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The Journal Gazette

Sunday, March 24, 2019 1:00 am


Why can't we do better?

In health rankings just released by the Robert Wood Johnson Foundation, Allen County moved from 47th to 46th among Indiana's 92 counties.

Dr. Deborah McMahan,Fort Wayne-Allen County health commissioner, is not celebrating.

“We're the second-largest city,” she said in an interview last week. “We have access to two health care systems. We've got amazing entrepreneurs ... a really engaged philanthropy. ... If you are in a rural community, and you don't have access to anything, I get it – it's really hard.”

But “when you are physiologically wired to want to feel better, in a community where there are all these resources, why are we 46th?”

And that's in a state that was 41st in the last America's Health rankings and 49th in public-health spending per capita.

“It's not like you're in the bottom 10 for twerking, or something that doesn't matter,” McMahan said. “You're in the bottom 10 for something your whole economy and prosperity of the community is based on.”

The Robert Wood Johnson evaluation this year offered some new perspectives on health deficiencies, emphasizing factors related to housing availability and costs. This year's report stresses that “health care is more than simply access and outcomes,” said Rachel Blakeman, director of the Community Research Institute at Purdue Fort Wayne. “It's more than, can you see a doctor and are your clinical numbers good?”

There are clear links between being “housing-burdened” – spending a third or more of your income on housing – and health problems. “When too much of a paycheck goes toward the rent or mortgage,” the foundation's report says, “it makes it hard to afford the doctor, cover utility bills, or maintain reliable transportation to work or school.”

Many in Fort Wayne struggle with this problem, despite the city's reputation for low housing costs. Census figures compiled by Blakeman's institute show 45.1 percent of Allen County renters are paying more than 30 percent of their household income for housing; 18.5 percent of the county's homeowners with a mortgage are in the same straits.

“In two ZIP codes – 46806 and 46803 – more than half of renters are spending more than 35 percent of their income on housing,” Blakeman said. “That puts them at risk for other challenges.”

Like most potential solutions to our health crisis, helping housing-burdened families transition to a less-stressful life requires planning, resources and long-term thinking. Those with physical or mental limitations may not be able to work and may need assistance with housing that is both suitable and affordable. Others need help with job training, child care and transportation so they can ease the housing burden by increasing their income. The Robert Wood Johnson Foundation suggests breaking down housing segregation – minorities struggle disproportionately with housing burdens and health challenges – and improving access to parks and grocery stores.

The need for housing solutions is just part of this area's health care challenge.

Other problems behind our community's and state's consistently poor health care rankings are detailed in the accompanying letter and graphics, which McMahan and several other health professionals recently sent to area legislators.

Substance abuse, depression, suicide and other types of “deaths of despair” are among problems that won't wait for long-term solutions. They play into some particularly disturbing new statistics that strike at the heart of the American dream.

“Historically, we have seen life expectancy grow, and now we are seeing it decline,” Blakeman said. Indiana ranks low among the states on this grim statistic, as well.

Why aren't we doing more to address this hydra-headed crisis?

So far this session, lawmakers have ignored a broad-based appeal to substantially raise the cigarette tax, both to cut our shamefully destructive smoking rate and to raise funds to combat other health problems. House Bill 1444, which would levy a tax on e-liquids, has passed the House and will be heard by the Senate Appropriations Committee this week. That assessment, which would be imposed on the distributor, would do little to prevent more young people from becoming addicted to nicotine through e-cigarettes, but it could produce around $4 million in revenue by 2021.

McMahan, who plans to work with other health professionals to produce a series of letters on other aspects of the health crisis for regional leaders to ponder, believes it's time to try some new approaches for funding local health initiatives.

McMahan suggests the state should dedicate new revenue from vaping or cigarette taxes to health concerns, and that half of those funds be returned to localities to apply as they see fit.

“Bring it back here, and let local experts figure out where it could be used best to support their community becoming healthier and more productive and more prosperous,” she said. ''Every county is not the same, and yet we're all given the same marching orders from the state level, and very little funding to implement those marching orders.”

Local leaders could work with foundations to merge private and public funds to meet local challenges, McMahan said. And maybe the prospect of bringing funds back to their local communities would motivate lawmakers to act.

Indiana's continually dismal record makes it difficult to argue we should maintain our current approach to addressing public health concerns. If directing more support toward local initiatives doesn't have an impact, McMahan said, ''we can always go back to what we know doesn't work.”