Dr. Richard Feldman: Public health report focuses on fundamental principles

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Dr. Richard FeldmanIn August 2021, Gov. Eric Holcomb established the Governor’s Public Health Commission. The charge of the commission was to analyze and advise state government on the condition of Indiana’s public health system, including its performance during the COVID crisis. The commission was also to identify ways to enhance public health funding, delivery of public health services, health equity, local health department sustainability, and emergency-response capacity.

The commission issued a good report, but it contains nothing really innovative or cutting-edge; Indiana is not ready for that. The report and its recommendations are conceptually based on just good, fundamental public health principles.

The commission outlines the pathetic state of public health in Indiana from decades of neglect and underfunding. Indiana remains one of the nation’s most unhealthy states. Indiana’s life expectancy is two years less than the national average. Worse, there is a nine-year difference between the counties with the highest and the lowest life expectancies, highlighting Indiana’s geographic, ethnic, racial and socioeconomic disparities.

Health insurance does not guarantee health. Public health is important. Twenty five of the 30 years of increased life expectancy gained in the 20th century were accounted for not by medical advancements but by public health measures that prevent disease and improve the conditions in which we live and work—vaccination; better housing, sanitation, nutrition and food protection; safer working conditions; and, very important, the promotion of healthy lifestyles.

The report makes detailed recommendations to enhance six essential elements for good public health: improve governance, infrastructure and service delivery; expand public health funding; cultivate a well-trained public health workforce; modernize public health data collection and sharing to support better planning and delivery; improve emergency-response capacity, especially for local health departments; enhance child and adolescent health through school-based clinics, health education and prevention programs.

Some thoughts: State funding, among the lowest in the country (45th), must be greatly increased to support local health departments to increase personnel, services and capabilities. COVID really brought these limitations to light. Public health funding has traditionally been a low priority for the General Assembly.

The report includes the importance of local health departments’ developing broad community partnerships. Going a step further, I have long advocated for “healthy community” initiatives that involve community leaders, business, government, not-for-profits, hospitals, educational entities, religious groups and the medical community working together to evaluate the needs of the community and effecting positive change. The state should sustainably fund a healthy-community initiative in every county.

Last, the commission recommended something I have always felt to be very desirable—regional local health department collaboration, partnerships or possible consolidation. Expertise, programs, service delivery, personnel and other resources can be shared, especially benefiting the smaller departments involved. As the report concludes, “Our poor health inhibits our economic performance, weakens our communities, and shortens the lives of too many Hoosiers. … We can and must do better.”

Indiana has counted very few public health triumphs. Will this report be shelved to collect dust? Or will the General Assembly meet the call?•


Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to ibjedit@ibj.com.

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