Indiana continues to have high smoking, obesity rates, and is below average in public health funding

February 2, 2009

Bill Wisniewski, a salesman from Munster, has shed 86 pounds in the past year with help from the "Ready, Set, Walk" campaign run by the INShape Indiana program.

The 56-year-old said INShape's e-mail tips helped him set a routine and work through pain as he ramped up to walking 70 minutes a day.

As the weight came off, Wisniewski finally was able to wear a suede University of Notre Dame jacket he had bought two years earlier.

"I wasn't able to zip it before. And now it's almost too big," Wisniewski said. "It really felt good to get into it. When I finally did, it was the best feeling."

Gov. Mitch Daniels' administration points to stories like Wisniewski's to conclude that the program and other public health efforts have at least stopped the collective expansion of Hoosiers' waistlines.

It's a small victory, but that's what Daniels' team has to claim in its four-year battle to get perennially unhealthy Hoosiers to eat better, exercise more and quit smoking.

The two numbers Daniels & Co. watch most closely—obesity and smoking rates—are little changed since the governor took office in January 2005. Obesity rates ticked up and then flattened. Smoking rates spiked and then came down sharply, producing a modest smoking decline.

Somewhat paradoxically, even though obesity has worsened in Indiana, it grew even more in other states, meaning Indiana's rank improved, to No. 30. Conversely, while Indiana's smoking rate has dropped, it hasn't fallen as fast as in other states, causing Indiana to slip to No. 45.

"There is good news in that, but the governor is not satisfied," said Daniels' health commissioner, Dr. Judith Monroe. "The reality is, we just had so much work to do."

Few would disagree. Some observers say the administration has fought the battle against bad health valiantly by celebrating companies, individuals and communities that change policies and practices to improve health, but, with the Legislature, has tied its other arm by directing paltry spending to public health.

Indiana spent $61.5 million on public health in fiscal year 2007, according to the Trust for America's Health, a Washington, D.C., not-for-profit that ranks such spending.

That was only $10 per person, and only two states spent less. Indiana public health spending would have had to triple to reach average.

Those numbers don't include revenue from the 55-cent-per-pack cigarette tax Daniels worked with the Legislature to pass in 2007. And they don't include $20 million Daniels spends to build outdoor trails around the state. Still, even Monroe admits Indiana's spending is low.

Jeff Levi, executive director of the Trust for America's Health, said other states are funding walking and biking trails or giving incentives to grocers to set up stores in poor neighborhoods and stock fresh produce and healthy foods.

Daniels has been a model for using the bully pulpit to change norms, Levi said. However, he added, "You have to have investment in community programs that really make a difference."

The buck starts here

Daniels' focus on public health started with himself. He rarely goes a day without working out. And he hasn't been shy about showing off his habits.

He has appeared in television commercials jogging around downtown and lifting weights, and has posed in print ads with his flexed bicep tattooed with "Real Men Get It," the tag line for a campaign promoting testing for prostate cancer.

Most of the ads touted the INShape Indiana program, which Daniels launched in July 2005, six months after taking office.

Operated by two staff members in Daniels' office, INShape Indiana has spent $1.3 million on advertising campaigns with money donated by the Indiana Tobacco Prevention and Cessation agency. INShape Indiana also has signed private sponsors to hold an annual statewide health summit and provide incentives for its programs.

Monroe said she's pleased with achieving a high profile while spending such little money.

"When I travel the state, everybody knows what INShape is," she said.

The INShape Indiana Web site declares that employers save money and see more productive workers when they institute wellness programs. It also notes that employers looking to add a location in a state consider the health—and therefore health care costs—of the workers there.

INShape also tried to sign employers to participate in a work-site wellness program. Representatives from 30 Indiana companies meet quarterly to share best practices. And employees at more than 200 companies tried to recruit co-workers last year to join INShape's "Ready, Set, Walk" campaign—the one that inspired Wisniewski.

INShape Indiana will not launch a new advertising campaign this year, in order to conserve money. Instead, it started a social networking program on its Web site, which attracted 1,000 visitors in its first month.

"We're essentially a non-funded entity," said INShape spokesman Joshua Gonzales. "It would be great to have some dollars."

Much work remains

Fat chance those dollars will come this year, since Daniels has ordered a spending freeze to deal with a projected revenue shortfall of nearly $1 billion.

Not only is public health spending a paltry $10 per person, but Indiana wins less than $25 per person in federal public health grants—next to last nationally.

Rep. Charlie Brown, D-Gary, who chairs the Indiana House Committee on Public Health and sponsored the 2007 bill that boosted the cigarette tax, said Daniels' support for public health has been mixed.

Brown points out that the Healthy Indiana insurance program has signed just 40,000 Hoosiers when the cigarette tax increase generated enough money to cover 130,000.

Also, Brown said the administration needs to push harder for federal grants, particularly now that President Barack Obama's economic stimulus plan includes $3 billion in new money for public health.

Monroe concurs—and she's working on it. The State Department of Health won a grant last year from the Centers for Disease Control to battle obesity. Lack of state funding hampers Indiana's grant applications, she said, but noted that INShape Indiana has helped spruce up its applications.

Given the state of the economy, she's not holding her breath for more state dollars. Instead, she started a competition among her staff for ideas about how to provide programs or services for less money.

"There's a lot of room for having a more efficient delivery of services," Monroe said. "That's translating into some really creative ideas around here."

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