Pennsylvania’s local health departments (LHDs) are the backbone of much of Pennsylvania’s public health system, responsible for the health of more than 46 percent of the State’s population. Unfortunately, Pennsylvania’s local health departments have been severely underfunded for years, creating a crisis that predates COVID-19 but has worsened during the pandemic response. COVID-19 demonstrated the dangers of not having the right people and systems in place to prepare for and respond to an emergency. It spurred the creation of the Delaware County Health Department, and compelled multiple other counties to now explore the creation of their own health departments as soon as 2023.
While the state government has disinvested from public health services and our local governments are experiencing dramatic revenue losses, the breadth and complexity of public health work has increased. Adjusted for inflation, Pennsylvania has decreased funding for local health departments by $30 million since 2004. In addition to combatting public health emergencies, our departments work each day to prevent and address a multitude of public health problems that do not make the headlines by providing immunizations, education, data tracking and other programs and services that reduce the impact of infectious diseases in our communities; curtail the opioid epidemic; elevate maternal and child health; perform food and sanitation inspections; monitor environmental threats; and serve as chief community health strategists, working with community partners to promote wellness, identify disparities and their causes among vulnerable populations, and promote equity among all community members.
State funding is critical to our work, in some cases, accounting for more than a quarter of local health department’s budgets. The Commonwealth’s primary mechanism for funding county and municipal health departments is through Acts 12 and 315. Under Act 315, local health departments may receive state funding of up to 50 percent of total expenditures, but no more than $6 for every person within each jurisdiction. Act 12, a 1976 amendment to Act 315, authorized the commonwealth to pay local health departments an additional annual grant of up to $1.50 per resident for environmental health services. Yet while LHD’s consistently face shrinking budgets and expanding health service needs, since 2004, Act 12 and 315 funding has decreased by 52 percent.
Acts 12 and 315 funding are crucial components in our LHDs’ ability to ensure effective standards and consistency in addressing new emerging threats, overseeing public health matters, enhanced coordination between local governments, school districts, hospitals, and other nonprofit public health private agencies and public health priorities that are focused on the specific needs of the community. With our local governments are experiencing dramatic revenue losses, this massive drop in public health funding has forced local health departments to reshuffle resources and strategies. Local governments simply have far fewer resources and options to generate revenue, particularly in areas of Pennsylvania that face higher levels of poverty. Relying on local governments to fund public health is not only impractical, but it also ignores the years of investments local governments have borne by backfilling state public health funding cuts.
Pennsylvania’s local health departments continue to face immense challenges addressing public health in our communities. State funding for public health must be increased to meet today’s needs and keep our communities safe. We urge you to fully support the work of local health departments by providing at least $36 million in funding for Act 315 and $9 million for Act 12.