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 major achievements, 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 outbreaks of disease to a preventive community stance.

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 prior to the Hughes-Griswold Act, but the legislation mandated 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 originally 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 and is 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 Ohio Administrative Code.

The District Advisory Council (DAC) is composed of the chief officials from the townships and villages. The DAC is responsible for appointing members to an oversight body called the “Board of Health” and considers 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. The Board of Health during this time was responsible for the maternity licensure of two Yellow Springs hospitals and one Jamestown hospital. It is interesting to note that 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 ODH proposed, in 1932, a merger between the general health district and the Xenia City Health District, did the county health department get into substantive health activities such as examination and immunization of preschool children, tonsil and chest clinics, and tuberculosis (TB) investigation.  The TB work apparently 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 in mind: that 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.  Dr. Savage from 1947-1950, served as Health Commissioner for the Greene County General Health District, Xenia City Health District, and the Fayette County General Health District, simultaneously.

In the 1950’s the county experienced rapid population growth. School nursing service contracts were approved for Bellbrook, Bath, Caesarcreek, Clifton, Ross Cedarville, Xenia township and Bowersville if funds were available. 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 the department was difficult. The district passed their first 0.3 mill five-year operating levy.
    
In 1963 following the retirement of Dr. Savage, 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 the financing of health care. Federal funds also supported child health in the form of grants.
    
Dr. Agna was followed by Herb Shubick.  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. Inside millage 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 construction of 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 their facility on Church Street was damaged by the tornado. 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. Support to Central State University was also provided in the form of 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 for 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, there were 34 dead: 19 female and 15 males, ranging from 1 month to 82 years of age.

Other important health issues in the 1970s included a swine flu outbreak and establishment of the Women, Infants and Children program.
    
William P. McCullough, MSPH, “Mac” served as Health Commissioner from July 1979 to May 2000.  During his tenure, public health standards appeared 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 degree in Preventive Medicine. During his tenure the health district experienced an influx on 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 faced new emerging disease threats from Monkeypox, West Nile Virus, SARS and H1N1.  Mr. McDonnell retired June 30, 2013.
    
Melissa Howell, MS, MBA, MPH, RN, RS became Health Commissioner 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 service for reproductive health, prenatal, child and immunization clinics. Electronic Medical Records were introduced, and credit cards were being accepted as well as online sales of birth abstracts (certificates).

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 the first year. Rabies investigations, purchase order processing, internships and clinic flow improved functioning of the district.  Communicable Disease reporting was reduced to less than a day and brought 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 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 those individuals who are well and ill, of any age and any insurance status. A new facility was planned on the same property of the previous building. In preparation, records were scanned for electronic storage in accordance with Ohio law. Employees received training in ethics ad mentoring 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. Community health issues addressed by the district included drug overdose deaths, obesity, first trimester 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 ranks 14th according to 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 in comparison to the rest of Ohio. Our rates of uninsured is at 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 health needs of the county.  This should serve as a wakeup 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