Indiana has to start somewhere

Richard Feldman

In August 2021, Governor Eric Holcomb established the Governor’s Commission on Public Health. The commission’s mission was to analyze and advise the state government on the current state of Indiana’s public health system, including its performance during the COVID crisis. The Commission should also find ways, including legislative recommendations, to improve public health financing, the delivery of public health services, equity in health, the sustainability of local health authorities and the capacity to respond to emergencies.

The Commission has presented a good report, but there is nothing really innovative or front-runners. Indiana is not ready for this. The report and its recommendations are conceptually based on good, fundamental public health principles. Indiana has to start somewhere. It might as well start with the essentials.

The commission outlines the pitiful state of public health in Indiana due to decades of neglect and underfunding. Indiana remains one of the unhealthiest states in the nation, ranking low on most public health parameters. Indiana’s life expectancy is two years below the national average. Worse, there is a nine-year difference between the counties with the highest and lowest life expectancies, highlighting Indiana’s geographic, ethnic, racial, and socioeconomic differences.

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Health insurance does not guarantee health. Public health is important. Of the 30 years of increased life expectancy in the 20th century, 25 are not due to medical advances but to public health measures that prevent disease and improve the conditions in which we live and work: immunizations; better housing, sanitation, nutrition and food protection; safer working conditions; and most importantly, promoting a healthy lifestyle.

The report provides detailed recommendations to improve six essential elements of good public health:

• Improving governance, infrastructure and service delivery

• Expansion of public health financing

• Building a well-trained public health workforce

• Modernize the collection and sharing of public health data to support better planning and delivery

• Improving emergency response capacities, particularly for local health authorities

• Improving the health of children and adolescents through school-based clinics, health education and prevention programs

Unfortunately, the report did not address Indiana’s high infant and maternal mortality rates.

Government funding, which is among the lowest in the country (45th), needs to be greatly increased to help local health departments ramp up staffing, services and skills. COVID has really brought these limitations to light. Public health funding has traditionally been a low priority for the General Assembly.

The report highlights the importance of local health departments developing broad community partnerships. Taking this a step further, I have long been a champion of healthy community initiatives where community leaders, businesses, governments, nonprofits, hospitals, educational institutions, religious groups and the medical community work together to assess community needs and make positive change effect. The state should sustainably fund a healthy community initiative in each county.

Finally, the Commission recommended something that I have always found very desirable – cooperation with regional health authorities, partnerships or possible consolidation. Expertise, programs, service delivery, human resources and other resources can be shared, which is particularly beneficial for the smaller departments involved.

The report contains a well-known important admonition from Benjamin Disraeli: “The health of people is truly the basis upon which all their happiness and all their power as a state depend.” weakening our communities and shortening the lives of too many Hoosiers… We can and must do better.”

Indiana has had very few public health achievements. Will this report get dusted? Or will the General Assembly answer the call?

Richard Feldman, MD, is a family physician from Indianapolis and former Indiana State Commissioner of Health. The opinions are those of the author.

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