In 2020, Gov. Mike DeWine faced a foe neither he nor most of us were expecting — a global pandemic that brought economic devastation to many Ohioans, taxed the state’s resources and hospital systems to their limits and killed thousands. The COVID-19 pandemic also exposed the stark inadequacies of Ohio’s approach to public health, including laws and a public health system that hadn’t been updated in a century, and whose funding was woefully subpar.
DeWine rightfully earned praise for how he’s led Ohio during the pandemic. So have the men and women of the state Health Department. Ohioans are also indebted to the department’s former director, Dr. Amy Acton, for the deep understanding and public health expertise with which she guided the state’s initial, determined response, and for her dedication to the public interest.
The governor, a Republican, has drawn fire, much of it demagogic, from publicity-hungry General Assembly Republicans. But given a relentless virus, and a White House that endangered Americans by discounting COVID-19′s danger, the DeWine administration has fought hard to protect Ohioans. The governor deserves our thanks.
But he also needs to push GOP legislators in 2021 to set aside the grandstanding and start making positive changes in our public health setup so Ohio isn’t so woefully handicapped in essentials such as contact tracing and disease reporting. The state also needs to be able to exercise far more comprehensive oversight to ensure efficient and effective approaches to disease testing, quarantines and vaccinations during health emergencies.
Generals are always prepared for the last war; we can’t see the future, but we can see the past. So, for example, we expect Pentagon planners to learn lessons from, say, the Vietnam, Afghan or Iraq wars to guide generals and admirals who’ll fight the wars that may come.
Yet as to public health, Ohio has been fighting COVID-19 using an administrative setup created just after World War I, in 1919, to fight the 1918-19 flu pandemic, which, among many other Ohioans, killed 4,400 Cleveland residents, the Encyclopedia of Cleveland History reports.
During episodic or localized outbreaks of disease or illness, a decentralized public health system, such as Ohio’s, can be — and has often been — effective. But due to ever-increasing international travel, and similarly accelerating worldwide trade in commodities that can host pathogens, COVID-19 may be just the beginning of a series of pandemics. For that, Ohio is unprepared – and must change.
Perhaps today’s public health machinery made sense in 1919 — so long ago that women couldn’t vote in Ohio. But a 101-year-old public health law is beyond its shelf life.
In part because the 113 local health districts (in a state with 88 counties) have for a century taken the lead on public health, General Assembly funding for the Ohio Department of Health and its mission has been constricted. For this fiscal year, the General Assembly appropriated about $108 million in state and federal general revenue for the Ohio Health Department; the appropriation for the Ohio Department of Natural Resources (fishing, hunting, state parks) was about $135 million. According to research reported by the University of Minnesota’s State Health Access Data Assistance Center, Ohio spends $14 per capita on public health. Only three states spend less: Kansas ($13); Nevada ($11); Missouri ($7).
True, the Ohio Department of Health’s overall appropriation for this budget biennium was significantly larger than it was for the previous biennium. But that was mainly because of additional funding for two children’s health programs. Moreover, in early 2019, the Legislative Service Commission found that, of the Health Department’s 1,105 employees, only 60 were assigned to the Bureau of Infectious Diseases (set to rise to 66), Of course, the pandemic led to some immediate changes in state operations.
But long-range, there’s a pattern of legislative underinvestment in the Health Department and overreliance on local agencies. Citing Ohio Association of Health Commissioners data, the Legislative Service Commission reported 75% of funds for local health departments come from local sources, not Columbus. That needs to change.
What also needs to change is the state’s difficulty in gathering statistics for accurate reporting and oversight of public health measures. That’s not just essential for being able to provide timely, up-to-date numbers that accurately measure the extent of the crisis, but also to make sure that such critical endeavors as infectious-disease testing and contact tracing and the timely and efficient delivery of vaccinations are carried out as fairly and quickly as possible.
Ohio is one of the few states that doesn’t license its hospitals, forgoing a critical lever of control in a health emergency. Yet Ohio’s hospitals have also proved themselves essential partners during this pandemic by assuring timely regional consultation and apportionment of hospital resources.
These facts hand the DeWine administration and the legislature a three-fold task: to modernize Ohio’s public health laws and system; to bolster the Health Department’s resources; and to give the state greater powers in a health emergency to mandate timely and accurate health reporting and deployment of scarce resources.
— The Cleveland Plain Dealer; Online: https://bit.ly/3pSMejd