When COVID-19 shut down the global economy in 2020, Berks County didn’t have a local public health department to lead the charge on contact tracing, prevention efforts, or immunization.
The community had to step up. A coalition of medical professionals, nonprofits, and community organizers joined the county commissioners to respond to the growing emergency.
One nonprofit, Co-County Wellness Center, worked to identify infected people and contact whoever they may have exposed, said Carolyn Bazik, the organization’s executive director.
People were amazed the county didn’t have a health department because everyone worked “seamlessly,” Bazik said. But out of that experience came a familiar cry.
“This has been a repeated refrain over my 30 years — why doesn't Berks County have a public health department, or why doesn't the city of Reading have a health bureau?”
As it currently stands, a loose network of nonprofits and community organizations temporarily assemble to tackle pressing public health issues in Berks County. The Pennsylvania community was commended for its coordinated efforts during the pandemic, but nonprofit leaders said those efforts underscore the need for a designated point of contact and county leadership in future public health emergencies.
The pandemic prompted Berks County commissioners to pay the national consultancy firm Health Management Associates $170,699 to explore public health services needs and gaps.
About half of Pennsylvania’s nearly 13 million residents live in a county or city covered by a local health department. But in more rural parts of the commonwealth — like Berks County — residents rely solely on the state for a limited number of public health resources and services, amenities bolstered by small, strained community organizations and nonprofits.
“I think [nonprofits] would be willing to invest, the problem is that they're tired of being the solution and letting county government off the hook all of the time by fixing it for them,” Bazik said. “I think they want the county to buy in and be invested in some way.”
While the commissioned study did not directly recommend creating a local department, it did provide a blueprint should Berks County take a more active role in protecting public health both during and before emergencies.
The report found Berks could improve the coordination of existing services by funding positions that track local health concerns and direct resources as well as forming a panel to “communicate with partners and the public as one authoritative voice about public health threats, emergencies, and risks.”
Berks Board of Commissioners Chair Christian Leinbach said the county had to pause moving forward with the recommendations because of other more pressing expenses — like a shortage of juvenile detention beds — as well as concerns about added costs.
These new costs led the Berks commissioners in December to approve a $705.8 million budget, which carries an 8% tax increase. The county also raised taxes by 9% in 2024 — the first time Berks had increased them in six years. The resulting budget left no room for additional ongoing public health spending.
“Unless something is absolutely critical [it’s] off the table,” Leinbach said. “All these recommendations are going to cost money. And so right now, it's on hold.”
Some nonprofit leaders fear Berks officials will sweep the recommendations under the rug.
Anthony Tucci, CEO of Western Berks Ambulance Association, said he was part of the community groups surveyed in the report and was excited about the prospect of putting “together all of the pieces” when it comes to public health issues facing county residents.
“I think it would have been … beneficial to us,” he said. “I'm afraid, though, that it has died on the vine.”
Pros v. cons
The lack of an organized, coordinated response to public health issues has led to some real consequences.
An assessment conducted by Penn State and Tower Health for Berks County as part of the public health study identified low rates of preventative care for all residents and disparities in that care for racial and ethnic minorities.
The assessment also highlighted serious gaps in mental health services, with few providers or skilled nursing facilities in the county.
According to the county health services report, Berks had higher rates of COVID-19 deaths and deaths related to strokes than the state and nation.
Bazik, who has worked at Co-County Wellness for 30 years, said there has been talk and questions about why Berks doesn’t have a county health department for decades.
The Berks County Community Foundation pushed for a local department through those years, and in 2012, the Berks Community Health Center became the county’s first and only federally qualified health hub. The center provides an array of primary health care, including dental and vision, to underserved communities — services lacking in Berks, the county health report found.
Monica Reyes, vice president for programs and initiatives at the foundation, said many residents believe public health issues are most prevalent in urban Reading, but the report shows that problems exist in rural parts of the county too.
“This study really highlighted some of the areas outside of the city where some of these public health needs are prevalent, and there really isn’t access to services in these areas,” she said. “The study really showed that it's not just the city, it's really throughout the county, and each area has specific high rates of a particular health issue.”
Within the overall costs of creating systems to protect the public’s health, Berks commissioners specifically worried about how a local department would afford to inspect restaurants, salons, and other facilities.
Those inspections bring in revenue for a department, but it’s typically not enough to cover the full budget, said Chester County Public Health Director Jeanne Franklin.
She said restaurant inspections are important for food safety, which her agency sees as part of a “continuum of care” it provides to residents.
“Delivery has to happen at the local level,” she said. “Really what you're doing is just extending the reach and benefits through the county system. So to me, that's the big picture benefit.”
Salon and other facility inspections, however, are not required of county health departments, Franklin said. The county could add them on later.
In neighboring Lancaster County, commissioners scrapped plans to create a local health department over concerns about cost and duplicating efforts handled by the state. Officials there have said the state’s public health laws are outdated and don’t give counties enough flexibility to tailor departments to their needs.
Franklin conceded that the commonwealth’s health department laws are antiquated, but when it comes to the regulatory pieces, she said those parts are still needed.
Chester County’s health department was created in 1967, which has allowed the southeastern Pennsylvania community to shape public health conversations and build strong partnerships with local organizations and nonprofits.
“You have to be creative with the funding … The other piece is building partnerships,” Franklin said. “You know, I always say that we don't have to do it all. We just have to make sure it's all done and done well.”
Forming a coalition
Co-County Wellness last year proposed a $226,250, two-year contract with Berks County to establish and coordinate a consortium to lead public health services there, one of the recommendations in the report. But Bazik said officials told her they were going in a different direction with the proposed Healthy Berks Coalition. About $50,000 would have been designated to pay Health Management Associates for working with the coalition to get things set up, she said.
The nonprofit’s executive director figured creating a coalition was an easy first step to getting a better handle on the county’s health needs and bypassing the bureaucratic process of creating a county health department.
“In my proposal, absent that full public health department, let's figure out where are the holes, what's being done, what's being paid for by somebody else,” Bazik said.
“Where are the holes in the network or the framework that we have, and then, how do we address them? How do we collaborate better and not compete with one another?”
Leinbach said that of all the recommendations, he envisions the Healthy Berks Coalition as the most attainable. He even met with coalitions in York and Adams Counties to learn about their programs. But cost remained a sticking point. Berks also has competing health care systems that make coordination challenging, Leinbach said.
Berks has Reading Hospital, operated by Tower Health, and Penn State Health St. Joseph Medical Center. Residents on Berks’ outskirts may also use networks in neighboring counties like Montgomery, home to Lehigh Valley Hospital–Gilbertsville.
“This model isn't as simple,” Leinbach said. “And the question becomes, how do you coordinate all of these private along with the public [entities]?”
County commissioners will try and implement some of the report’s recommendations during the 2025 budget discussions.
Even creating a coalition is a “pretty expensive thing to pursue,” Leinbach said.
While the county has a healthy fund balance, Leinbach said that isn’t something to use for recurring operational expenses.
“If we make a commitment to one of these actions on the health study, we’re making an operational commitment on a long-term basis.”