In August 2021, Governor Eric Holcomb created the Governor’s Commission on Public Health. The commission was tasked with analyzing and advising state government on the current state of Indiana’s public health system, including its performance during the COVID crisis. The commission was also to identify ways, including legislative recommendations, to improve public health financing, public health service delivery, health equity, local health department resilience, and emergency response capacity.
The commission issued a good report, but nothing really innovative or cutting-edge; Indiana is not ready for this. The report and its recommendations are conceptually based only on sound fundamental principles of public health. Indiana has to start somewhere; might as well start with the most important.
The commission outlines the sorry state of public health care in Indiana after decades of neglect and underfunding. Indiana remains one of the unhealthiest states in the nation, ranking near the bottom on most parameters of public health. Life expectancy in Indiana is two years less than the national average. Worse, there’s a nine-year gap between the counties with the highest and 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 achieved in the twentieth century were due not to medical advances but to public health measures that prevented disease and improved 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 a healthy lifestyle.
The report makes detailed recommendations for improving six key elements of good public health:
- Improving governance, infrastructure and service delivery
- Expand public health funding
- Cultivate a well-trained public health workforce
- Modernizing public health data collection and sharing to support better planning and delivery
- Improve emergency response capacity, especially for local health departments
- Improving child and adolescent health through school clinics, health education and prevention programs
Unfortunately, the report does not address Indiana’s high infant and maternal mortality rates.
State funding, among the lowest in the nation at 45th, must be significantly increased to support local health departments to increase staffing, services and capabilities. COVID has really exposed these limitations. 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. Taking it a step further, I have long advocated “Healthy Community” initiatives involving community leaders, business, government, non-profit organizations, hospitals, educational institutions, faith groups and the medical community working together to assess community needs and achieving positive change. The state should sustainably fund a healthy community initiative in each county.
Finally, the commission recommended something that I have always felt very desirable – cooperation between regional local health departments, partnerships or possible consolidation. Expertise, programs, service delivery, staff and other resources can be shared, particularly to the benefit of the smaller departments involved.
The report includes a well-known important reminder from Benjamin Disraeli: “The health of the people is indeed the foundation on which all their happiness and all their powers as a state depend.” As the report concluded, “Our ill-health hampers our economic performance, weakens our communities and shortens the lives of too many Hoosiers… We can and must do better.”
Indiana has had very few public health triumphs. Will this report be left to gather dust? Or will the General Assembly answer the call?
Dr. Richard Feldman is an Indianapolis family physician and former state health commissioner. Send comments to [email protected]