As LNP | LancasterOnline’s Nicole C. Brambila reported last week, “Lancaster County commissioners voted 2-1 on Wednesday to create a health advisory council tasked with providing data analysis and recommendations to detect, prevent and respond to illnesses that pose a public health threat to residents. The move stops short of creating a local health department — something county leaders, organizations and health officials have for decades pushed for — and instead creates an advisory council that cannot make public health statements on behalf of the county. Additionally, the council can recommend strategies only at the commissioners’ request. It is for these reasons that (Democratic) Commissioner Craig Lehman said he could not support the health council, which commissioners Tuesday said could be implemented by January.”
We’ve been calling for the creation of a county health department because Lancaster County has been winging it through this pandemic, with no agency to advise local school districts or long-term care facilities on how to handle outbreaks, no agency to gather essential data, or to counter disinformation, or to lead public messaging, or to continue contact tracing, or to make difficult decisions.
As Alisa Maria Jones, president and CEO of Union Community Care, told LNP | LancasterOnline last November, a county health department could have developed and implemented a countywide response at the outset of the COVID-19 crisis. “When we don’t have that professional, accountable, countywide perspective, then we waste time” formulating a response, Jones said.
In an email Friday, Jones said that a health advisory council is “a step in the direction of more coordinated planning” that she hoped would “be informed by what we lack the most — data. However, it’s not the most critical step, which is the establishment of a health department with experts in epidemiology and public health.” She said the creation of a health advisory council will create “overdue momentum that should continue to be built upon to create a more equipped and accountable health department that takes into account all individuals in the county — including the unseen and the unheard.”
That is what is truly needed.
Jones’ point about the lack of data here is a particularly strong one. Lancaster County, which ranks fourth worst among Pennsylvania's 67 counties for our rate of children with elevated blood lead levels, does not have access to the timely and specific health data that counties with public health departments receive.
A health advisory council is a poor alternative to a health department. And we mean “poor” in more ways than one: According to its charter, “The Advisory Council shall not have the authority to expend or encumber County funds, enact or enforce policy or procedures, endorse programs or policies, or speak on behalf of the County.”
So it will be basically a volunteer effort that will leave untapped the $106 million in American Rescue Plan funds that Lancaster County has received.
The health advisory council was proposed by Republican county Commissioner Ray D’Agostino, who said last week that he will not “vote to study, much less establish, a county health department.” Apparently, the 18 months he spent developing the advisory council convinced him that he knows more than the physicians and public health experts who believe that Lancaster County needs a county health department.
As Brambila reported, D’Agostino “provided few details on how members — particularly those with expertise to provide recommendations on health issues — will be appointed. Instead, he referred to the council’s charter, which states, in part, that members “may include knowledgeable community health representatives.”
"May” is not the same thing as “shall.”
“May” suggests that public health will be politicized, controlled by partisan commissioners guided by ideology rather than medical knowledge. “Shall” would indicate a willingness to rely on recognized health experts to deal more capably with public health issues.
Why are we skeptical about this advisory council? Let us count the additional ways.
Politicians and public health
Oddly, despite the fact that there was little public notice that a fully formed proposal for a health advisory council would be unveiled at the commissioners’ work session Tuesday, supporters of the idea happened to be in attendance — with prepared statements in hand.
D’Agostino said plainly that the council proposal was meant to be a workaround to the 1951 Local Public Health Administration Law, which authorizes the creation of local health departments in Pennsylvania.
“Under the (1951) law, once a Board of Health is established there’s no local oversight as the Board of Health … would have complete autonomy, almost,” D’Agostino said last week.
What he clearly meant is that such a department would be out of the control of the board of commissioners. Which is unpalatable, obviously, because it might have its own ideas about how to curb a lethal pandemic like COVID-19. Or how to address lead exposure in children. Or how to handle Lancaster County’s serious air quality problems. Or how to prepare for the next pandemic. Or how, as Penn State College of Medicine Drs. Thomas Godfrey and Sangeeta Saxena wrote in this newspaper in February, public health expertise could be linked “with clinical medicine resources,” so that we no longer would be “at the mercy of what fate has to throw at us.”
It is a bad idea for politicians to make public health decisions without the input of medical experts who can offer advice free of political consideration. Josh Parsons, chairman of the Lancaster County commissioners, continues to give us examples why.
Thursday, he tweeted out the letter that acting state Health Secretary Alison Beam is sending to families whose children are required to quarantine after a COVID-19 exposure or infection. “Our question to the Pennsylvania Department of Health — what in the world were you thinking?” Parsons tweeted.
He and D’Agostino sent a letter to Beam, demanding that she “cease threatening and bullying children in Lancaster County.”
The Department of Health letter warns that failing to heed a quarantine directive could result in court-ordered confinement “in an appropriate place … to make certain that you are not able to infect the public, and to make certain that you receive proper care.” (State Sen. Scott Martin, a Republican from Martic Township, has been kicking up a fuss about the language, too.)
Its language is harsh, and we would have advised the state Department of Health to tone it down. But it’s a boilerplate as far as public health quarantine letters go, because they are meant to convey the seriousness of infectious illness. In no way do these notices constitute “bullying.” Which Parsons might know if he actually had public health training. But he doesn’t, which is why he filters his views on masking, vaccination and other COVID-19 mitigation measures through a political prism.
Seen, but not heard
D’Agostino said officials at all four health systems in Lancaster County — Penn Medicine Lancaster General Health, Penn State Health, UPMC and WellSpan Health — support and would participate in the council. We’re sure they would, because their interests lie admirably in advancing public health, however incrementally — and this health advisory council would merely be an incremental change, if that.
“We are open to considering all efforts that seek to measurably improve the health and well-being of our community and look forward to learning more about the Council’s work,” Lancaster General Health spokesperson John Lines said in an email to LNP | LancasterOnline.
The italics are ours, because “measurably” is the key. We are at a loss as to how this council will measurably improve the health of Lancaster County residents. It will not be able to disseminate public health messages that might be politically unpopular, but are nevertheless imperative. It will be the Victorian child of county government — seen, but not heard by the public.
The council’s charter states that it will conduct outreach and provide recommendations “at the request and consent of the Board of Commissioners.” (Again, the italics are ours.)
It will: “At the Commissioner’s request recommend strategies, grounded in consensus, to deal with emergent health threats to achieve positive outcomes.” Grounded in consensus? Should that not read “grounded in medical data and scientific research”?
It also will prepare “and participate in community education programs on health matters as directed and approved by the Board of Commissioners.” The council will not be permitted to work with the Pennsylvania Department of Health unless the commissioners grant prior approval.
The commissioners will appoint the council’s nine to 13 members. The council won’t even be permitted to choose its own chairperson — Parsons will make that call.
According to the latest census numbers, Lancaster County has more than 552,000 residents. As the Manheim Township Board of Commissioners pointed out in a Sunday LNP | LancasterOnline column in March, of the largest seven Pennsylvania counties, “all but Lancaster County and Delaware County have public health departments, and Delaware County is preparing to launch one. … It’s time we join the other large population centers in our state to support the health care of our citizens.”
Indeed. This county’s residents deserve more than a toothless advisory council that will be subject to the whims of partisan elected officials.
Ernest J. Schreiber, retired executive editor of the predecessor of LNP | LancasterOnline, supports the advisory council. At the commissioners’ work session Tuesday, he maintained that it “takes the best of what health department advocates want and avoids the excesses that critics dislike,” and is “a true Lancaster County solution — logical, local and low-cost.”
It is low-cost, for sure. And local. But logical? Only if the aim is to ensure that the commissioners can continue making public health decisions that are in keeping, above all, with their personal political views.
County residents deserve better.