By: James Misak, M.D.

Dear Mayor:

I am a family physician who has lived and worked in the city of Cleveland for over 30 years. I care for patients, and I work to address the social and economic factors that impact the health of our communities. The COVID pandemic and its aftermath have made two things abundantly clear for Cleveland: Access to health care matters. Public health matters.

Access matters. Public health matters.

Working to increase health insurance enrollment among Clevelanders, and building a more effective and equitable local public health infrastructure, should be among your administration’s top priorities.

According to the 2019 American Community Survey five-year estimates, 8.8 percent of Cleveland residents under the age of 65 were uninsured. This amounts to over 29,000 people – nearly all of them eligible for Medicaid. This has surely worsened with COVID-related job and employer-based health insurance losses.

People who are uninsured delay obtaining health care, resulting in more advanced illnesses, avoidable hospitalizations and premature disability and death. Even before COVID, the uninsured had a 40 percent increased risk of death compared to their insured counterparts, corresponding to one American death every 12 minutes.

People who are uninsured delay obtaining health care, resulting in more advanced illnesses, avoidable hospitalizations and premature disability and death.

As mayor, you are in a unique position to lead a public awareness campaign to encourage uninsured Clevelanders to enroll in Medicaid if they are eligible, or to obtain health insurance through the healthcare.gov marketplace if not.

Access to health care is essential, but it is only part of what produces healthier communities. Spending on public health and preventive care in the United States, already low for the last several decades, has declined as a percent of total national health spending, from 3.7 percent in 2000 to 2.9 percent in 2018. The workforce of local health departments correspondingly decreased 17 percent from 2008 to 2019.

Our inability to control the pandemic exposed the deadly consequences of these policy choices: over 600,000 lives lost as of this writing, resulting in a decrease in life expectancy of almost two years from 2018 to 2020, with an even greater decline for Blacks and Hispanics; the largest drop in U.S. gross domestic product since 1946; the closures of thousands of schools and businesses; and innumerable families impacted by illness, job loss, foreclosure and eviction.

Our inability to control the pandemic exposed the deadly consequences of these policy choices: over 600,000 lives lost as of this writing.

I witness daily how devastating these impacts are on my patients and on Cleveland.

I urge you to use your position to advocate for adequate, flexible and sustainable public health funding from federal, state and local sources. Beyond just funding specific programs, we need to recruit and pay a diverse workforce of public health professionals and equip them with robust data collection and analytic capabilities. I also urge you to prioritize medical and public health expertise in the leadership of the Cleveland Department of Public Health.

Addressing health disparities exacerbated by the pandemic calls for courageously articulating a vision for public health that embodies a commitment to confronting systemic racism—through challenging and changing the structures through which it operates—to reduce these disparities and improve community health outcomes.

Cleveland is fortunate to have outstanding health care institutions and a robust community-based health care network. But as the pandemic made clear, this alone is not enough to ensure the well-being of our residents in the present, and it will not be sufficient to address the health challenges of the future.

Coverage matters. Public health matters.

James Misak, M.D.
Medical Director, Institute for H.O.P.E.^TM
The MetroHealth System