COLUMBUS — Ohio’s state and local health departments are garnering high praise for their successful handling of the coronavirus thus far, despite being vastly underfunded, experts say.



Health departments in Ohio receive less funding for emergency preparedness than nearly every other state and Washington, D.C., according to an analysis from the Health Policy Institute of Ohio. The state ranks 48th for emergency preparedness dollars per capita, according to the Columbus-based institute.



Gov. Mike DeWine has repeatedly said the COVID-19 crisis is a clear sign that Ohio needs to invest more in public health.



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"Not just in Ohio, but we’ve historically in this country underfunded public health," DeWine said during a coronavirus update last week. "One of the lessons from this pandemic ... there's going to be a consensus. We've got to fund consistently year after year public health and do a much better job."



DeWine’s comments last Wednesday came the same day that the state Controlling Board appropriated a $15.6 million increase to the Ohio Department of Health in an effort to provide much-needed supplies to frontline coronavirus workers.



Ohio, home to nearly 11.7 million people, spent around $13 per person on public health in 2018, according to an analysis from the State Health Access Data Assistance Center at the University of Minnesota. The only states that spent less on public health per capita that year were Arizona at $10, Nevada at $8 and Missouri at $7, according to the analysis.



Public health’s insufficient funding is a long-standing problem, said Tom Campanella, an associate professor of health economics at Baldwin Wallace University in the Cleveland suburb of Berea.



Along with insufficient funding, Campanella said, there’s also a lack of interest and understanding about what exactly health departments do. Though they are always working to prevent the next pandemic, that work is typically going on behind the scenes and not in public view, he said.



"The areas that public health focuses on, most people in effect can't touch or feel," Campanella said. "So you don't have the visibility from that standpoint and consequently, from a political standpoint, it doesn't get the attention that it needs, which results in a lack of funding."



Prevention efforts like social distancing don’t require much in terms of funding. But the ability to trace the virus’s spread is heavily impacted by a health department’s funding and subsequently its manpower, said Dr. Mysheika Roberts, director of Columbus Public Health, which serves the cities of Columbus and Worthington.



When Roberts joined Columbus’ health department in 2006, the city had 20 people on its disease-tracking team and now has eight, she said. To deal with that decline in pandemic staff, Roberts said Columbus Public Health has trained some of its other 400 or so employees to be able to pitch in on disease tracking when necessary.



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Despite the lack of funding for public health in general, Roberts said Columbus’ health department is "one of the lucky" ones.



This year, the city of Columbus increased the amount of funding it provides Columbus Public Health by more than $1.7 million, according to the city’s annual budget.



Around 75% of the Columbus health department’s $35.8 million budget is provided by the city. Another 25% is paid for by license and permit fees, payments for vital documents on births and deaths and miscellaneous charges for services, among other things, according to the city’s 2020 budget.



"Columbus is fortunate," Roberts said. "We've done some creative management of our finances to keep some of that. ... I would say we're one of the lucky jurisdictions."



Ohio’s public health system is decentralized, meaning its authority is spread out among offices in each city and county. That can make things a little tricky when it comes to dealing with an issue such as coronavirus, which affects everyone across the state, said Amy Stevens, vice president at the Health Policy Institute of Ohio.



The disorganization around testing, Stevens said, is a prime example of the "fragmented" setup of Ohio’s health departments. If Ohio’s health system was more centralized, the public probably would have a better sense of how many tests are available across the state, how many people have already been tested for coronavirus and how many people have tested negative for the disease, Stevens said.



It’s common for local health departments, such as Columbus’, to get most of their funding from local resources, while statewide health departments are very reliant on federal funding, which has been slashed in recent years, Stevens said. State health departments usually get around 70% of their funding from the federal government and the other 30% from the state, Stevens said.



Most of Ohio’s 113 local health departments are funded, in part, by tax levies.



In Knox County, that’s about 20% of its $5 million annual budget, said Julie Miller, health commissioner. The rest is from state and federal grants and service fees. And fewer residents coming in for routine procedures means less revenue.



"We do the best we can with what we have, but it’s never enough to stay ahead, to be proactive," Miller said.



She and others have repeatedly sought more from residents and lawmakers.



But public health’s behind-the-scenes nature makes her feel left behind, she said.



"If you don’t see it, it’s like you’re not there."



And the battle for funding can become frustrating, said Madison County Health Commissioner Chris Cook.



"Many of us, especially small and rural health departments, get stuck in a cycle of chasing money for whatever intervention is being pushed," he said. "We are forced to chase those dollars many times just to keep the lights on."



The pandemic brings the problem to focus: "Unfortunately, funding emergency response is very different from funding emergency preparedness," Cook said.



As the pandemic rages on, Stevens said she appreciates the preventative measures DeWine has taken. State Health Director Dr. Amy Acton has really "put a face on this for Ohio," Stevens said.



While the attention DeWine and Acton are drawing to public health right now may be helpful in the short term, Stevens said she still worries about funding down the road. More people out of work because of COVID-19 means less tax revenue, and ultimately less overall funding to go around, Stevens said.



"There's going to be less money in the state budget and state agencies," Stevens said. "So even if there is a greater awareness, the challenge is going to be: How do we fund it going forward?"



Dispatch Reporter Dean Narciso contributed to this story.



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