As our country faces the death of Daunte Wright at the hands of police in Minnesota – just 10 miles from the courtroom where a former police officer is on trial for the murder of George Floyd – I think it’s appropriate that we are discussing both public safety and public health at Council tonight.
Chief Bey shared the efforts the Lancaster City Bureau of Police has made in the last several months. This is an ongoing process – evolving policy, practice and culture in an institution that is more than 150 years old while seeking the highest standards in delivering public safety services 24 hours a day, 7 days a week, 365 days a year. Chris Dreisbach shared pilot efforts around crisis response in partnerships with Police Departments around Lancaster County. These efforts are essential to protect our most vulnerable residents and support officers with what they’ve asked for: trained, experienced counselors who are better equipped to meet those in crisis. It is imperative that we track these calls for crisis intervention and the outcomes from this new approach – and then leverage those data and outcomes to ensure Countywide implementation of permanent and expanded crisis intervention services. Also tonight, Lancaster City Council added its voice to the chorus calling for a public health department.
While COVID-19 and the sickness and death that continues to be left in its wake has become the primary focal point of this discussion, I’d like to return to the key underpinning of this conversation and that is the word “public.”
Public means the whole – as in the whole of our community – every block, street, road, route, and zip code. Whether you live in a City, borough, or township. Certainly, we understand now, more than ever, that the public health has great consequence to our communities – wherever you live, whoever you are.
Right now, there is not a single entity in Lancaster County with the expertise to plan, guide, and lead efforts that encompass the whole of the “public” as it relates to our collective health. Instead, what we have is a group of health care providers, non-profit entities, and government who from time to time join together to solve issues of import. We’ve become really good at coalitions including LiveWell Lancaster County, Joining Forces, Let’s Talk Lancaster, Hunger-Free Lancaster County, and Lancaster County Lead Coalition. And most recently, the Lancaster County COVID-19 Task Force.
To be sure, these coalitions have played a role in mitigating health crises and improving the quality of health; however, there is no one minding the collective work of these efforts, reviewing progress, tracking data over time, and reporting to the public consistently. In addition, the capacity of these coalitions is limited.
There is no doubt that we are fortunate, most fortunate, to have local leadership and health care providers that work exceedingly hard to respond to our health care needs. And we are lucky, so lucky to have an accredited Level 1 Trauma Center in Lancaster County, a state-of-the-art cancer facility, and soon a pediatric hospital in our collective backyards. However, let’s be very clear about this: by relying on private entities, we are also outsourcing public health to organizations that are balancing their organizational priorities, capacities, and finances, with the needs of the public.
As it relates to the pandemic, Penn Medicine/LGH as the largest health care provider in our community, has taken on considerable responsibility for COVID response by planning, providing services, and coordinating efforts – even amongst its competitors. And very fortunately, because of CARES funding, the County has been able to compensate Penn Medicine/LGH for the kinds of services that are not reimbursable like contact tracing.
The City of Lancaster is extremely grateful for Penn Medicine’s leadership during these momentous times. And we are grateful for their ongoing partnership addressing a host of community health concerns in the City beyond the pandemic. Just before COVID struck our community, we were close to completing a feasibility study in partnership with Penn Medicine to launch a health department in the city. The pandemic made it immediately clear that a City focus wouldn’t meet the need – nothing less than a County approach will work. You see, even our largest, most involved health care provider in our community recognizes the value add of an entity that is focused on the public.
I’d like to be explicit about that value add – because it isn’t the central part of the conversation community-wide. The value is:
1. Leadership. All public health requires coordination at the local, state, and national levels as well as public- and private-led efforts. A single entity that can guide the public in making investments to protect and preserve the health of everyone – non-partisan, scientifically sound, independent, accountable to the public. Think Dr. Fauci – someone coordinates overall response rooted in science and data for the benefit of the whole.
2. Monitoring and reporting. These are essential activities that are glaringly absent. If you want to know where children live who have elevated blood levels, those data can’t be released to an entity like the City actively working to address lead poisoning through home repair. Lancaster County has higher rates of Lyme disease and chicken pox than the state overall, but where these cases are is unknown. COVID monitoring was equally opaque – and while we finally had data about deaths, positive tests, we still don’t have any data about vaccination rates. Our conversations about Crisis Intervention dovetail here as well: a public health approach could include monitoring how many community members struggle with mental health issues, if services are available meet their needs, and what their health outcomes are. If we want to make data driven decisions, we actually need to have data.
3. Accountability and Transparency. We should absolutely expect accountability and transparency to be hallmarks of anything that is public. Our community’s current efforts are fragmented at best, unduly influenced by politics, and lacking vision. Let’s take note of the emerging support across Lancaster County for a Countywide health department and join together in a conversation about what is possible with a public health investment for the public good.