Last summer, the Governor’s Public Health Commission submitted its final report. The commission was formed to find ways to improve Indiana’s public health system in the wake of the COVID pandemic. It was led by retired Senator Luke Kenley, one of our state’s most consistent financial hawks, and former state health commissioner Judith Monroe. They were joined by experts from local public health departments, the state health department, and health professionals.
The 107-page report available at www.in.gov/gphc is unusually detailed and unlikely to be read by most Hoosiers. The Commission is tasked with making recommendations for better delivery of public health services that will make Hoosiers healthier and give them more equitable access to care. The report also looked at the structure of local health departments.
The first thing Hoosiers need to know is that we’re a lot less healthy than we should be. Our overall health ranking ranks 40th out of 50 states. Our biggest problems are in areas most susceptible to public health interventions. We fail in diabetes, obesity, smoking and premature death of young people. We have an appalling infant mortality rate, and health care outcomes across Indiana vary widely based on income and overall wealth in a community. Where a better public health system can benefit the most, they are the least supported.
Poor health among Hoosiers makes doing business in Indiana more expensive due to higher health insurance costs. As I’ve mentioned often in this column, poor public health isn’t the only cause of our high healthcare spending in Indiana, but it’s an issue that legislatures can easily address. This report contains very detailed changes in legislation and presents 32 detailed recommendations. The way I see it, these recommendations do three big things.
First, the recommendations make the role of public health departments more locally focused. Changes to local public health departments will make them more responsive to the needs of schools, first responders, and other community groups. They would also commission local public health offices to focus on coordinating activities such as free clinics in schools or neighborhoods. More importantly, these recommendations make the relationship between counties and the state more of a partnership than a top-down bureaucracy. The health needs of each county differ, sometimes significantly. These recommendations allow local governments to focus on their local needs.
Second, the recommendations outline a series of steps for local public health departments to get better at their job. This includes professional standards for workers and greater coordination with local healthcare providers, government agencies and first responders. Proposals range from allowing local health departments to bill Medicaid when they provide clinical services to requiring a common minimum set of services to be provided in each county.
Third, these recommendations will force local health departments to be more effective in emergency response, health education, and identification of impending threats to public health. They do this by requiring data sharing, more working groups, and coordination with other agencies and private providers doing the work.
In the wake of COVID, many citizens will watch changes in their local health departments with some skepticism. Therefore, it is helpful to consider what these recommendations do not do and what they are trying to achieve. Nothing in this Commission report can change the rules for wearing masks or how decisions are made about a pandemic. These are part of a different set of rules that were changed after the pandemic. This is not a major government takeover of local health departments.
A better way to think about the commission’s recommendations is how they will affect more mundane everyday issues of public health. I will present two examples. The first is the HIV/AIDS crisis in Scott County in 2014. A local doctor noted an increase in patient numbers, but delays in reporting to the local health department and the local health department and delays in analyzing the data meant that response was delayed. significantly. When the government fully understood the problem and took action, the disease spread widely.
An estimate in The Lancet (Gonsalves & Crawford, 2018) was that response delays led to as many as 170 additional HIV infections. The lifetime cost of HIV treatment was up to $400,000, a $65 million failure in just one county. But I think the second example is even more urgent and pervasive. A modern, highly trained local health department would be among the first to detect an overdose of opioids or an increase in more dangerous drugs such as fentanyl. These are a chronic problem in Indiana and most of the nation.
Local health departments, such as those recommended in the Commission’s recommendations, can better support police, EMS and hospitals. More importantly, they will be able to share data in a way that can limit the spread of the disease. Most importantly, they will be able to more fully support schools and other local groups that educate citizens about the risks of these drugs. We need these changes now.
Today, in counties that fully fund their local health departments, many of the best practices are already in place. Elsewhere, a small, under-resourced staff can’t do much of a disservice to the many health issues Hoosiers face. The Commission’s recommendations will ensure that we all have access to effective local health department services.
Naturally, embracing all these new recommendations is not a panacea. It will take some time, perhaps decades, to truly improve our poor public health rankings. But the gaps identified during the pandemic suggest now is a very good time to take Indiana’s public health challenges more seriously. Of course, this will cost money and take time.
The Commission noted that it would cost $242 million a year to raise our government funding to the national average per citizen. Part of this amount will have to come from state money and part from local currency. Everyone needs a “skin in the game” with this problem. But there’s something about spending tax dollars on public health: You pay now or pay later. Paying now is much cheaper.
Michael J. Hicks is director of the Center for Business and Economic Research and the George and Frances Ball Distinguished Professor of Economics at the Miller School of Business at Ball State University. Submit comment [email protected]