News
- Published on: 3/4/2022
York County Health Department Feasibility Study Summary Report
EXECUTIVE SUMMARY
York County is the 8th most populated county in the Commonwealth of Pennsylvania, with 72 municipalities and a population of 445,565 (2018 US Census). Like most of its fellow Pennsylvania Counties, it does not have a county-wide Health Department. York County is the 8th most populated county in the Commonwealth of Pennsylvania, with 72 municipalities and a population of 445,565 (2018 US Census). Like most of its fellow Pennsylvania Counties, it does not have a county-wide Health Department.
Instead, most public health responsibilities are ceded to the Commonwealth, with the major exception of the public health functions carried out by York City for city residents. As York County rebounds from the COVID pandemic, there is an opportunity to leverage available resources and bounce forward by establishing a county public health department that can attract funding and bring partners together across sectors to define and work towards shared outcomes to improve the health of those that call York County home.
The COVID-19 pandemic has required state and local governments to act swiftly to limit the human cost and economic disruption of this public health threat. The lack of trusted, county-level, public health leadership contributed to a sometimes fragmented, confusing, and inequitable response to COVID-19 and has highlighted the inadequate public health resources in the county. A strong backbone unaffiliated with any one health care provider increases the ability to speak objectively as a county and could support efforts to address community-wide public health challenges.
In August 2020, the York County Commissioners allocated a portion of CARES Act funding to support a feasibility study to explore the creation of a county-wide health department. With the support of Health Management Associates, Inc. (HMA), a healthcare consulting agency, the work yielded insights on a 21st Century Model and how it would meet the identified and expressed needs of the York County community.
HMA worked closely with a Blue-Ribbon Panel and the Healthy York Coalition Steering Committee. The process included interviews and focus groups with key county stakeholders; a community wide survey; a review of relevant Pennsylvania public health laws and regulations; an analysis of York County health data and statistics; and comparator jurisdiction information, examination of generic stromectol. The feasibility study provides a 2021 COVID-19 response analysis for York County, guiding principles for establishing a county health department, and recommendations for a three-year phased approach for creating a centralized public health department for York County.
The feasibility study recommendations conclude that a 21st century county public health department would strengthen and expand the existing public health foundation offered in York City by transitioning the city level health department and integrating these functions into a new county health department that could coordinate and increase the value of existing county-wide community assets, including non- profit organizations, grass roots efforts and coalitions, while also attracting new state and federal funding to the county. A new county health department:
- Starts with a robust county-wide COVID-19
- Creates a neutral backbone, unaffiliated with any one health care provider and core infrastructure to coordinate and synergize existing strong county
- Integrates and expands multi-sector data to assess health and target resources
- Aligns and leverages York City Health Bureau, WellSpan, UPMC, local and county government and Family First Health infrastructure, services, and leadership and provides “one voice” for public health in the
- Assures essential public health services and optimizes state and federal
FEASIBILITY STUDY PROCESS
THE NEED FOR PUBLIC HEALTH INFRASTRUCTURE
Public health is what we do as a society to establish an environment in which conditions ensure everyone can be healthy. Public health is distinct from health care or social service delivery, but an important catalyst for the impact of healthcare and social services. As evidenced by the COVID-19 pandemic lack of a core public health infrastructure can mean that when a public health emergency or disaster strikes, the response can be severely hampered.
COVID-19 has hit certain population groups within York County harder than others. The underlying inequities exposed by the pandemic - access to healthcare and community resources like food and transportation, are usually the focus of a 21st century public health approach, which prioritizes prevention and root causes for poor health, placing equity at the center.
While York County ranks on par with the state across several health measures, including prevalence of diabetes and overall life expectancy, strong health disparities exist in the county between different racial and ethnic groups. Child and infant mortality rates of Black children are 2-3 times higher than mortality of White children and teen pregnancy among Latinas is more than three times higher than among White teens (Robert Wood Johnson Foundation, County Health Rankings & Roadmaps, York County Snapshot). In other domains, the county has worse health outcomes than other Pennsylvania counties, like behavioral health and chronic disease. York County residents reported concern about these observed health trends. In the Community Survey, respondents indicated that the top health issues in the county include mental health conditions, substance use disorders, obesity, chronic diseases, and community violence.
Investment in critical components of infrastructure would strengthen our community’s capacity for effective assessment, policy development, and assurance of York County residents’ health beyond COVID-19 (“10 Essential Public Health Services,” Centers for Disease Control & Prevention). This enhanced response capacity could increase the county’s opportunity for federal funding and state funding where there are aligned goals. Building the public health workforce and programs would also position the county to draw down state funds for county-level health agencies which are supported by state tax revenue but not fully realized by York County residents. Above all, by bringing together key stakeholders, such as healthcare providers, businesses, school districts, and community organizations, York County would strengthen community trust, improve communication and coordination of services to all its residents, and better enable them to meet their fullest potential.
DATA ANALYSIS
The feasibility study findings are the result of input and direction from members of the Healthy York Coalition Steering Committee, a Blue Ribbon Panel comprised of community leaders, and the Healthy York Coalition Leadership Committee. The data collection and analysis included interviews and focus groups with stakeholders and leaders; a community survey; a review of relevant Pennsylvania public health laws and regulations; an analysis of York County health data and statistics; semi-structured interviews with two comparator jurisdictions (Erie County, Pennsylvania, and Carroll County, Maryland); and a review of the major characteristics of 21st century public health systems.
Participants in the data collection processes shared a common vision with the Blue Ribbon panel- a healthier York County where everyone has the same opportunities to live a happy and healthy life and where leaders are responsive to their needs. Participants believed that a York County Health Department would be a key contributor to this vision of a healthier community.
FINANCIAL CONSIDERATIONS
To create a sustainable plan for the implementation of a County Health Department, the identification of potential funding sources at the state, federal, and local level is crucial. The establishment of sustainable funding streams to support the public health model necessitates specific actions to ensure eligibility for funds.
PHASED APPROACH TO IMPLEMENTATION
A phased approach to development of the health department and funding model is pertinent to sustainability. As such, the Phases would be as follows:
Phase 1 (Explore and Bolster Resources)- Bolster existing efforts to ensure appropriate COVID-19 response, demonstrate initial local investments in staff positions needed and begin to develop the implementation plan aligned with integration of York City Bureau of Health services and programs within a County wide approach.
Phase 2 (Origin of County Health Department)- Initiate focused and deliberate actions to secure start- up funds, employ the required personnel, and meet the requirements of Act 315 positioning the department for eligibility of initial grant funds to create a sustainable health department.
Phase 3 (Expansion of Services and Funds)- Explore additional funding sources, including the expansion of services and programs that would yield fee revenue, categorical state and federal grants and other revenue streams that would continue to build as the county health department enters phase 3. Phase 3 marks final stage of funding modeling and focuses on sustainability.
COUNTY HEALTH DEPARTMENT FINANCIAL RESOURCES
To create a sustainable plan for the implementation of a County Health Department, the identification of potential funding sources at the state, federal, and local level is crucial. Potential revenue sources would include:
State and County Funding
Act 315 - Act 315 is Pennsylvania’s Local Health Administration Law which authorizes state grants to counties and certain municipalities with established departments of health that meet fixed requirements. Act 315 funded health departments are required to provide public health programs in the areas of administrative and supportive services, personal health services and environmental health services.
State funding under Act 315 will not exceed six dollars ($6) per capita annually.
Act 12 - Act 12 is an amendment to Act 15 to add support for environmental health initiatives. The Commonwealth shall pay an additional grant of not more than one dollar and fifty cents ($1.50) per capita funding to each county department of health or department or board of health of a municipality eligible for grants under this act for environmental health services provided by the county or municipality (PADOH, 1995).
Fees, Licenses, Permits
The establishment of a County Health Department can authorize the collection of fees for a variety of environmental health services rendered, including restaurant licensure, sewage system permits and inspections, childcare facility inspections and asbestos and lead related inspections. Each of these fees are determined by the County Health Department based on the programs and services they offer.
Beyond the Act 315 and Act 12 funding opportunities, categorical grants, defined as public funding normally used for a narrowly defined purpose or specific program, from both the state and federal governments represent a significant stream of funding for many of the County Health Departments across the state.
Additional Funding Support
In addition to the revenue sources detailed above, grants, including federal, state and local sources, could be explored for additional support as applicable. Local funding sources including specialized foundation funds focused on community health and wellness could be annually allocated to support the County Health Department.
The two large health systems within York County, WellSpan Health and UPMC Pinnacle along with the Memorial Health Foundation may consider contributions for the establishment and ongoing operations of the county health department.
Additional grants, including donor gifts or endowments, and small-scale grants from community agencies within the county could be leveraged to offset specific expenses or generate additional revenue.
FINDING OF FEASIBILITY
The COVID-19 Pandemic has revealed that a public health system is an essential element of modern and thriving communities. Based on the data analysis and funding considerations, a county health department is feasible for York County. A 21st century county health department would provide the opportunity to strengthen and expand the existing public health foundation built by York City and better coordinate county wide assets thereby increasing their overall value to the community. By investing in the recommendations in this study, York County can bridge the current divided structure of public health services among the City and the County resulting in greater well-being for every York County resident.
GUIDING PRINCIPLES FOR A PUBLIC HEALTH MODEL
The Blue Ribbon Panel agreed on the following guiding principles for a York County public health model:
- Tailored to York County needs and opportunities
- Leverages strengths and assets in York County in a collaborative model
- Provides data-driven approach - “source of truth” for county specific health information
- Fosters a healthy community and advances health equity
- Garners support of local leadership and county officials
- Operates in fiscally responsible, sustainable manner, and provides high value for York County
- Draws down state and federal funding previously unavailable to York County to support and advance public health
- Achieved over a three- year phase-in approach
OVERALL RECOMMENDATIONS
1. Identify Interim (12-18 Months) York County Public Health Leadership
Ensure that there is one accountable person to direct, coordinate and manage the activities required to establish a York County Health Department. Provide adequate administrative support and authority for this position to be successful.
2. Implement a Plan to Reduce the Burden of COVID-19 on County Residents and Businesses Establish county-wide public health services by starting with the robust COVID-19 response to address needs raised by residents, school districts, hospitals and healthcare providers, businesses and county public and private entities. This includes continuing supports to provide PPE while strengthening the ability of the county to speak with “one voice” in guiding the public and county organizations to reduce risks effectively while keeping the local economy strong.
3. Implement the Steps to Establish a York County Health Department and Create a Detailed Three-Year Budget
Initiate the process of establishing a York County Health Department by requesting a certificate of approval from the State Secretary of Health. Establish a Board of Health and fill certain key positions defined in statute to be eligible for state funding under Act 315. Begin the work to transition the York City Bureau of Health to a county health department and assess staffing gaps and needs for the desired 21st century health department model. Develop a three-year county health department budget that identifies revenue sources and expenses that will coordinate funding and optimize local, state, and federal revenue.
4. Map Existing Data Infrastructure and Create a Plan to Connect and Expand These Assets to Understand and Target Health Needs.
Develop capacity to integrate and expand multi-sector data to assess health and target resources effectively, ensuring that a county health department is well equipped to serve as a much-needed “source of truth” for county specific health information.
5. Begin a Community Engaged, Structured Planning Process and Develop an Approach to Center Health Equity
Using a community engagement framework, undertake a strategic planning process to develop a detailed county-tailored plan for a public health department that will provide a neutral backbone, not affiliated with any single health care provider and core infrastructure to coordinate and synergize strong community assets providing “one trusted voice” for the county’s health. Develop a plan centering health equities by engaging diverse communities to assess the efficiency of existing efforts. The plan will also address disparities and continue to focus on high need geographies, including but not limited to York City, to efficiently expand the county’s ability to provide high quality public health services county-wide.
WHY NOW?
The COVID-19 pandemic has thrust public health into the spotlight. Our nation’s public health system, chronically underfunded and often invisible, has revealed itself to be essential. As new federal funding proliferates through states and localities to respond to COVID-19 and strengthen public health systems, our nation’s leading public health associations are also generating frameworks and roadmaps to support local health departments not only in their COVID-19 response but in “bouncing forward” to update and modernize public health systems to be equipped to meet the ongoing health needs and challenges in their communities across York County.
Additionally, while available state public health funds through Act 315 have not kept up with need in recent years and as the role of public health becomes less “invisible” and its benefits clearer, there could be an increased appetite at the state and federal level to establish adequate state-level funding that York County would then be well-positioned to access.
Special appreciation to the Healthy York Coalition for the support and coordination of the process for this feasibility study.
In acknowledgement and appreciation of those that volunteered time and expertise to this feasibility study:
Blue Ribbon Panel Members:
Amada Cresswell, RN UPMC Memorial Pinnacle
Christine Harrop-Stine York College of PA
Matthew Howie, MD York City Health Bureau
Mark Kandrysatz WellSpan Heatlh
Barbara Kovacs York City Health Bureau
Bev Mackereth Consultant, UPMC Pinnacle
Nakesha Muldrow WellSpan Health
Michelle Mummert WellSpan Health
Hatal Patel, MD, MPH Family First Health
Michael Spangler, MD UPMC Memorial Pinnacle
Dr. Vern Webb Pastor/Black Ministers Association
William Yanavitch Kinsley Construction
Don Yoder Long term care consultant
Focus Group Participants/Organizations:
York Area Housing Group Pressley Ridge in Central Penn
York Area Agency on Aging True North Wellness
York XL Family First Health
York County Libraries Planned Parenthood
UTZ Quality Foods Healthy Housing
York County Planning Commission
York County Economic Alliance
Rabbit Transit
York County Literacy Council
AARP York County Parks
UPMC Pinnacle Foundation WellSpan Health
York Traditions Bank Covenant Family Ministry
Black Minister’s Association Latinos Unidos LifePath Christian Ministries
York College Center for Community Engagement York YMCA – New American Welcome Center
Community Stakeholders:
Ed Singer and Maggie Kunz Carroll County Department of Health
Matthew Howie, MD York City Bureau of Health
Robin Rohrbaugh Community Progress Council
Felicia Dell York County Planning Commission
Phil Hess WellSpan Behavioral Health
Barbara Kovacs York City Bureau of Health
Michael Spangler, MD UPMC Memorial Pinnacle
Dr Vern Webb Black Ministers Association
Chris Echterling, MD WellSpan Health
Melissa Lyon and Kristina Burling Erie County Health Department
William James York County Office of Emergency Management Doug Koszalka and Ray Barishansky PA Department of State
Brittany Shutz York Opioid Collaborative
Sarah Boateng PA Department of Health