Ohio near the bottom for public health spending per person. Should we spend more?

Ohio Statehouse

Before the coronavirus outbreak, Gov. Mike DeWine put more money and focus on public health issues hammering Ohio — such as high rates of suicide, infant mortality, drug addiction and tobacco use — as the state ranked near the bottom for public health spending per person.

But sustaining or further increasing that funding will be a challenge as the economy staggers and state government braces for a drop in tax revenues.

“I’ve felt for a long time that we have not paid enough attention to public health. When I look at the problems that we face in Ohio, so many of the challenges that we face have to do with health issues. So I think (the coronavirus pandemic) is going to make us look really hard at that,” he said at one of his daily briefings on the crisis.

DeWine, a Greene County Republican, said he will keep pushing to build up public health programs.

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“My commitment will be to do that. Are we going to be able to do that overnight?” he said. “No, we are not. It’s going to be a tough, tough time for the next six months, next year as far as anything that costs money.”

Ohio and local governments are bracing for a massive budget hit since they rely on income and sales taxes to fuel operations. A report by the Pew Charitable Trusts this month said the coronavirus pandemic will throw state budgets into turmoil.

The federal stimulus bill signed into law by President Trump on March 27 includes $150 billion fund for state and local governments.

Ohio’s fiscal year ends June 30 and the state constitution mandates that the budget be balanced. Bumping the income tax filing deadline to July 15 is expected to widen the gap that Ohio will have to close with its current budget. DeWine has said he might use the state’s rainy day fund, which stands at $2.69 billion, to bridge funding gaps.

When it comes to spending on public health, Ohio has ranked near the bottom, according to the State Health Access Data Assistance Center at the University of Minnesota. Ohio’s per capita spending on public health was: $11 in 2005, $15 in 2010, $13 in 2018 — the latest data available. In 2018, Ohio ranked fourth from the bottom among 50 states and the District of Columbia.

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Ohio’s public health system is decentralized among 113 local authorities, plus the state department. The Ohio Association of Health Commissioners reported in 2018 that 75% of local health department budgets came from local sources, 22% from federal sources and 2% from state sources.

Ohio’s local health departments are under-funded and need an additional $93 million a year — about $8 per capita — to cover basic programs, according to a 2019 report commissioned by the Ohio Public Health Partnership.

Amy Bush Stevens, vice president of the Health Policy Institute of Ohio, said the strength of a decentralized system is that local departments are accountable to local communities. But it means the quality of the system is uneven across the state.

“People living in one community might be able to count on a level of public health protection that people living in another county don’t have,” she said.

Public health investments that save lives might not pay off in the short term, and that can make prioritizing the funding difficult, Clark County Health Commissioner Charles Patterson said, pointing to the DeWine administration’s initiatives to prevent smoking and vaping. Those were the right thing for health but might take decades to really show the results.

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“Prevention work is not sexy work, but it’s a much cheaper way to do business in the long run than the amount of money we spend on treatment,” Patterson said.

In fiscal year 2009, Ohio Department of Health’s total funding was $621.2 million. In fiscal year 2019 — the last budget year under Republican Gov. John Kasich — ODH funding stood at $573.4 million, a decrease of 7.7 percent over a decade. DeWine boosted ODH funding by 17.8% to $675.7 million for fiscal year 2020.

The ODH budget, 70% of which comes from federal sources, is a limited view of what the state spends on public health. DeWine noted that programs outside ODH, such as $675 million a year for K-12 wellness programs, also serve the goals of public health.

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The pandemic is an opportunity for public policymakers to consider what shapes health — infectious diseases, nutrition, education levels, air quality and more, said Stevens of HPIO. The focus has been on treating problems downstream, rather than looking for ways to prevent problems upstream, she said.

“What we’ve learned from this pandemic is that we need to invest upstream in public health infrastructure, including a bigger workforce to do things like contact tracing, epidemiology and development of systems to conduct, coordinate and report testing,” she said.

Amy Fairchild, dean of the College of Public Health at Ohio State University, said during an online panel discussion at Ohio State that public health is the invisible foundation for healthy populations.

“This moment in time has exposed the ways in which the foundation has collapsed,” Fairchild said. “We need to see investment in a strong, fair, nimble public health infrastructure, not just to prepare for a pandemic, but to support and protect us day in and day out, and year in and year out.”

The governor made that point as well, saying, “Public health permeates almost everything that we do, so that’s a focus we’ll continue. We’ll continue to work to build up the health department but also work to continue to do everything we can with the other departments in state government and the local ones that have something to do with public health.”

Public Health – Dayton & Montgomery County Health Commissioner Jeff Cooper said the current COVID-19 pandemic sees those with underlying health conditions at greater risk.

“It is vital to increase funding and efforts around prevention programs particularly for our most at risk and vulnerable populations,” he said.

Staff Writer Kaitlin Schroeder contributed to this story.

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