Who makes public health decisions for your community? In Pennsylvania, it depends on when you live

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HARRISBURG — For more than two years, public health officials have answered Pennsylvanians’ most pressing questions about the coronavirus: Where are tests available? Are masks necessary? Who is eligible to get a vaccine?

Who provides this information and how easy it is to find may depend on where you live. Roughly half of the state’s nearly 13 million residents live in a county or city covered by a local health department. The other half — many of them living in rural parts of Pennsylvania — rely solely on the state for a limited number of public health resources and services.

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The split setup presented new challenges during the pandemic as local officials worked to gather rapidly changing data and communicate evolving health guidance to residents.

In places with a local health department, many of those tasks were handled by health officials on the ground. But in counties without one, some officials said they were frustrated by a lack of communication with the state and limited control over how decisions were made. As a result, a few contemplated creating their own local health departments. Some of those plans were ultimately scrapped, while other counties are still considering how to move forward.

To better understand those discussions, Spotlight PA talked to public health experts, researchers, and local and state health officials to probe how local health departments work, when they can be useful, and why some counties chose to walk away.

Do I have a local health department?

If you live in Allegheny, Bucks, Chester, Erie, Montgomery, or Philadelphia Counties, you have a county-level health department. Allentown, Bethlehem, Wilkes-Barre, and York all operate city health departments. The newest local health department, in Delaware County, is nearing final approval from the state and is expected to officially launch this year. These areas represent 46% of the state population.

If you live anywhere else, you get services directly from the state Department of Health.