I’ve written a ton about the pressing need for regional public health departments over on the other blog, focusing on activists’ multi-year push to create a Bi-County Public Health Department in the Lehigh Valley metro area.
Basically, the problem advocates were trying to solve is that there is very little going on in terms of population-level public health services at the local level. Some towns have a health department, some don’t, but that’s not sufficient to address the kinds of public health problems that can come up, since those problems are regional by nature:
The Lehigh Valley has no public health infrastructure. Only Bethlehem and Allentown have public health departments. The other municipalities rely on the state to provide bare bones services like restaurant inspections, but those inspectors are thin on the ground.
So lots of things that would improve health outcomes for residents are simply not getting done, and council evidently does not have a plan to get them done.
There’s no plan to deal with communicable diseases. There’s no plan to deal with food-borne illness.
There’s no plan to monitor water and air quality, even though there are two unregulated coal ash basins in Northampton County. And there’s no plan to coordinate vaccinations in the event of an outbreak.
The LV Bi-County Health Department was going to set an example for the rest of the state, but ultimately the proposal got tabled due to parochial concerns and then the anti-government Republican waves in the 2009 and 2011 municipal elections. But these problems are still quite real all over the state, and nobody is doing anything about it.
Even the recent state efforts to put all the restaurant inspection reports online amounts to layering good stuff on top of crap:
The Pennsylvania Department of Agriculture is working on a system to aggregate thousands of restaurant inspection reports each month from counties and municipalities and post them on its website.
The department itself conducts about 40,000 inspections of restaurants in communities that do not have their own inspection programs. Those reports are already available online.
But about 60,000 other restaurant inspections each year are handled locally, and online access varies from agency to agency. So the agriculture department is aiming to put all of them on the website, too, the Pittsburgh Post-Gazette reported.
The actual problem is that the decision of whether or not to have a public health department is left up to individual towns, and there are 2562 different municipalities in PA. Some towns do it, some towns don’t. Some counties do it, some counties don’t.
But if you believe that population-level public health services work, and you should, it follows that regions are the correct level for those issues to be addressed at. The ebola virus doesn’t care about your little municipal boundaries.
It’s not enough for the state to leave restaurant inspections and vaccines and the rest up to local governments, and then try to fill in the enormous gaps with state inspectors. State law needs to require all counties to provide these services and pay for them with state tax dollars, just like with criminal justice services.