Differences in community health outcomes in counties with and without health departments in Pennsylvania

Abstract

Within the field of public health, communities are protected and disease is prevented when action is taken at the local level; the phrase all public health is local is often quoted to emphasize the importance of having public health officials at work at the local level. Evidence shows that when communities invest in public health, measurable improvements can be seen; there is clear evidence that a local department of health can positively impact the health of the community it serves. Despite evidence that local health departments improve community health, there are only seven county and four municipal/city health departments across the state of Pennsylvania; 54% of Pennsylvanians do not have access to or the services provided by a local health department. We conducted an ecological epidemiological study in the state of Pennsylvania. Specifically, we measured various health outcomes at the county level and compared counties with and without a local health department. We found that overall the counties in Pennsylvania without a local health department had poorer health outcomes compared to counties with a local health department after controlling for race, education, income, access to health insurance, and the urban–rural status of each county. Policy changes are needed in Pennsylvania to establish and maintain a local health department in every community. Local health departments provide the foundation for creating healthy communities and they are needed throughout the state.