Local Health Departments Provide the Foundation for Creating Healthy Communties

My research published in the journal "Discover Public Health"

When I wrote in November (following the election) about the health challenges we are going to face during the next four years, I also mentioned —

“Last semester I worked with an amazing group of undergraduate researchers, and we completed a huge project looking at the community health benefits of having a local health department. That research should be published soon. I CANNOT wait to share it with you all — and yes, you will be the first to read and hear all about it.”

Well, I can finally share our work with you now that it has been published.¹

Long story short —

In Pennsylvania, there are only 11 local health departments (while there are 67 counties). More than 50% of Pennsylvania residents live in a location where they do not have access to a local health department.

Our research team wanted to know if communities with a local health department are healthier than those without one.

The answer was a resounding —

To learn everything — you can read our full research paper online.

You should know that in Pennslyvania living in a county where there is a health department results in a healthier community — people live longer, infant mortality is lower, there are more primary care providers, more people get their vaccines, more people have health insurance, and fewer people are obese.

Public health programs and services make a REAL difference in Pennsylvania.

If you live elsewhere, stay tuned… we will have more research to share with you soon.

Before I share the genesis of this project (and how many of you, especially Commissioner Eric Henry and Mary Kay Radnich, served as inspiration), I want to give an enormous shout-out to my research team — Joel Pszczolkowski, Malia Guillory, Emily Herrold, Sara Karns, Tannaz Latifi, Carson Messemer, Kathryne Reed, and Tyler Znaczko. These Allegheny College students worked tirelessly during the Spring 2024 semester gathering data, analyzing data, and thinking through the implications of the results. This is their first published paper. And I so proud to see their names in the byline.

So how did this research come to be?

Well, it all started after those of us here in Crawford County, PA —

Survived a Pandemic Without a Local Health Department

NOTE: this essay was published as a behind-the-research blog post on Jan.9, 2025

As schools, businesses, travel, and life as we knew it began to shut down in March of 2020, an often repeated phrase was “listen to your local health official.” Federal officials encouraged the public to tune into local leaders who could provide detailed accounts of what was happening in their local communities – how many new cases were there, how many people were hospitalized, how many ventilators were available, and how many people were dead (or dying). Similarly, as the country began to reopen during the summer of 2020, the public once again was told to “listen to your local health official” for instructions regarding how to safely navigate the world still swarming with COVID.

For those of us living in the 56 counties of Pennsylvania with no health departments, these instructions to “listen to your local health official” made no sense. There was/is no local health official. There were local health clinics (staffed with nurses; not trained in public health) and public health professionals in Harrisburg, nearly 5 hours away, who were directing the public health response to the pandemic, but nothing about that felt relevant or local.

We were required to survive the pandemic without a local health official to listen to or lead us.

In Crawford County, home to Allegheny College and the research team that completed this study, a group of volunteers – a county commissioner, epidemiology professor, and retired science teacher – banded together to track cases, answer community questions, and establish a single online resource page (on Facebook because there was no money, resources, or expertise to build out a county health website). This band of volunteers had little (if any) contact with leaders in Harrisburg, but they shared information within the county and did their best to keep community members informed and calm through the initial crisis of the pandemic.

From 2020-2022 – we felt the void left by not having a local health department as the pandemic turned our worlds upside down. We had to source our own COVID tests, set up a contact tracing protocol (with only one individual in the community trained in public health), track our own data, establish relationships, and follow policies set by leaders who had never stepped foot in our community and who we did not know or trust.

It was not public health practice; it was survival.

In the years following, our research team started to ask questions that went beyond the pandemic – are counties with local health departments healthier? Do residents there have access to better healthcare? Do they get vaccinated more often?

These questions led to us completing an ecological epidemiological study where we assessed community health impacts, including obesity, infant mortality, smoking and vaping, percent of the population with health insurance, and youth suicidality, among others comparing 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.

We believe there are significant benefits to having a local health department, and more than half of the population in Pennsylvania does not have access to those benefits due to the public health governance structure in the state. 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 communties and they are needed throughout the state of Pennsylvania; not just in 11 of 67 counties.

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As you might guess — my legacy project is to help establish a local health department in my home county as well as the 55 other counties across the Commonwealth that do not have access to a local public health department.

This research is just the beginning…

Next week this research will be highlighted on WHYY (the Philadelphia NPR station).

Social media posts are being shared.

And we will have an executive summary available by the end of the week.

By no means are public health departments perfect or the silver bullet for solving all of our health projects. BUT they do make an impact — they improve the quality of life for the communities they serve and make measurable impacts on health.

Just like we all need access to healthcare, we all need access to public health.

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Thoughts or questions?

Please be sure to share this with your friends & family. And for those of you who live in Pennsylvania, please share this with your elected officials, community leaders, and people in a position to enact change.

Finally, please do not forget to click the “Like” button on this or any post that you enjoy. It’s a small thing, but it helps.

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Epi(demiology) Matters is written by Dr. Becky Dawson, PhD MPH — an epidemiologist, teacher, mom, wife, and dedicated yogi. She is a tenured professor at Allegheny College, Research Director at a community hospital, and an exclusive contributor (all things health & medicine) at Erie News Now (NBC/CBS). Her goal is to create healthy communities for all. She writes Epi Matters — first & foremost because epidemiology does matter (to all of us) and she hopes that each post will help to educate and empower readers to be healthy and create healthy communities.

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Epi(demiology) Matters is free — because science, reports, news, updates, and alerts about health should NOT be behind a paywall. EVER. Everyone needs access to up-to-date health information in order to be healthy and create healthy communities for all.

1. A quick note about the publication process… we submitted our draft paper in August. It went through two rounds of peer review (where individuals in the field provide feedback and decide whether or not the research should be published). Our paper was under review for more than five months (which is not that long but felt like an eternity). Based on our responses to the peer reviewers the editorial team at the journal makes the final decision regarding whether or not the research is published.