Health officials say Ohio should provide more money for local public health, including prevention and emergencies, as local health districts prepare to ask voters for levy renewals this fall.
Both the Clark and Champaign County Health Districts will be back on the ballot this year with renewal levies, but aren’t asking for any new money from residents.
The state needs to do more to fund proactive prevention programs, which can save lives over time, said Clark County Health Commissioner Charles Patterson.
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“Prevention money needs to be spent years and years ahead of time to see the impact of it,” Patterson said. “Ohio has always ranked low (in health funding) … and I think you’re seeing the results of that.”
Ohio ranked 45th in per capita public health funding, spending about $159 million in 2015 or about $13.80 per person, according to a report released in April from the Trust for America’s Health, a non-profit organization.
The legislature’s focus should be on providing high-paying jobs to allow people to pay for their own health care — including preventative measures, State Representative Kyle Koehler (R-Springfield) said.
“That’s a key to improving our economy — taking the burden off the government and put it where it’s supposed to be,” Koehler said. “We need to get people to start thinking: ‘If I have to pay for this, I’m going to take care of myself a little bit better than if someone else is paying for this.’”
Prevention dollars needed
Nationally, about $1 trillion was budgeted for the U.S. Department of Health and Human Services last year, including about $6.7 billion for the Centers for Disease Control and Prevention.
At the state level, health and human services spending totals about $1.4 billion this year, including about $85 million for the Ohio Department of Health, excluding Medicaid dollars.
A 10 percent increase in public health spending can save lives being lost to preventable diseases, including a 7-percent reduction in infant deaths and a 3-percent reduction in heart disease death, according to the report.
In the per capita rankings, West Virginia ranked first at $220.80 per person, while Nevada ranked last at $4.10 per person. The organization broadly defines public health to include all health spending with the exception of health coverage programs for low-income residents, such as Medicaid.
“Those are some serious discrepancies there,” said Rich Hamburg, interim chief executive officer and president at the Trust for America’s Health.
Federal funding for prevention has been flat for several years, especially at the CDC, Hamburg said. The trust recommends core funding be increased at all levels, including prevention and emergencies for disease outbreaks such as Ebola or Zika.
“It takes a long-term commitment to prioritize public health as it affects population,” Hamburg said.
Local health districts provide a wide range of services in both personal and environmental health, including prenatal care, immunizations, inspections and safety and health education programs, among others — which are typically funded through federal, state and local sources.
The Clark County Combined Health District receives about $2 million annually from its 5-year, 1-mill levy — which makes up about 30 percent of its $7 million budget. The local dollars are used as leverage to bring state and federal funding – which makes up about 40 percent of the budget. The remainder of the budget consists of user fees from inspections and immunizations, among others. The district has 78 employees, including five part-time employees.
The people of Clark County are doing exactly what they should to fund public health, Patterson said. The disconnect is with the money provided by the state for specific health issues, he said.
The district believes it needs more money to improve public health, but doesn’t want to ask voters for more money due to local economic conditions. The renewal will continue what residents have paid since 2001, Patterson said.
“We believe it’s prudent to try and stay within our means,” Patterson said. “We just don’t know if there’s more money out there.”
The district receives about $25,000 in public health subsidy annually from the state, Patterson said.
More support from the state is needed for emergency preparedness, where funding has been cut in recent years, Champaign County Health Commissioner Jeff Webb said. The Champaign Health District’s state subsidy is about $7,500 annually, Webb said.
“You can’t really do much with that when you’re running a whole county health department,” Webb said.
The Champaign Health District has a .4-mill levy that generates about $270,000 per year, which expires at the end of 2017 Webb said.
“Compared to some levies out there, we’re microscopic,” Webb said. “We’re small.”
The district will ask voters to renew the five-year levy in November, but won’t ask for more money. The district brought in about $1.08 million last year, which includes inside millage from townships and villages, and spent about $993,000, Webb said.
“It would be nice if we had more local funds coming in, but in the environment we’re in now, I just wouldn’t ask for our community right now to come up with additional funding,” Webb said.
Cuts in Logan County
Recent cuts in Logan County have health officials concerned about fighting infectious diseases in the future if a breakout were to occur there.
The Logan County Health District has been on the ballot five times in recent years, but each levy has been narrowly defeated by voters, Health Commissioner Boyd Hoddinott said.
The district primarily operates on local fees and $600,000 of inside millage paid by cities, villages and townships.
Public health has been a tough sell in Logan County, he said.
“I always say it’s one of those things where you don’t know you need us, until you need us,” Hoddinott said.
Due to low funding levels there, the district has reduced its staff from 39 to 19 employees, including just three public health nurses.
The district has recently reduced hours and cut other programs such as home health care and health education. While the cuts could affect public health, Hoddinott doesn’t see the district asking for money again soon, especially given the cost and time of running a levy campaign.
“I don’t think you can convince people,” Hoddinott said.
The Association of Ohio Heath Commissioners is working with the state health agency to increase that subsidy to help health districts become accredited, similar to hospitals, which passed in 2013, Executive Director Beth Bickford said.
The costs for local health districts to become accredited was expected to be about $2.3 million, Bickford said. However, due to rising costs with the federal accreditation board, it will cost about $4.6 million, she said.
“It’s a huge expense that hasn’t been funded at this point,” Bickford said.
About 50 of the 88 counties in Ohio have local public health levies, Bickford said.
“Without those levies, I don’t where we would be,” Bickford said.
While the Medicaid dollars are not included in the public health rankings, Ohio has committed $18.5 billion, including $6 billion in state dollars, to provide health coverage to more of its residents this year.
Ohio has to do a better job in several areas, including improving infant mortality rates in low-income areas, Hackett said.
“Hopefully, Medicaid expansion will do that with more people having coverage,” Hackett said.
However, increased public health spending will be difficult with the state’s portion of the expansion coming due in a few years, he said.
“I think a lot of the movement in the public and private sector is to get people to be healthier and live healthier lives, but it’s more difficult than what’s expected,” Hackett said.