Allegheny County, Pennsylvania

Allegheny County was once one of the nation’s most populous counties. And home to a prosperous manufacturing industry.

A metropolitan community of more than 1.2 million residents, Allegheny County is home to 130 municipalities, each with its own municipal governance. Pittsburgh is the county’s biggest city, representing 25% of the population and 13% of the county’s physical area. Outside of Pittsburgh, the surrounding 129 suburban municipalities are individually much smaller, each accounting for, at most, 4% of Allegheny County’s population.

After the collapse of the steel industry in the 1970s, the county’s population declined by 24% from its peak in 1960. Widespread financial hardship exacerbated disparities in education, employment, poverty, and access to care. Today, Allegheny is undergoing a transformation, driven by Pittsburgh’s efforts to revitalize the city center. Young people are moving in, attracted to jobs in the technology industry. However, issues like unemployment and poverty continue to disproportionately affect the region’s Black residents.

Overview

Population and Demographics

Population: >1.2 million

SOURCES:
U.S. Census Bureau; photography courtesy Flickr user Rockin’Rita, CC BY-NC-ND 2.0.

Context and Actions

Community Context and Challenges

Urban renewal has displaced older, low-income residents to the outlying suburbs, where access to public transportation and health services is limited.
Racial disparities exist in educational attainment, a linchpin to higher paying jobs; 17% of Black residents hold a bachelor’s degree, compared to 38% of white residents.
Black residents are less likely to have health insurance coverage or maintain a primary care provider; many low-income neighborhoods report a shortage of primary care physicians.
With smoking rates and hazardous air toxins higher in the county than the nation, cancer (along with heart disease) is a leading cause of death in Allegheny County; Black men and lower-income people in particular are at risk for cancer.
Despite an overall decrease between 2008 and 2015, infant mortality rates are almost three times higher among Black residents than white.

SOURCES:
U.S. Census Bureau. (2014). 2010-2014 American Community Survey 5-Year Estimates.

Taking Action

Allegheny County is leveraging cross-sector partnerships, strong civic institutions, and resident engagement for positive change.

The Allegheny County Health Department and county leaders have engaged hundreds of residents and over 80 different partnerships to examine health disparities, map local assets, and set health and strategic priorities. While the impact of this collaborative approach has yet to be realized, Allegheny County has secured the infrastructure and the means to enact transformative improvement in residents’ health and well-being.

NOTE:
These baseline reports, created in 2016, track community programs and initiatives in their early stages and measure initial progress only. Future reports will provide more in-depth insights and analysis into this community's efforts to build a Culture of Health.

Plan for a Healthier Allegheny

The County undertook a comprehensive health planning effort in response to health disparities; the plan included extensive engagement of community residents and stakeholders through surveys and community meetings; and identified action steps and tracks progress toward goals.

A Comprehensive Plan, Consensus Building, and Funding

There are multiple examples of wide-ranging cross-sector collaboration among the health department, mayor of Pittsburgh, and the county executive branch, with support from legacy foundations. With a comprehensive plan, consensus building and resident engagement, collaborative relationships across key decision makers, and access to funding support, Allegheny County has the infrastructure and the means to enact meaningful county-wide policies and initiatives.

Live Well Allegheny

Administered by the health department, Live Well Allegheny is a county-wide initiative that focuses on health promotion and disease prevention activities in partnership with local schools, restaurants, and communities. Partners can earn a Live Well designation through active participation in the program.

High Coverage, Unequal Access to Care

Allegheny County has an extensive, high quality health care infrastructure and high insurance coverage, but continues to struggle with unequal access to care due to disparities in employment-based coverage and unequal access to transportation and health care in the outskirts of the county. Continued surveillance and additional data and information gathering will explore how these issues are being addressed.

Going Forward

Questions for Consideration

The range of multi-sectoral collaborations for health in Allegheny County, in combination with extensive economic revitalization efforts, suggest a path forward toward greater health equity. Future reports will examine the extent to which these efforts are having a positive, equitable influence on the health and well-being of all Allegheny County residents.

We will also examine the extent to which stakeholders can leverage the strengths of the region’s philanthropic, health, and technology sectors to address priority health concerns.

Questions meriting additional attention include:

In what ways is Allegheny County addressing economic disparities throughout the county that are either unaffected by or possibly exacerbated by progress in Pittsburgh?
What impact has Allegheny County’s Plan for a Healthier Allegheny had on improving the health of all residents? Which goals have realized success? Which goals have been re-evaluated?
In what ways is Allegheny County addressing health inequity throughout the county, and specifically among low-income residents? What are the social and economic drivers influencing homicide and opioid rates in the Allegheny County? To what extent has Allegheny County addressed the social determinants of homicide, drug-related deaths, and cancer mortality?
What are the narratives that drive or inform health in specific populations of concern, such as low-income and Black communities, and how do key leaders use them for civic engagement around health?
In what ways do the existing nonprofit and health department initiatives reach low-income residents, especially Black residents?
In what ways has gentrification and revitalization affected the health and wellness of county residents, both within the city center and in surrounding suburbs? How has gentrification affected access to resources and promoted health and well-being?
In what ways have plans for revitalization been successful? What success stories or models of economic revitalization can be scaled up to address other drivers of health and well-being? What have been the health and well-being impacts for those displaced by inner city revitalization?
To what extent are other coalitions and collaborations addressing the social, structural, and economic drivers being leveraged to consider their role in health and well-being, and what efforts have been tried to link across? What are key facilitators and barriers to initiating and/or maintaining those linkages?