Municipal health districts in some Ohio cities may be forced to merge with their county’s health departments within the next few years to save money and consolidate resources.
Officials in several of the small- and medium-sized cities that may be affected are critical of the state meddling with their local affairs.
All 88 counties in Ohio have a countywide health department. There are 25 additional cities which have their own unique departments:
Combined, these 113 health departments provide a wide array of health services, from restaurant inspections to maternal health programs. They have been active in 2021 with helping schedule and administer COVID-19 vaccinations.
The two-year budget recently approved by the Ohio House of Representatives includes a provision that may wind up abolishing many of the city health departments.
Cities with fewer than 50,000 residents that have a local health department would be required to evaluate “the efficiency and effectiveness” of merging with the county department versus remaining on their own.
The state health director and state auditor would be tasked with developing criteria used by cities for these studies. If a local study concludes a merger is “advisable,” the city would be forced to consolidate soon after.
For this provision to go into effect, the Ohio Senate would need to approve the language in its own budget currently under negotiation. Gov. Mike DeWine would then have to sign the budget without issuing a line-item veto to this section.
Of the 25 cities with their own health departments, 19 of them would be potentially impacted by this provision:
An earlier version of the House budget called for merging all departments within cities of fewer than 50,000 residents. The amended version includes the required study before any action is taken.
Joe Mazzola, the Franklin County Public Health commissioner who also serves as president of the Association of Ohio Health Commissioners, said his organization welcomes ways to make government health services more efficient.
But the association is critical of any state mandates that would lead city health departments to be eliminated.
“As we continue to respond to the COVID-19 pandemic local health departments are also carrying out our work to improve the health of our communities by preventing disease, promoting healthy living and protecting against public health threats,” Mazzola wrote to lawmakers. “Now is the time to strengthen our public health system with the tools and resources it needs.”
Pros and cons
City departments have merged with their respective counties for decades without any state mandate, Mazzola pointed out.
Examples include the Zanesville-Muskingum County Health Department and the Athens City-County Health Department.
The biggest reason for consolidating is in an attempt to save money, according to Kent State University’s Center for Public Policy and Health, which researched the issue of health consolidation in a 2013 report.
The Great Recession accelerated the process in some communities, which faced rising deficits and cuts to local health services.
Ohio had as many as 160 health departments in the 1980s, a number that declined to 135 in 2005 and 125 by the year 2013.
There are 113 that remain today.
“(L)ocal communities are finding the political will to merge and consolidate, when it makes sense and in the interest of public health,” Mazzola told lawmakers.
Kent State researchers tracked 17 health department consolidations from the years 2001-2012 and found that in most cases, the mergers helped achieve cost savings without raising local taxes or leading to job losses. Senior health officials in 15 of the 17 communities later viewed the consolidation as “a good idea.”
The city health commissioner in New Philadelphia described being “dumbfounded” at the budget provision with the pandemic still going on, according to the local Times-Reporter newspaper.
New Philadelphia is the county seat of Tuscarawas County, which has one of the lowest rates of new coronavirus cases in the state. But the county has seen more than 8,400 cases and 241 deaths since the pandemic began, per Ohio Department of Health data.
The New Philadelphia Health District reports to have administered 5,000 COVID-19 vaccinations, or around one-fifth of all vaccinations in the county. The city health department led vaccination efforts at local schools, businesses and hosted a “drive-in” clinic at a park.
The local department also pointed to other services, such as providing HIV and diabetes testing, issuing birth certificates and enforcing health ordinances.