Backers of a countywide public health department say it would coordinate services, improve disaster planning for emergencies and oversee efforts to promote healthy lifestyles.
By Jack Brubaker
Updated Feb 19, 2007 15:58
Lancaster County’s public health services operate day to day in a complex, uncoordinated system that, under normal circumstances, serves many residents fairly well.
But would the county’s system work under severe stress?
“In case of a disaster, we would be very good about directing the traffic and getting emergency workers here,’’ notes Susan Eckert, president of the United Way of Lancaster County.
“We wouldn’t be very good at curing people.’’
Emergency workers could save Lancastrians from drowning during a Hurricane Katrina-type disaster, Eckert explains, but would this community have the technical expertise to teach people how to handle mold and mud following the flood?
Incomplete disaster planning is one of several shortcomings that public health supporters cite as reasons to establish a Lancaster County Health Department.
At the request of the United Way, Drexel University researchers recently examined public health deficiencies here and recommended that a county department be created to correct them. Community leaders are now examining that recommendation.
The Drexel study identified one encompassing concern: No one is coordinating Lancaster County’s public health services, including a medical response to disasters or epidemics.
“In Lancaster County we have the United Way doing this and the hospitals doing that,’’ says Eckert, whose agency is leading the effort to establish a county health department.
“We don’t have it all under one umbrella.’’
Adds Dr. Robert Krissinger, the chairman of the United Way’s Physicians Task Force that recommended a health department: “The whole system here in public health is archaic and fragmented.’’
The lack of coordination not only hurts individual patients who may fall through cracks in the everyday medical care system, public health spokesmen say, but it can have a negative effect on environmental issues.
For example, Drexel researchers learned that the City of Lancaster has better code enforcement for lead toxicity in homes than other areas of the county have. A county health department would standardize enforcement of lead regulations.
In addition, Eckert notes, lack of a central, coordinated health department may be costing the county money.
For example, townships and boroughs now pay the price of planning for water and sewer lines. A county health department would qualify for state funds to help pay for that work.
Drexel researchers characterized the county’s public health heritage as “remarkably rich’’ but said that very breadth of health services makes coordinated efforts difficult.
The study said a number of private and public organizations provide abundant public health services. Researchers also found gaps in those services — insufficient disaster planning, dental treatment and tuberculosis therapy, among others.
For two decades, Lancaster General Hospital, the county’s largest health care facility, has provided extensive public health services such as immunizations for children; screenings for skin cancer, lead and asthma; and clinics on a variety of health issues.
Alice Yoder, LGH’s director of community health, assembles extensive data on disease each year. That data helps the hospital determine its priorities for public health initiatives. The three key areas of concentration now are domestic violence, obesity and tobacco use.
There are other, more limited providers of such services. They include the county’s other hospitals, as well as community health centers such as Southeast Lancaster Health Services, the Community Action Program and the Welsh Mountain Medical and Dental Center.
Penn State Extension concentrates on the public health issues of nutrition education and food safety.
Lancaster City and the boroughs of Columbia, Elizabethtown and Mount Joy provide some public health services.
All of these services are financed by the private organizations and municipalities that sponsor them.
In addition, the state employs two nurses to provide immunizations and HIV testing and counseling. The state also holds a tuberculosis clinic and refers patients with sexually transmitted diseases to treatment facilities.
And yet, despite this wide array of public health services available to Lancaster County residents, many did not know where to turn for flu vaccinations in late 2004 when vaccine supplies were short. Some stood in line for hours at supermarkets and other sites that offered just a few doses to firstcomers.
Michael Huff served for several years as the state’s community health nursing supervisor here before becoming director of community health for the state Health Department. His replacement supervises nurses in both Lancaster and Berks counties.
Huff says public health services function fairly well in Lancaster County. But he believes they could be improved if they were coordinated locally.
“From a state perspective, we believe the citizens of a county are best served by a county health department that can best advocate for that individual county’s needs and is not dependent on outside funding streams or the state,’’ he notes.
Asked to provide an example of what a county health department could do better than the state, he mentions treating the local Amish community. He says a county health department would understand that community’s unique needs and could respond to them more directly.
A county health department also would inspect restaurants, monitor air and water quality, and refer elderly or indigent patients for treatment, Huff notes.
In Lancaster County, those functions currently are performed primarily by state agencies.
“It’s better to have direction locally, rather than coming from Harrisburg,’’ maintains Huff.
There are other selling points for a county health department.
Promoters say a health department here would employ dozens of workers — from doctors and nurses to children’s and women’s outreach workers — to help expand the client base for public health.
“In Chester County, the difference is the county health department has people out there looking for needs,’’ says Krissinger.
“First off, in Lancaster County we could use more personnel finding the 20 percent of women not getting in for first trimester care and the children who are not getting in to be immunized.’’
Supporters also say a county health department would do a better job of anticipating public health needs.
LGH collects and publishes health data each year and the United Way performs a community needs assessment every three years, but no one here ranks public health needs on an annual basis — a process that promoters say would help medical workers uncover emerging health issues in the community.
Moreover, a county health department would not be costly, say promoters.
The Drexel study estimated that revenue obtained from the state, other medical partners, county government and patient fees would slightly exceed annual expenses of nearly $5 million after three years. The county expense during that time period would be $150,000.
The cost to the county would rise after three years, as programs expand and the state expects increased county participation, but that expense would be offset in part by state payments for public health services currently covered by local finances.
The Drexel study did not estimate the costs to the county after three years. Neighboring Chester County contributes more than $2 million in county funds a year to its 37-year-old public health department.
But supporters say the bottom line for public health is not about money or even treating disease: it’s about disease prevention and planning for medical emergencies in the general population.
“Public health is not about curing illness,’’ says Eckert. “It’s not about the people in the hospital. It’s about those of us outside.’’
Those outside get along fine from day to day, notes Krissinger. Given a serious medical crisis, however, the outcome might be different.
“We’ve been lucky so far,’’ he says. “There has been no great epidemic here.’’
