Christopher E. Press
The Cincinnati Department of Health is expected to suspend its national search to replace outgoing health commissioner Melba Moore. The departure provides an opportunity to reform and modernize public health throughout Hamilton County.
Today, Hamilton County has four separate public health departments: Cincinnati, Norwood, Springdale and Hamilton County. Residents and businesses would be better served by one unified public health agency. Other Ohio communities have done so, including Dayton and Montgomery County, Findlay and Hancock County, Toledo and Lucas County, and, a pioneer among them, Akron and Summit County.
I had the privilege of serving as Vice Chairman of the Ohio Legislative Committee on the Future of Public Health in 2012. Its recommendations did not require, but rather encouraged, consolidation – inadequately, it now seems. More recently, lawmakers specifically sought to reduce the number of public health districts by 113 (for 88 counties and 14 metropolitan statistical areas), so the push for consolidation — a small boost, really — continues. and for good reasons.
While bigger is not better, nor is smaller. The combined expenditures of the four local health districts exceed approximately $36 million per year, of which two districts account for less than 4%. The Cincinnati Health Department – in addition to providing birth and death records, emergency preparedness, restaurant inspection, and Ohio-mandated public health department roles to all districts in local health, including environmental health, epidemiology, communicable disease control, vital statistics, health promotion – is also a major provider of health care, with 53,000 patients and almost 150,000 annual visits.
A unified district could spend more on direct service and less on overhead. Compulsory programs might more effectively meet – or exceed – legal requirements; all programs could remain responsive, and accountable, to constituents’ needs. Attracting and retaining qualified and dedicated staff and Commissioners would improve. Health emergencies would require less coordination between independent agencies, freeing up resources to serve constituents rather than negotiate and coordinate responses. A unified district would simplify interactions with local health systems whose services or facilities span all four health districts and, ironically, are among the largest employers in the region.
The world has changed since the basic structure of public health was designed. This design is obsolete. I call on the elected leaders of our four local jurisdictions to appoint a panel of experts to outline how a “unified public health service” might work.
The reluctance would be understandable, although the irresponsible management of public resources. Finding facts of this nature is not an option; it’s a duty. The design of the proposed suit must show significantly lower overall cost, better public health outcomes for which ministries are responsible, both subject to public and political accountability.
The question would be “how”, not “if”, to combine. “How” is a question to be answered by public health and management experts; the elect can use the answer to decide “if”.
Christopher E. Press is a career health car executive, former hospital president and adjunct faculty member at Emory University’s Rollins School of Public Health, and a member of the Hamilton County Hospital Commission. His opinions are his own.