A commission tasked with reviewing Indiana’s public health infrastructure has found spending per capita lags and is set to pitch a significant investment.
The weakness of Indiana’s public health system became glaringly obvious during the COVID-19 pandemic, when part-time local health departments in rural areas didn’t have the resources to educate their communities on the virus or the benefit of vaccines.
The suggested price tag to update Indiana’s system? Nearly $250 million, according to the Governor’s Public Health Commission. Details of the final proposal will be presented at the commission’s last meeting, scheduled for Thursday.
“This is a totally justified expense and idea on the part of state government. It’s something that Indiana really needs to do and the time has come to do it,” said Luke Kenley, a former state senator and commission chair. “The fact that Indiana has a very weak public health delivery system is undeniable.”
Indiana ranks 48th in the nation for public health funding, spending approximately $55 per Hoosier on public health initiatives or $36 less than the nationwide average of $91 per capita.
Hoosiers receive vaccinations—whether for the flu or COVID-19—at lower rates than the national average and smoke at higher rates, making the state’s workforce less healthy than its peers.
A December 2020 report from the Indiana University School of Public Health analyzed the state’s public health system, calling the system “chronically underfunded and undervalued.”
Researchers credit much of the increase in life expectancy for Americans over the last century to innovations in public health that prevented the spread of contagious diseases and improved sanitation.
Indiana lags behind other states when it comes to implementing best practices, particularly during the COVID-19 pandemic.
“While it may be difficult to imagine, during the early response to the COVID-19 pandemic, there were (local health department)s in Indiana that literally closed their doors and were not participating in the response or available to their communities,” the report said. “It cannot be more obvious that the public health system is not functioning as a system when (local health department)s are not seamlessly plugged into a statewide response to a pandemic.”
Local health departments depend on their communities for funding, making coverage inequitable across the state. The governor’s commission will advocate for a common fund that counties can opt into. Funding would be distributed based on the greatest need, akin to the allotment of education monies.
Kenley, who crafted the state’s current education funding index, noted that 64 Indiana counties had less than 50,000 people and nearly half of those counties, 30, had less than 25,000 residents.
“They are of such a small size that as modern health has advanced, the cost of delivering even a simple public health system is beyond the means of most of these counties,” Kenley said. “When you’re a poor county commissioner out there in one of the smaller counties—this is pretty far down your priority list of what you need to do first.”
Just 17 miles—from Fishers to downtown Indianapolis—illustrates the disparity between the state’s wealthy and impoverished counties. Life expectancy in suburban Fishers is 16.8 years longer than in downtown Indianapolis.
The IU review concluded that investing $14 per capita in public health would increase life expectancy for lower-income populations by one year and prevent 890 deaths annually. Within 10 years, medical costs would decrease by $168 million annually.
Indiana has one of the highest rates of adult smokers in the nation and higher mortality rates for new mothers, infant deaths, accidental deaths and suicide.
In a September 2021 presentation, the Indiana Department of Health calculated the cost of Indiana’s poor health, including $3 billion in annual health care costs for Hoosiers who smoke. In terms of cervical cancer, the agency reported more than $54 million in health care costs.
Selling public health
Commissioners face an uphill climb when it comes to persuading the General Assembly to invest funds in public health. Legislators will draft the next two-year budget during the 2023 session, starting in January, but Republican leaders said in May they worried about the pressure of inflation on the budget.
“Everybody’s already coming to us. The cost of road projects is up 50% in the last three months, what we’re seeing in bids, we’re seeing state infrastructure projects, buildings (and) those types of things through the roof,” said House Speaker Todd Huston, R-Fishers.
But Senate President Pro Tem Rodric Bray, R-Martinsville, didn’t dismiss the potential of investing in public services.
“There’s an opportunity to invest in lots of things, including public health issues like infant and maternal mortality,” he said.
Lawmakers will return to the capitol building July 6 to consider a proposal to distribute $1 billion to Hoosiers through an Automatic Taxpayer Refund, as suggested by Gov. Eric Holcomb.
Kenley acknowledged he has a tough job to convince budget writers to dedicate nearly $250 million toward the commission’s recommendations, especially when many Hoosiers have a low opinion of public health because of pandemic precautions.
“That should not be a deterrent to us evaluating what we’re doing … (or) to the legislature adopting a full program,” Kenley said. “It needs to be a partnership agreement and the partnership needs to be the state, the regional and local health departments, and the local government.”
Kenley said he believed legislators would see the benefit of the commission’s recommendations if they give it an “honest review.” He rated the overhaul of Indiana’s public health funding equally as important as his prior budget work on property tax reform, school funding, road infrastructure and economic development.
“The reason why I’m asking for only the national average in per capita funding is that—in all of the years that I was involved with budgets and state government … our attitude was if we spend only the average of what all the states are doing, Indiana will do a better job,” Kenley said. “We will deliver a superior program for a middle-of-the-road price.”
The Indiana Capital Chronicle is an independent, not-for-profit news organization that covers state government, policy and elections.