Looking at Public Health through Pennsylvania History

It’s May 2021, and COVID-19 vaccines are now available to the majority of Americans. I got my second Pfizer jab last week and I’m getting ready to ease back into un-distanced socializing. Of course, the pandemic is ongoing; we are not yet at herd immunity (and may never be), the virus will continue to spread, and vaccination progress has been uneven—especially globally. We will soon have some semblance of normality back—not normalcy, Mr. Harding—even if certain elements of our pre-COVID world remains elusive for the time being.

In the meantime, our public health agencies will continue to work overtime to maximize vaccination and flatten local outbreaks as they pop up. These entities have played a key role in the fight, and despite a fair number of critical blunders, they remain the best thing we’ve had to a trusted source of information. Before the COVID-19 pandemic, how many ordinary citizens thought about the CDC or state departments of health on a regular basis? It turns out these entities play an essential role in society, but as is often the case with government, we only realize it when something goes wrong.

A few months back, I needed some light reading for a hike, so I grabbed a 2017 issue of Pennsylvania History, the journal of the Pennsylvania Historical Association (by light reading, I mean I needed something easy to pack). By coincidence, one of the articles was “Under the Stimulus of Great Epidemics”: Reformers, Epidemics, and the Rise of State Level Public Health in Pennsylvania, 1872-1905.” Great epidemics have been on my mind recently, so I figured it was worth reading.

In the article, historian James E. Higgins detailed how the state’s public health services belatedly emerged through a series of fits and starts, and often only in response to various public health crises. Despite its 19th century industrial might, Pennsylvania had no statewide public health organ until 1885, at a time when 25/38 other states did. Even once Pennsylvania had a board of health, it was notoriously underfunded. Fundamentally, Higgins explained, “the state’s abiding conservatism could only tolerate so much government control of private property,” and the General Assembly failed to proactively invest in public health even as the field developed interventions that would have saved the lives of Pennsylvanians.

Given recent events, it’s worth taking this opportunity to view on conservative opposition to the Department of Health. Opponents, especially the wealthy, objected to funding public health at every opportunity until a crisis was in process. When outbreaks happened, local boards of health and volunteer relief committees were on their own against typhoid, cholera, smallpox, and other highly transmissible diseases. Even after the state established a weak Board of Health in 1885, its limited authority left it powerless after Allentown leaders rejected a recommendation to replace pipes spreading typhoid. Lives were lost needlessly because of the fear of big government.

It was only in 1905, after disease transmission was better understood and Progressive Era reformers set out to remake government that Pennsylvania established its Department of Health, the entity today leading Pennsylvania’s fight against COVID-19. I don’t think there’s anyone in the state entirely satisfied with the department’s performance. Even if for folks who agreed with the lockdown strategy last spring, Pennsylvania’s vaccine rollout has until recently been slow and confounding. Still, I’d rather have a Department of Health empowered to protect people than a toothless husk of a health board. Even in non-pandemic times, the department is hard at work on STI contact tracing, environmental health, end-of-life care, and the opioid epidemic. Hopefully our appreciation for this essential work carries over into the post-COVID era. As Higgins concluded in his article four years ago, “If Pennsylvania’s experience at the turn of the twentieth century can teach people at the turn of the twenty-first century, it is that it is far better to maintain a robust defense of the public’s health and to . . . push against death’s ‘debatable borderland’ than to laud great leaps forward that emerge from needless agonies.”

As it has in the last year, history can play a role in helping people recognize why public health and other long-term policy issues matter. If we’re going to talk about government’s shortcomings—and we should—we also need to talk about its successes. It’s wholly legitimate to debate the size and scope of government, but the history of the Department of Health illustrates why government has evolved to fill roles that it didn’t in the early Republic. Government can be slow, bulky, and inefficient, but it can also be responsive to tragedies of the commons that no one else will.

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