The state of healthcare quality is a nationwide concern. However, healthcare quality and health disparities throughout the rest of the country vary tremendously. While Ohio has made some improvements in preventing illness and injuries, policymakers and others can take additional actions to strengthen Ohio's public health system (Health Policy Institute of Ohio [HPIO], 2022). Spending for specific public health disparities in Ohio is not comparable to spending in other states such as Washington and Missouri. Ohio's low spending stands out in 2019 having spent $14.01 per capita, but the state of Missouri spent less at $7.13 (HPIO, 2022).

Ohio has focused more specifically on certain disparities and has had some success in this area. Public health and prevention are one of seven hot topic areas in 2021 for Ohio, but Ohio's strengths in this area include decreases in opioid prescribing and senior falls (HPIO, 2021). However, according to HPIO (2021), Ohio performed worse than many other states, ranking 32nd out of 50 states and D.C. on an overall ranking of public health and prevention metrics. Several outcomes could be improved in Ohio by stronger community-based prevention efforts, such as grass-roots naloxone distribution to prevent drug overdose deaths, enforcement of the tobacco 21 law to prevent youth nicotine use, and home visiting to prevent infant mortality (HPIO, 2021). Ohio is combating an opioid crisis and rising infant mortality rates. The public health workforce, funding, and emergency preparedness and response stand out as areas needing improvement (HPIO, 2021). Ohio invests far less in public health than most other states, resulting in an undersized state and local public health workforce that was strained even before the COVID-19 pandemic (HPIO, 2021). HPIO (2021) states that the large number of deaths in 2020 caused by COVID-19 and a new surge in overdose deaths indicate major threats to health that further strained the public health system over the past year (HPIO, 2021).

Like the state of Ohio, Washington has a great interest in providing health equity to the people of the community. The local health departments provide a great deal of care to patients who need affordable healthcare and could not afford care otherwise. Many communities in Washington experience health inequities because of their race, culture, identity, or where they live (Washington State Department of Health, 2022a). The state of Washington is also dealing with the HIV stigma. Washington State Department of Health (2022c) discuss the fact that reducing the HIV stigma requires recognition of complexity as well as the interrelation of homophobia, transphobia, racism, and sexism. Like the state of Ohio Washington would also need to investigate HIV prevention tactics. According to the Washington State Department of Health (2022c), between 2018 and 2019, the office of infectious disease expanded the scope of these projects to incorporate broader initiatives, including efforts to address issues of inequity in drug user health. Additionally, like all states, the state of Washington is working to reduce COVID-19 numbers by increasing vaccination efforts. As of December 20, 2021, 82.2% of Washingtonians 12 and older have received at least one dose of the COVID-19 vaccine, and 75.6% of people 12 and older are fully vaccinated (Washington State Department of Health (2022a).

Just as Ohio and Washington have their fair share of health disparities, Missouri shares the same troubling matter. According to the Washington State Department of Health (2022c), local public health agencies located throughout Missouri work to improve the health of thousands of Missourians every year addressing a wide range of public health issues, from assessing the health risks of environmental problems to providing emergency services during natural disasters. Chronic diseases, including heart disease, stroke and diabetes; cancer; and communicable diseases affect the health of millions of people and cost billions of dollars in medical expenses every year in Missouri. Additionally, Missouri also shares in the effort to reduce the spread of HIV. Efforts to prevent the spread of the virus, counseling and testing individuals who are at high risk, and caring for people living with the disease are key to reducing HIV and AIDS in Missouri (Missouri Department of Health & Senior Services, 2022a). Moreover, like the state of Ohio Missouri is also amid an opioid crisis. Missouri's data tell a troubling story: the opioid epidemic affects all genders, all races, many age groups in both rural and urban Missouri communities, and has a steady increase in opioid overdose deaths (Missouri Department of Health & Senior Services, 2022d). Further discussing the state's crisis, the Missouri Department of Health & Senior Services (2022d) explains trends indicating that misuse in Missouri, and nationwide, continues to affect people across all demographics.

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