100 Years of Public Health
The history of public health in Greene County includes information from meeting minutes of the Board of Health, annual reports, and meeting minutes of the District Advisory Council. It is intended to document the health district’s successes and inform readers of where we have been collectively. It is updated annually to reflect significant achievements and changes in focus on specific health threats and reflect upon the tenure of the Health Commissioners who have served Greene County. Over the past 100 years, public health in Greene County has been impactful and successful. The public health system has transformed from reacting to disease outbreaks to a preventive community stance.
The Greene County Combined Health District (dba Greene County Public Health) was formed in response to the Hughes-Griswold Act as a separate political jurisdiction of the State of Ohio. Evidence demonstrates there were health officers or boards of health before the Hughes-Griswold Act, but the legislation mandated that the villages and townships combine to establish a general health district, and the cities automatically formed their own health district. The general health district was initially formed by Bath, Ross, Spring Valley, Caesarcreek, New Jasper, Miami, Silvercreek Cedarville, Jefferson, Sugarcreek, and Xenia townships; and the villages of Fairfield, Osbourne, Yellow Springs, Cedarville, Bowersville, Clifton, Spring Valley, Jamestown, and Bellbrook. Much like a school district, a health district has a specific geographic location overseen by a board. While many refer to health districts as health departments, there is only one health department in Ohio, the Ohio Department of Health. The authority to carry out duties in a local health district stems from the Ohio Revised Code Chapter 37 and the associated sections of the Ohio Administrative Code.
The District Advisory Council (DAC) comprises the township and village chief officials. It is responsible for appointing members to an oversight body called the “Board of Health.” The DAC considers the reports of the Health Commissioner and makes recommendations to the Board about health problems in the community.
Early activities of the district involved providing community health services for diphtheria, scarlet fever, typhoid fever, rabies, smallpox, and premise sanitation. During this time, the Board of Health was responsible for the maternity licensure of two Yellow Springs hospitals and one Jamestown hospital. Interestingly, the health department’s participation in the Greene County Fair started with assisting the Ohio Department of Health (ODH) in the latter’s exhibitions at the fair.
It was not until 1932 that ODH proposed a merger between the general health district and the Xenia City Health District that the county health department got into substantive health activities such as examination and immunization of preschool children, tonsil and chest clinics, and tuberculosis (TB) investigation. The TB work increased dramatically enough that the Board contacted County Commissioners to set aside funds to combat this disease.
In 1936, ODH again approached the general health district about merging with Xenia with a new concept: the health districts also consider hiring a full-time Health Commissioner. That year, Dr. Gordon Savage was named the first full-time Health Commissioner for the Greene County General Health District. Dr. Savage succeeded Dr. W.C. Marshall (who became a sanitarian), who succeeded, in 1929, Dr. R.H. Grube. Under Dr. Savage’s leadership, from 1936-1963, several programs were established, including school health, immunization, dairy inspections, restaurant sanitation, dog quarantine, food establishment regulation, venereal disease clinic, milk regulations, plumbing inspection, camp inspections, meat inspections, nuisance abatement, landfill inspections, and subdivision regulations. Greene County had the first public health clinic in Ohio. Personnel policies also appeared for the first time. From 1947 to 1950, Dr. Savage served simultaneously as Health Commissioner for the Greene County General Health District, Xenia City Health District, and the Fayette County General Health District.
In the 1950s, the county experienced rapid population growth. If funds were available, school nursing service contracts were approved for Bellbrook, Bath, Caesarcreek, Clifton, Ross Cedarville, Xenia Township, and Bowersville. Additional jurisdictions were added, and the schools were charged ten cents per pupil. One hundred fifty infants and 175 children ages 1-6 years were seen at a well-baby clinic. The first communicable disease laws were passed, but funding for the department was difficult. The district passed its first 0.3 mill five-year operating levy.
In 1963, following Dr. Savage's retirement, Dr. Mary Agna became the Greene County Health Commissioner. In addition to the programs already established, Dr. Agna began the home care services program primarily because of the introduction of Medicare. Medicare represented the first time a third party was involved in healthcare financing. Federal funds also supported child health in the form of grants.
Herb Shubick followed Dr. Agna. In the 1970’s, there were 162 health districts in Ohio. Greene County ranked 12th in health outcomes, and per capita expenditures were $10.74. The inside mileage was $110,763.64. In May of 1976, the budget commission acted to reduce the health district budget by $13,330. The total proposed budget was $1,051,486. The amount was reinstated; however, in 1977, the budget commission again reduced the health district budget and specified which line items were to be cut. Funding for a health district facility allowed for constructing a 13,000 sq. ft. building at 360 Wilson Dr., Xenia.
Following the Xenia tornado of April 3, 1974, the role of the health district was to support recovery in the community. Environmental services were impacted because the tornado damaged their facility on Church Street. Clerks and nurses supported Greene Memorial Hospital operations and patient care. Resident contact was made door to door, offering tetanus, treating minor injuries and employees were placed on 12-hour shifts. Nursing home residents were moved to an undamaged facility. Central State University was also supported through food, water, medical supplies, and toilet facilities. Mutual Aid was received from Montgomery and Clark counties.
Post-tornado, the health district started surveillance and control functions in environmental health. Concerns were raised about environmental hazards, nuisances, rodents, mosquitos, and sewers. Intensified efforts were made in dental, medical, social, and psychological services. The services were funded by the U.S. Department of Health, Education, and Welfare through the Ohio Department of Health. In all, 34 people were dead: 19 females and 15 males, ranging from 1 month to 82 years of age.
Other essential health issues in the 1970s included a swine flu outbreak and the establishment of the Women, Infants, and Children program.
William P. McCullough, MSPH, “Mac” served as Health Commissioner from July 1979 to May 2000. Public health standards appeared during his tenure, and contracts with the four cities in Greene County were developed. Chronic underfunding led to massive layoffs in the district, and many programs were cut. Health issues in this era included measles, mumps, water fluoridation, and the need for sanitary sewers. A car seat program was established.
Mark A. McDonnell became the Health Commissioner in June of 2000. Mr. McDonnell was a Registered Sanitarian with a Master of Science in Preventive Medicine. During his tenure, the health district experienced an influx of infrastructure dollars following the attacks of 9/11/2001. In the fall of that same year, health districts across the country were called to respond to “white powder” incidents, presumably anthrax. Over the years, the health district has faced new emerging disease threats, such as Monkeypox, West Nile Virus, SARS, and H1N1. Mr. McDonnell retired on June 30, 2013.
Melissa Howell, MS, MBA, MPH, RN, RS, became Health Commissioner on July 1, 2013. Her background includes 20 years of combined experience in nursing, environmental, public health leadership, and finance. Ms. Howell focused on organizational culture and leadership development as part of Accreditation, and she penned the first strategic plan to improve agency effectiveness and health outcomes. By late 2013, the health district had a dental clinic operating again and had contracted with several private insurance companies to provide services for reproductive health and prenatal, child, and immunization clinics. Electronic Medical Records were introduced, credit cards were accepted, and online birth abstracts (certificates) sales were made.
In 2014, Greene County had the first nationally reported case of H3N2 in a female child, presumably from swine. Later that same year, there was intense media interest in Ebola following an outbreak in Sierra Leone, Guinea, and Liberia. The health district conducted surveillance of travelers using Skype, and quarantine laws were scrutinized but held up to prevent the spread of disease.
In 2015, Quality Improvement was introduced. Four projects and a Kaizen were completed in the first year. Rabies investigations, purchase order processing, internships, and clinic flow improved the district's functioning. Communicable Disease reporting was reduced to less than a day, bringing the district into compliance with standards from the Ohio Department of Health. An “insurance” clinic started to sign individuals up for Medicaid or marketplace insurance. A Workforce Development Plan was created, and all job descriptions were revised and updated.
In 2016, another quality improvement project was completed for reproductive health and wellness, and the clinic was converted to electronic medical records. Immunizations and the Child and Adolescent clinics were also converted to electronic medical records. People's first language was adopted into the Ebola Plan, the Strategic National Stockpile Plan, the Information Sharing Plan, and the Pandemic Influenza Plan.
On October 6, 2017, Greene County Public Health successfully transitioned the prenatal, child & adolescent, dental, reproductive health and wellness, and immunizations to a Federally Qualified Health Center co-located with Greene County Public Health. In cooperation with Five Rivers Greene County Health Center, healthcare services expanded to individuals of any age and insurance status who are well and ill. A new facility was planned on the same property as the previous building. In preparation, records were scanned for electronic storage in accordance with Ohio law. Employees received ethics and mentoring training, and a new performance appraisal form was developed. The food service program was improved in response to a customer satisfaction survey, and all licensees were compliant for 2018. We uploaded all required documentation for public health accreditation.
In 2018, the health district achieved Public Health Accreditation and moved to a new facility on the same property in Xenia. The district addressed community health issues such as drug overdose deaths, obesity, first-trimest
er care for pregnant women, and falls in senior adults. We also achieved accreditation for the Home Visiting program from Healthy Families America.
In 2019, the district continued to address community health issues and ranked 14th in the Robert Woods Johnson 2019 County Health Rankings. Greene County life expectancy has not declined as in other areas of the state, and infant mortality remains low compared to the rest of Ohio. Our uninsured rate is 5% compared to the state rate of 7%. The uninsured rate for children is 3% compared to 4% across Ohio. Greene County still has pockets of people living in poverty and individuals who are disabled or have trouble navigating our healthcare system due to system and language barriers. Greene County Public Health recognizes that it is but one component of a community’s health services and only part of a puzzle to improve community health. The health district has established partnerships and collaborations with private, voluntary, and public agencies and residents to effectively meet the county's health needs. This should serve as a wake-up call to the community concerning unmet health needs in Greene County.
Adapted from “A History of Public Health in Greene County” by William P. McCullough