The campaigning has begun for this fall's mayoral race in Cleveland. When voters cast their ballots this fall, one issue they may be keeping in mind is the health of the city. During the past 12 years of Mayor Mike White's term, City Hall has taken on an entirely new role in public health. The person who succeeds him will inherit a set of responsibilities and expectations that are unlike any in recent history. 90.3 WCPN's April Baer reports.
April Baer- To get a picture of the major health issues facing Cleveland, the candidates need go no farther than University Hospitals' Otis Moss Clinic, in the East Side's Fairfax neighborhood, where Doctor Carla Harwell sees patients several times a week. The patients who come here face problems very typical for Cleveland neighborhoods. This morning Dr. Harwell's patient include an elderly patient with diabetes. The man's lost several toes - a sign that he's had problems maintaining his condition over the years.
Carla Harwell- My patient population is about 99% African American, 70% women, 30% men, and the most common medical problems that I see in this community are diabetes, hypertension, high cholesterol, asthma - so Mr. Miller is a classic case.
AB- The diseases Dr. Harwell mentions are all high on the list of Cleveland's top killers, according to the Ohio Department of Health. Beyond the diseases themselves, Dr. Harwell says her patients are constantly threatened by their lack of access to the prescription drugs that might help control their problems. But what worries Harwell most is the people she's not seeing at the clinic.
CH- There are some disparities in access to health care. Even though there are a lot of medical centers, a lot of patients - for a number of reasons, including transportation (and) lack of medical coverage - still do not have access to preventive primary care medicine and they're abusing the emergency rooms. I get a lot of patients on E.R. follow-ups that have no idea they should be seeing a doctor on a regular basis!
AB- In facing these considerable problems, the city's next mayor has a tall order. According to most observers, the Cleveland Health Department is in no shape to carry out a proactive agenda. The department's had major budget problems for years, and has gone through four directors in 12 years. Both the state and federal branches of the Environmental Protection Agency have cracked down on the department, for lax enforcement and messy bookkeeping. At times, the financial situation has been so bad that staffers had to be laid off for weeks, when there were gaps between funding grants.
A number of the candidates running for mayor this year have strong backgrounds in health issues. They'll need it, says City Councilwoman Merle Gordon, to get the Health Department into shape. Gordon chairs council's health committee.
Merle Gordon- We have to look at what we're doing on a county level: what kinds of things can coexist together, looking at these larger hospitals, and the smaller clinics and looking at how we are providing health care to residents, and if this is the most efficient way to bring these services to the residents, the city and the county, and are we actually doing that? Who is monitoring it and how do we get to a point when there IS a hospital closing and are they actually serving the community to the best capacity and is that what they community needs - we have not had that kind of needs assessment.
AB- Gordon, who's defending her own seat on council this year, says what the city needs is a partner at City Hall who's willing to take a good look at the way health services are funded. Right now, the health department budget pays for some direct services - plus a few things you might not expect. The City Jail, for example, run by the safety department, is funded under health. Other services that are health related, such as lead paint monitoring and Cleveland's EMS brigade, fall under entirely different departments.
Councilwoman Gordon and other observers say the next mayor will have plenty of fences to mend as well. Relations have been frigid between the Health Department and Cuyahoga County. Bette Meyer is the county's Deputy Administrator for Health and Human Services.
Bette Meyer- One thing the city has responsibility for is environmental and public health issues: lead, air quality, HIV/AIDS. I would hope the next mayor would be able to address those issues more comprehensively for the city of Cleveland.
AB- Meyer is unwilling to criticize the city's performance, but other sources at the county say communication has fallen apart on several important projects that require the cooperation of city AND county officials.
BM- There's sort of an overlapping jurisdiction around health involvement, in that the county looks at the needs of health populations, and a large segment of the county is in the city. One example is the county's responsibility to enroll children in Healthy Start.
AB- Healthy Start is a federal program that's trying to lower infant mortality rates by providing better prenatal and postpartum care. Meyer says technically, it's the city that gets the federal grant for the program, but the county is also deeply involved, since many eligible families are listed on county welfare rolls. In addition to all this, Cleveland's next mayor is likely to be called on to mediate a highly competitive hospital market.
Relations with Metrohealth Medical Center have soured in a squabble over lease arrangements at three public clinics. Then there's the full-blown war between the Cleveland Clinic and University Hospitals. Mayor Michael White caught fire for failing to intervene when Mt. Sinai Medical Center closed. Just a few months later, when another East Side hospital was threatened with a similar fate, the mayor infuriated University Hospitals by cutting a back-room deal with the Cleveland Clinic to take over the struggling St. Michael.
Redefining the city's health policy will be no small task for whoever wins this fall's election. What's always on the mind of health activists is that this is only part of the job Cleveland's next mayor will face. In Cleveland, April Baer, 90.3 WCPN News.