A Prescription for Dr. Margolius: Loren Anthes

Guest columnist Loren Anthes is Senior Fellow/William C. and Elizabeth M. Treuhaft Chair in Health Planning at the Center for Community Solutions.

Recently, Cleveland Mayor Justin Bibb appointed you, Dr. David Margolius, Director of the Cleveland Department of Public Health.

Unlike many roles in government, you know success is best measured in zeros – achieved through freedom from illness, disease and death. That said, a good public health strategy should not be accidental. Far from there.

According to Gallup data, public trust in health agencies has fallen from nearly 70% in 2020 to less than 45% today. And, as a family physician, you know that trust is central to a healing relationship.

But we have a lot of injuries.

For some, mistrust has been fueled by misinformation and the weaponization of the pandemic for political purposes. We have all experienced, to varying degrees, the disruptions the pandemic has created in our lives. Our underfunded public health system was often not centered as an authoritative source of truth, leaving many people to find and promote information inconsistent with science.

For others, health has never been accessible, defined by the stark contrasts created between the light shone upon our towering institutions of medical skill and the shadow of poverty and racial discrimination cast upon the communities they live.

So for our city to move forward, you need to address both causes of mistrust.

As the first physician to lead the department in years, and coming from an organization considered the most socially responsible hospital in Ohio, you have the opportunity to refocus truth and expertise on the identity of the department work.

In other words, you should be our town’s doctor. And, just like when you have a sick patient, you need to diagnose the problem.

That’s why you should heed the advice of the transition report and conduct a comprehensive review of departmental operations, valuing interdepartmental transparency, efficiency, collaboration and effectiveness.

Also, you have to be bold. Ohio is 47th in state funding for public health. Of Ohio’s 117 underfunded public health departments, Cleveland is 24th. The city spends only 6% of its total budget on public health activities, or 1/8 of the amount allocated to public safety, in comparison.

It’s no surprise, then, that Ohio also ranks 46th in health and has some of the worst records for guns, overdose, and infant mortality.

Moreover, many politicians have taken advantage of the radicalism that fuels distrust of government, doubling down on policies that deepen poverty, eliminate basic social supports and reduce local control.

To that end, you must be prepared to fight on our behalf and do whatever is necessary to uphold your oath and pursue “all necessary measures” to restore us.

Finally, you must get involved in reforming the systemically racist institutions that produced these results.

It is simply not enough to think about the biological sciences. You must participate and make your voice heard in the interconnected systems of education, law enforcement, housing, and public transit while preparing for the challenge of climate change.

Racism is a public health crisis. It acts like an aggressive cancer, spreading to nearly every synapse of our civic life, with economic injustice being the greatest indication of its severity.

Some will say that this task may be too big or that the Ohio Statehouse will do everything it can to make it difficult for you.

And, admittedly, you have a very difficult patient. But Cleveland hasn’t had a doctor for a long time. I look forward to seeing you develop your practice.

Guest columnist Loren Anthes is Senior Fellow/William C. and Elizabeth M. Treuhaft Chair in Health Planning at the Center for Community Solutions.

Readers are invited to submit opinion page essays on topics of regional or general interest. Send your 500-word essay for review to Ann Norman at anorman@cleveland.com. Essays should include a brief biography and photo of the author. Essays disproving today’s topics are also welcome.

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