Indiana's dismal performance on the latest America's Health Rankings survey leaves no question of the need for a statewide public health commission. The state's investment in public health spending leaves doubt for its effectiveness.
Still, Gov. Eric Holcomb deserves credit for tackling this long-ignored need. The 15-member commission will be led by Dr. Judy Monroe, a former state health commissioner, and Luke Kenley, a former state senator and fiscal leader. While the other appointments have yet to be announced, northeast Indiana should have strong representation. The region's well-qualified public health and medical professionals are experienced in serving urban, suburban and rural health needs.
Each of the commission members should be prepared to advocate for public health policy and spending. In announcing the new panel Wednesday, the governor compared it to the teacher pay commission he appointed after educators statewide protested lagging investment in public education. While the panel produced a comprehensive report with some sound recommendations, they seemingly did nothing when it came time to convince lawmakers to implement their recommendations. If not for the millions of dollars in federal pandemic relief supplanting other funds, Indiana teachers would have seen little improvement in state support.
The GOP-controlled legislature can and should be held accountable for its lack of support for public health. Public health spending in Indiana was just $55 per resident in 2020, according to the America's Health Rankings survey. Spending on the state's public health agencies declined by 5.7% from 2010 to 2018.
Shortchanging public health is not sound fiscal policy. The practice has proven costly time and again. A Kaiser Health News/Associated Press analysis highlights Scott County, Indiana, where the health department once operated a children's clinic and home health agency. Both were lost as funding declined.
“The county was severely outgunned when rampant opioid use and needle sharing sparked an outbreak of HIV in 2015,” the analysis notes. “The HIV outbreak exploded into the worst ever to hit rural America, infecting more than 230 people.”
The full cost of the coronavirus will likely never be determined, but Indiana's per capita death rate as of Thursday was the 15th highest in the nation, at 211 deaths per 100,000 residents. How much lower might it be if Indiana had gone into the pandemic without a high rate of obesity and smoking, each linked to risk for severe COVID-19?
Kenley, the former Senate budget leader, will be an asset in making a case to former colleagues, but he never succeeded in efforts to increase Indiana's cigarette tax, unchanged since 2007. Republican legislators already have shown disregard for the lame-duck governor in limiting Holcomb's executive authority during a public health emergency.
The new commission demands members prepared to speak truth to power. Aside from a moral obligation to protect Hoosiers' health, the General Assembly has a responsibility to ensure tax dollars are spent on prevention, not more costly treatments. Lawmakers should be held accountable for public health rankings that make Indiana unattractive to employers and the talent they want to hire.
The commission also is expected to study delivery of services and collection and use of data. But its most important and challenging task is to educate Indiana lawmakers on their costly neglect of public health.
The 2020 America's Health Rankings survey assigns low marks to Indiana:
• 48th in the nation for per-capita public health spending
• 46th worst among the states for air quality
• 43rd worst for access to mental health providers
• 44th lowest childhood immunization rate
• 43rd worst for the percentage of physically inactive adults
• 41st worst for percentage of adults who smoke