Should Cleveland and Cuyahoga County merge the health departments?

The Cleveland Department of Public Health has come under fire for years – facing challenges like high employee turnover, loss of major grant funding, and accusations of a hostile work environment.

The coronavirus pandemic has also peeled back the curtain and revealed that public health departments across the state are under-resourced.

Some citizens - and now a Cleveland mayoral candidate - suggested a possible solution to the department’s challenges: a partnership or merger with the Cuyahoga County Board of Health.

The idea to combine the efforts of both departments is not new, but it’s gaining some new ground in the Cleveland mayoral race.

“This pandemic truly exposed how inept we’ve been managing this health department year, after year, after year,” said candidate Justin Bibb, a nonprofit executive and political newcomer, during a recent debate at the Idea Center. “I intend to explore a partnership with our county health department to make sure we can fully support public health in this city.”

The city health department has been plagued with problems for years

As efforts continue to increase vaccination rates to combat the COVID-19 pandemic and the spread of the delta variant, the health department recently shared data pointing to a very low COVID-19 vaccination rate in the city. Only 39 percent of residents are fully vaccinated compared to 56 percent in Cuyahoga County as a whole.

The Cleveland health department has also experienced high employee turnover, lost a major grant to address HIV and AIDS due to underperformance and faced accusations of a hostile work environment.

An investigation sparked by employee complaints of poor treatment and racial discrimination did not find evidence of racism, but concluded that supervisors made “detrimental mistakes” and treated staff poorly.

Cleveland Mayor Frank Jackson announced a “top-down” shake-up of the health department last year that included the reassignment of department Director Merle Gordon at a sensitive time as the department was leading the fight in the city against the pandemic.

Jackson also moved the health department under the Office of Prevention, Intervention and Opportunities for Youth and Young Adults. 

Former Cleveland mayor Jane Campbell, who led the city before current mayor Frank Jackson, also explored the idea of merging the departments in the early 2000s, said John Corlett, president of the Cleveland-based Center for Community Solutions. At that time, a study group recommended consolidation, but that idea did not get very far, he said.

“Since then, it's been mostly, sort of, initiated from the community,” he said. “It comes up, I think, every time that there's an issue related to the city health department, whether it was around lead, whether it was around infant mortality. It is perennially raised and it does not seem to move much farther than that.”

Both health departments currently work closely together on a number of issues such as lead abatement and the region’s COVID-19 response, said Cuyahoga County Health Commissioner Terry Allan. Allan said the departments are not currently considering a merger.

The city’s health department did not respond to Ideastream Public Media’s request for comment.

Other Northeast Ohio county and city health departments have merged

Several other Ohio cities have previously merged with county health departments. Toledo and Dayton used to have their own health departments but now fall under county jurisdiction, while smaller cities like Kent and Canton still have their own.

In Northeast Ohio, Akron and Barberton also used to have their own health departments, but merged under Summit County Public Health in 2011.

Since then, studies show the health department’s overall services improved, and did not decrease, after the merger, said Summit County Health Commissioner Donna Skoda.

“I just think for the general public, it's much easier to understand. There's one health department, we have one big building,” Skoda said. “We do have these other little clinics and we can do immunizations there, and we've been more mobile."

Additionally, consolidating the departments saved Akron about $2 million, and the county health department saved money not having to hire new people, she said.

It has also been easier for the department to receive grants and use the funds more equitably across the county to address health disparities and social determinants of health, Skoda said.

“In the past, what would have happened is we would have had to contract with maybe Akron or Barberton to do either the Creating Healthy Communities [program], the gardens, the housing, … you know, if we were doing the lead abatement,” she added. “But now, since it's - we have the grant, we are the holder of the grant, we can do it all, and there really are some efficiencies that are created in that.”

Cons to consider with consolidation

A 2013 Kent State University study of Ohio health department mergers found not all departments saw the same level of success as Summit County, Corlett added. Namely, the health officials did not see as big of financial savings as they had expected, he said.

When it comes to the workplace environment concerns at Cleveland’s health department, a merger with the county might only further complicate things, Corlett added.

“I think the issues that were raised are important, but I don't know that a merger helps you address that,” he said. “I would not merge to somehow improve employee morale because you know, the thing about a merger, particularly public mergers, is you're often merging, you know, one or more different cultures together, organizational cultures.”

Instead, Corlett added, the county and city could explore other potential partnerships in the meantime, such as working together on grants and lobbying at a regional and statewide level.

Corlett added that while job losses could be a concern in usual circumstances, that might not be the case right now. Both health departments have seen a decline in staff due to the pressures of responding to the pandemic and could benefit from consolidating, Corlett said.

However, now may not be the best time to execute a merger, said Adriane Casalotti, chief of government affairs at the National Association of County and City Health Officials. All local health departments are currently strapped due to the demands of the COVID-19 pandemic, she said.

“After a year and a half of services and efforts and the staff being so taxed … operationalizing a change like that, given all the other things that are on the health department’s plate right now, is a large undertaking,” Casalotti added.

Next steps

If Cleveland and the county do explore a merger, which officials said should happen once the COVID-19 crisis has subsided, the first step is to get an outside firm to do an analysis of whether coming together would be beneficial for both departments, Skoda in Summit County said.

The last time this idea was formally explored, during Mayor Campbell’s tenure, the city was in a similar situation to the present: a new administration coming in after a longstanding mayor, in that case Michael White, Corlett said.

“It’s a natural moment when you have new leadership coming in, you know, after an extended time, to ask questions about this,” Corlett said. “I think absolutely you want to look at it … Whoever takes over, whatever new administration there is, they will learn a lot from that process.”

More health department mergers across Ohio could take place in the near future, Skoda added.

Smaller, rural health departments are facing funding and staffing challenges, she said, and the state has asked departments in cities that serve less than 50,000 residents to explore merging with their respective county's departments.