In unhealthy Indiana, business and health leaders rally around plan to boost public health spending

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IBJ health care reporter John Russell leads the discussion at the Health Care & Benefits Power Breakfast on Sept. 23, 2022, at the Westin Indianapolis. (IBJ photo/Mason King)

Indiana needs to rally around a plan to increase spending significantly on public health to help curtail the effects of obesity, smoking, infant mortality and other critical measures where the state ranks low, a panel of health and business leaders said Friday morning.

A blue-ribbon commission appointed by Gov. Eric Holcomb is recommending that the state spend an additional $242 million a year to help local health departments and school districts make their communities healthier.

Some say the extra investment could have a huge effect not only on health, but economic development and community prosperity.

“We are losing our working-age population at an alarming rate,” Brian Tabor, president of the Indiana Hospital Association, said during at panel discussion at IBJ’s Health Care & Benefits panel discussion. “Our life expectancy in Indiana over the last couple of years has dropped two years behind the national average.”

He said substance abuse, suicide and early deaths from unhealthy environments are taking a toll and could affect the ability of Indiana to attract investments due to a growing worker shortage in some poor rural counties where the life expectancy is notably shorter than wealthier counties.

Some medical professionals say resources are stretched to the breaking point in some communities.

About one-third of Indiana’s 92 counties are designated “maternal health deserts,” which means that women have to travel an hour or more to get obstetrical care, said Dr. Camueal Wright, an obstetrician-gynecologist and Indiana chief medical officer for CareSource, a managed-care Medicaid organization.

“So I think there would be a huge benefit to improving public health, starting with the basics and working from there,” she said.

The large price tag, she said, could be more than made up with healthier communities, where people miss less work and are more engaged in civic affairs, which are drivers for productivity and economic development.

One of the top recommendations of the public health commission is to help local health departments, which are often understaffed and have limited resources for school nurses, ambulance service, providing immunizations and collecting health information.

Indiana spends about $55 a person on public health annually, or about $374 million. The money is used for such things as preventing, detecting and tracking disease outbreaks, as well as tobacco cessation programs, emergency preparedness and infant health programs.

That per-person spending ties Indiana with Arizona and Ohio for second-to-last place among U.S. states, according to America’s Health Rankings 2019 report by the United Health Foundation. Only Nevada spends less.

The commission is recommending that the state increase annual public health funding to $91 per person, an increase of about 65%, for an extra $242.6 million a year.

Much of that money would be funneled to local health departments, many of which have bare-bones offices and programs, according to the commission’s report, released last month.

Dr. Roberto Darroca, an obstetrician-gynecologist in Muncie and past president of the Indiana State Medical Association, said physicians recognize the need for increased spending on public health, as many are county health officers around the state.

“The complaints we hear from them is that they don’t have enough resources, they don’t have enough employees in order to provide the care that the community needs,” he said.

Gloria Sachdev, president and CEO of the Employers’ Forum of Indiana, which pushes for more transparency and value in health care, said many business leaders in her group understand the need for higher spending and support at the commission’s recommendation.

Luke Kenley, a  retired Republican state senator from Noblesville who co-chairs the commission, said many parts of Indiana can’t support public health efforts in their communities without more state money. He said more than two-thirds of Indiana counties have a population of 50,000 or less.

“They do not have an asset or wealth base that makes it easy to fund up the local public health department,” Kenley said. “Other priorities like roads and jails and law enforcement are clearly going to come ahead of that. So the state needs to pick up the mantle and do its share.”

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9 thoughts on “In unhealthy Indiana, business and health leaders rally around plan to boost public health spending

  1. This money only makes sense if it is iron clad ring fenced for things like subsidizing access to pre-natal care, anti-smoking, etc. As we saw from the pandemic, the “public health” profession is highly politicized in a leftist direction and happy to be dishonest in the service of politics (e.g., you can’t have a funeral for your grandmother but mass protests over George Floyd post no covid risk).

    1. Oh give me a break. What a foolish comment. You can’t just lambast the entire public health profession as “politicized in a leftist direction” because you didn’t agree with covid precautions (which are no longer in effect pretty much everywhere in the US). It’s attitudes like yours that have contributed to Indiana ranking last or close to it in virtually every public health indicator.

    2. Why do you object to ring fencing the money to only bona fide health related activities then?

      By the way, you obviously know nothing about the public health profession. I was on the APHA mailing list for many years. Virtually all of their communications were about how things like climate change, guns, or racism were big public health problems, whereas infectious disease, opioids, etc. got much less play.

    3. Go on and list those activities.

      I’d just like to point out that the state of Indiana just passed an abortion law that in theory would lead to thousands more births a year and specifically chose not to pass significant increases in pre-natal care at the same time. The $55 million dollar increases didn’t even cover the current funding shortfalls.

      The excuse given was that they couldn’t appropriate money during a special session… of course, during that special session, they chose to instead appropriate a billion dollars back to Hoosiers instead of improving pre-natal care or even doing something like fixing our roads.

      But, please, go on about dishonesty in politics. I guess I’m just a socialist because I’m tired of living in Indianapolis and my tax dollars going to places in Indiana that are bleeding population left and right.

    4. So, Aaron, from your reply you do seem to agree that infectious disease is a reasonable focus for public health, and yet you disparage public health efforts taken during the biggest infectious disease outbreak in a century. I’m confused. Yes, you are right that opioids are also a public health issue. But if you really believe there is no public health impact from climate change, guns and racism, you are living in a right-wing echo chamber. Those three issues account for an ever-growing impact on the health of Americans. They deserve to be addressed in a systemic way, the way public health efforts can.

  2. We need to first look at what programs are NOT working. Either stop them or modify them to streamline spending. And don’t just throw money at things. Find solutions to the problems. Lack of education is the root of much of the unhealthy habits. In the end, you can lead the horse to water, but you can’t make them drink.

  3. Indiana, with a tax of just 99.5 cents per pack of cigarettes, ranks as the 13th cheapest state for smokers. Or, put another way, we are the 13th best place to live when it comes to state-assisted suicide (sarcasm intended).

  4. And at the same time our state leaders disparage ESG efforts by corporations. ESG is not only real, it provides a real framework to engage our corporations/employers in the solution. Public health, health and wellness broadly are complicated topics and issues that requires a focus on both the big picture and the specifics in formulating effective solutions. I look forward to seeing the output and impact of the commission.