Gov. Mike DeWine said he wanted to invest more in public health programs that can dramatically reduce problems down the road even before the coronavirus global pandemic shined a light on the shortcomings of Ohio’s public health system.
“There’s no question that public health in Ohio has been chronically underfunded, and we’ve seen the results in the past year. If you don’t build up a strong infrastructure and workforce before a crisis hits, then it’s not there when you need it,” said Micah Berman, associate professor in the Moritz College of Law and the College of Public Health at Ohio State University.
During the coronavirus pandemic, Ohio spent big on public health. The money flowing through the Ohio Department of Health hit $1.39 billion in fiscal year 2021, up from $631.6 million in fiscal year 2020.
DeWine’s two-year budget proposal released earlier this month recommends funding to ODH drop to $1.2 billion in fiscal year 2022 and then $887.8 million in fiscal year 2023 — an indication that the pandemic response will wind down.
Despite the lower overall budget numbers, the governor’s plan is to invest more into programs that help babies and young children, at-risk moms, and people struggling with addiction.
“Focusing on Help Me Grow, infant mortality, disease/injury/overdose prevention, lead poisoning reduction all are critical to the governor’s goal of ensuring every Ohioan have the opportunity to thrive,” according to the Ohio Department of Health.
Ohio still lags the nation on several key health metrics — rates of smoking, obesity, suicide, infant mortality and fatal drug overdoses.
Nearly 35% of Ohio adults are obese, compared with 31.9% of Americans. Roughly 20.8% of Ohio adults smoke, compared with 15.9% of Americans. Ohio’s infant mortality rate is higher than the national rate for both white and Black babies. The number of Ohioans who die by suicide is 15.7 per 100,000 people, compared with the national rate of 14.8. And the fatal drug overdose death rate in Ohio is 34.8, compared with 20.6 per 100,000 people nationally.
A 2019 study by Trust for America’s Health said of Ohio: “Deaths owed to drug misuse, alcohol or suicide outpace the country as a whole. Its rates of obesity and related conditions indicate an area of concern, with the percentage of adults with obesity higher than the U.S. median, as rates of diabetes and hypertension rank high. Finally, the state achieved a score of three out of a possible 10 measures of public health preparedness for diseases, disasters and bioterrorism.”
Trust for America’s Health found in 2017 that Ohio ranked 44th among states for per capita spending on public health and in 2020 Ohio ranked 45th in per capita funding transferred from the federal Centers for Disease Control and Prevention.
Ohio Department of Health Director Stephanie McCloud told lawmakers on Feb. 10 that she doesn’t know if the governor’s proposed budget would move Ohio up in those rankings.
Focus on children, substance abuse
Public health focuses on systemic solutions to prevent widescale problems for entire populations. For example, advocating for immunizations prevents the spread of infectious diseases, or advocating for clean water and air helps prevent health issues.
DeWine’s proposed two-year state budget calls for increased spending in some areas of public health:
- Home Visiting Services. Increase funds by $1.95 million a year for a total investment of $41.2 million over two years. The program provides one-on-one parenting support to pregnant women or new parents and their young children who are at-risk.
- Infant Mortality. Allocate $5.5 million over two years to provide services to reduce infant deaths, particularly among Black families. Services include crib distribution, pre-natal care, transportation and other programs.
- Substance Use. A total of $3.25 million over two years will be earmarked for naloxone distribution, data collection and analysis, and creation of a comprehensive care plan for patients who show up in emergency rooms with substance use disorders.
- Child Lead Poisoning. Spend an additional $14.3 million over two years to help families, doctors and communities reduce and prevent lead poisoning. The focus is to reduce lead in properties owned by low-income and middle-income families, provide training to abatement workers, and strengthen the enforcement of lead hazard control orders.
Former state senator Shannon Jones, who leads a child advocacy group called Groundwork Ohio, said DeWine’s budget proposal puts young children on the state’s agenda with modest increases in programs.
“Given how hard many young children have been hit by the pandemic, we need to make sure we position them for lifelong success,” she said.
DeWine also wants to allocate $10.8 million to build up capacity at 42 of Ohio’s 113 local public health districts and $25 million with the Department of Administrative Services to upgrade antiquated information technology systems so that health data can be collected, analyzed and displayed in real time.
“Investing in data systems is important, but it’s not going to be helpful unless there are also funds to hire people to collect the data and then act on what they find,” Berman said.
The governor’s proposal is at the front end of a long process. After hours and hours of hearings, the Ohio House Finance Committee is expected to put its own stamp on the proposal before sending it to the full House for a floor vote. Then the Senate Finance Committee holds hearings and a Senate floor vote is expected in June. The House and Senate then must agree to a compromise version of the budget bill before the state fiscal year begins July 1. And the governor has line-item veto authority, which allows him to strike out portions he doesn’t like without rejecting the entire bill.
Throughout the legislative debate, DeWine is likely to face push-back from conservative lawmakers who are upset with how the governor has handled the coronavirus pandemic. Dozens of lawmakers have refused to wear masks in public and passed legislation that seeks to the governor’s authority to issue public health orders in an emergency, which DeWine vetoed in late 2020.
While lawmakers opted not to hold a veto override vote, they are holding hearings on another bill that seeks to undercut his power to enact public health orders during an emergency.
Senate President Matt Huffman, R-Lima, who supports pending legislation that would give lawmakers a larger role in public health orders, said he agrees with DeWine that the public health system has been underfunded.
Huffman said he favors restructuring the governance system.
“Ohio generally has let the local public health districts kind of (figure) it out on their own ... The local public health districts kind of just evolved into where they are right now so we have 113 health districts within 88 counties,” he said.