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 where there is no health department, 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 a 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.