Local governments: Critical partners in Pennsylvania's Public Health Infrastructure

Pennsylvania's public health workforce numbers only 37 per 100,000 residents, the lowest number of public health practitioners in any state and less than one-third of the national average. Furthermore, only 10 of Pennsylvania's 67 counties have established Local Health Departments and fewer than 210 of the state's remaining 1,600 municipalities have any formal local public health presence. Acknowledging this, researchers from the University of Pittsburgh Center for Public Health Practice analyzed Pennsylvania law to identify how the public health system legal infrastructure impacts the system's performance. This analysis revealed that Pennsylvania law provides for both a centralized and decentralized infrastructure, with the locus of responsibility vested in the state health department and counties authorized to create autonomous Local Health Departments. However, a deeper analysis of Pennsylvania law revealed that the legislature also created a system of Municipal Codes that expressly provide public health authority to local governments. State municipal codes expressly give each jurisdiction's governing body the authority to designate a local health officer or local board of health to undertake specific public health activities. This research found that frequently however, this municipal authority is not fulfilled because either the code lacks the legal mandate to require the authorized actions or the municipality does not follow the code. To increase local public health presence, these legally authorized public health officers must be cultivated to enable them to become vital partners in the public health system, ensuring the local delivery of essential public health services in Pennsylvania