserve public health.

"Increased taxes" is another mantra Republican county council candidates and members usually invoke when addressing the issue of a county health department without allowing for federal grants or the decreased expense of municipal "health officers."

When county council members are not denying the need for a county health department, they are claiming to study the need for one. In 1995, they discussed the prospect of a health department at a conference called "Delco in the Year 2000" as though it was a futuristic concept.

Delaware County Council Vice Chairman Jack Whelan has said the county is about to commence yet another health department feasibility study through Johns Hopkins University. County legislators need only look to neighboring Montgomery and Chester counties to see how county-level health departments responsibly serve suburbia.

While 60 counties in Pennsylvania may not have their own health departments, Delaware County, as the fourth most-populated one in the state, should. The health of more than a half million people depends on it.

Advice For County Council

Tue, 06 May 2008 00:00:00 -0600

On April 15, 2008 Delaware County Council announced its first Energy and Environmental Advisory Board. The nonpartisan Working Group for a Delaware County Health Department approves of the formation of an advisory board. However, we question its effectiveness and openness given the fact two years ago to equal fanfare, Delaware County Council announced the formation of the Delaware County Health Advisory Board. This advisory board has never held a public meeting, nor provided access to minutes of its meetings or publicly reported on what it was doing.

We have very limited vital public health infrastructure and over a half million residents; which makes us one of the largest counties at risk for health and environmental disasters in the United States. For example Delaware County has had an 80 percent increase in one year of gonorrhea cases and has the third highest rate of AIDS in the state, according to the Pennsylvania Department

of..Health.

Public Health and Environmental Health go hand in hand. In Pennsylvania, county health departments combine both of these areas in one department. If Delaware County had a county health department we would receive funding of $750,000 for environmental concerns! The county would receive millions of dollars under PA ACT 315 and in federal categorical grants, it currently is ineligible for these grants. In emergency preparedness CDC grants alone we would have received over a million dollars since 9/11. That is our tax dollars coming directly back into the county!

Now that would be some good advice to take.

Editorial: 'Superbug' scares up need for health dept.

Wed, 24 Oct 2007 00:00:00 -0600

Infectious diseases have existed in the world probably since time began and people have been dying from them just as long.

But when a child dies of a communicable affliction, everyone especially takes notice.

Such was the case Oct. 15 when a Virginia high school student died of methicillin-resistant Staphylococcus aureus, a skin infection commonly known as MRSA.

Staphylococcus is a type of ever-evolving bacteria that can become resistant to certain antibiotics the more the antibiotics are used, hence the disturbing "superbug" nickname.

Many different strains of MRSA are known to be resistant to antibiotics. Ironically enough, people are most likely to be infected with them in a hospital or via other health care delivery systems.

Staph is spread skin-to-skin or through broken skin in contact with contaminated surfaces and objects and can enter the body through surgical wounds, catheters and other sites of medical procedures.

It may start as an abscess, boil or cut then invade the bloodstream, if it goes unchecked. On the other hand, some people can carry MRSA without any symptoms. In fact, staphylococcus can be found in the nose and on the skin of healthy people.

According to the Journal of the American Medical Association, about 94,360 people developed invasive MRSA infections in 2005 and about 18,650 people died during a hospital stay related to these infections.

However, while 85 percent of all invasive MRSA infections were related to health care, about 14 percent occurred outside of apparent health care scenarios.

Those cases are known as community-associated or CA-MRSA infections, the kind that can crop up among school children, especially students engaged in contact sports.

So last Thursday, when the bacterium was diagnosed in a Chichester High School athlete three days after the MRSA death of the Virginia teen, the community was understandably alarmed.

That same day, Rose Tree Media School District Superintendent Denise Kerr learned that a student at Indian Lane Elementary School in Middletown was also diagnosed with MRSA.

Delaware County does not have a health department of its own to provide guidance on protocol in such matters, so the two superintendents were left to their own devices.

Both Kerr and Chichester School District Superintendent Michael Golde turned to officials at the Pennsylvania Dept of Health and the Centers for Disease Control and Prevention in Atlanta, Ga. to determine how to respond to the MRSA infections.

"The CDC and the Department of Health advised us that MRSA is not contagious as long as it is covered, but it would be a good idea to sanitize areas the student spent a lot of time at," said Golde.

He cancelled Thursday's after-school activities then had maintenance workers disinfect locker rooms with water and bleach. On Friday, classes were held as usual at Chichester High School. Since she learned of the Indian Lane student's MRSA infection Thursday night, Kerr felt she had insufficient time to disinfect the school and reassure parents, so she cancelled classes on Friday.

"Parents for the most part are glad we did what we did. Some were overanxious and thought we should have closed the whole district," Kerr said on Monday.

It wasn't the first time MRSA was encountered in Rose Tree Media School District. Kerr noted that several years ago, when a Penncrest High School wrestler was diagnosed with MRSA, there was very little concern among the community.

"We notified the members of the wrestling team and life went on," she noted.

In fact in a letter to the community now on the Rose Tree Media Web site, Kerr said a Penncrest student as well as the Indian Lane student, had recently been diagnosed with MRSA.

"Both students under treatment are medically cleared to attend school," wrote Kerr.

On the Web site she also listed such basic hygiene as frequent hand-washing and routine cleaning of athletic areas, locker rooms and other buildings to prevent the spread of MRSA.

Golde also posted a letter on Chichester's Web site with similar measures.

While Kerr and Golde deserve credit for good common sense in handling the MRSA cases in their school districts, a county level medical official would have been able to provide on-site guidance as well as inform the general public about the situations and allay unfounded fears.

Delaware County does have a department of Intercommunity Health Coordination that is a clearinghouse of information on such communicable conditions as MRSA available to those who have computers or who think to call the office, but it has no medical authority in terms of public health. Recently a flu task force was organized by the Intercommunity Health Coordination staff to educate the public about preventive measures such as hand-washing, the same major defense against MRSA.

However, relying on task forces is risky business since they are generally comprised of volunteers, many from the private sector, with no mandate to the general public.

The recent MRSA scare, nationally and locally, is yet another example of why the more than half a million people of Delaware County need a health department of their own.