Guardians of the Public's Health

Going Local: A Call to Strengthen the Capacity for Local Public Health Action

Did you know Local Health Departments have shed 51,700* jobs since 2008?  

* Updated  on June 20, 2015.  See for the full report.

To learn more about the original study which documented nearly 40,000, please review the slides from an excellent lecture given at our November 2013  meeting  or review the related website of the National Association of County and City Health Officers.     Members can listen to the lecture and further discuss how we can ensure the capacity to act locally in our members only forum    To learn why local public health capacity is important, please  read a recent article from our November 2013 Bulletin.

Going Local: A Call to Strengthen the Capacity for Local Public Health Action

The Black Death. Small pox. Swine flu.    The West Nile virus. Cyclospora. All of these disease epidemics, from our historical past to our present day, begin with tiny mutations in individual cells that spread to affect larger communities and populations.  Stopping outbreaks early requires science, cooperation, resources, and national, state and local public health action.  Without all four, we may go back to a time when outbreaks regularly killed many people.

The importance of a properly functioning public health infrastructure could not be more relevant. On June 28th, 2013, the Centers for Disease Control and Prevention (CDC) were notified of two laboratory confirmed cases of Cyclospora infection in Iowa. By September 20, the count had grown to 623 cases in 25 states.1 The cases assessed by Dallas, Tarrant, Denton, and Collin Counties in Texas represent the core of the outbreak in the state, and provide crucial information to the Texas State Health Department and nationally to the CDC.2 The outbreak data collected, assessed, and responded to by Dallas, Tarrant, Denton, and Collin Counties in Texas proves how crucial local public health departments are in maintaining a properly functioning public health infrastructure.

Local public health departments are the first level of defense against bad health. They maintain healthy tap water, healthy air, healthy food, and, as in the Cyclospora outbreak, detect, investigate and stop disease outbreaks. They facilitate programming to help the public make better health decisions, including community exercise programs, smoking cessation support groups, and diabetes informational sessions. Local public health departments have one motto: Don’t treat disease, do one better and prevent it.

   Examples of local public health action include:

  • Interview a recently diagnosed measles patient, and give measles vaccine to their contacts.
  • Assist medical staff in obtaining laboratory confirmation of a rare disease.   
  • Take samples to test for dangerous bacteria and chemicals such as lead. 
  • Visit restaurants, sewage plants, pools, camps and hospitals to verify that the correct procedures are used to prevent outbreaks.
  • Train local volunteers and interact with local healthcare and first responder workers.
  • Facilitate the testing and treatment of individuals was exposed to tuberculosis or a sexually transmitted infections. 
  • Monitor patients taking tuberculosis medication to prevent the development of antibiotic-resistant bacteria
  • Educate the community through nursing homes, schools, day care centers, and other institutions on control measures for epidemics.
  • Arrange for a bat or raccoon that was in contact with humans to be tested for rabies.
  • Provide advice and expertise on when rabies vaccines are needed. 
  • Interview individuals who might have food poisoning to obtain information about where, when, and what they ate. 
  • Interview individuals who went to a party or meeting where people got sick afterwards.
  • Provide medication and medication instructions to community members who live near nuclear power plants.
  • Prevent individuals with contagious disease from infecting other community members.


The roles of local public health departments are essential, but not glamorous. Most community members are unaware of local public health department activities that is until the department stops functioning as it should. This is due in part to the policies guiding public health department structure and function. For example, in Pennsylvania, the Section 15 of the Disease Prevention and Control Law of 1955 states that public health workers cannot disclose information about certain diseases unless the intent is to prevent future disease. This policy is reflected nationally, as an extension of the Health Insurance Portability and Accountability Act of 1996, commonly referred to as HIPAA.3

The community can be thought of as a patient population. Therefore, public health departments, national, state, and local, have a responsibility to keep information confidential unless needed for specific public health purposes. Public health information is disclosed only on a need-to-know basis, meaning that many in the community are unaware of the important roles played by the local public health department.

But, local public health departments need to disclose one big secret: they have an illness all their own. Staff and funding are being cut from many local public health departments all over the nation.  Of the 1.7 trillion dollars that are spent on healthcare in the United States every year, less than four cents of every dollar are spent on public health.4 This is a problem, as funding and adequate staffing for local health departments is required to keep community illness, outbreaks, and epidemics at bay.

Preventive and public health services are unique from disease care services: every individual in the community uses them, depends on them, and expects them. Without public health services, communities may lose access to clean drinking water, safe food, safe air, vaccine services, and disease prevention services. Adequate increases in funding for local health departments are required to maintain public health services, and everyone is a stakeholder in the issue.  


Poornima Oruganti is a medical student attending Northeast Ohio Medical University in Rootstown, Ohio and is a former American Association of Public Health Physicians (AAPHP) Summer Health Policy Fellow and American Medical Association Government Relations Intern.


Virginia M. Dato, M.D., MPH is a federally funded public health physician employed by the Pennsylvania Department of Health, based in Pittsburgh.  She is also President of the American Association of Public Health Physicians.  The views set forth in this article are her own and do not represent the positions of any Commonwealth of Pennsylvania or private agency.




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