Public Health: An Ounce of Prevention is Worth a Pound of Cure

In American history, gains in life expectancy and quality of life can be attributed to investments in public health infrastructure. Diseases such as cholera and typhoid have been largely eliminated due to improvements in sanitation; immunizations have prevented death and disability from polio, whooping cough, measles, and five different cancers; and countless children have avoided lifelong health effects from lead exposure.

Unfortunately, since 2010, life expectancy in Indiana has been declining, for the first time in generations falling to 77.1 years in 2018. This decline, which places us 40th nationally for life expectancy, can be attributed in large part to increases in drug overdoses and increasing burdens of chronic disease such as diabetes, cancers and heart disease related to our high obesity and smoking rates.

Even more concerning is the disparity in life expectancies across counties in Indiana, with a gap of nearly nine years between the county with the highest life expectancy and the county with the lowest. This is a reflection on the state of our public health system, which forms the foundation of many efforts to prevent and address these risk factors.

The COVID-19 pandemic has tested Indiana’s public health system in ways not seen in more than a century, exposing incredible strengths and dedication and troubling gaps. Last August, Gov. Eric Holcomb established the Governor’s Public Health Commission to conduct the first comprehensive review of Indiana’s public health structure since the 1980s. The goal was to closely examine those strengths and weaknesses and make recommendations for lasting improvements.

What is public health

Indiana has 94 decentralized health departments that fall under county or municipal control. All are charged in state statute with carrying out the same core functions in their jurisdictions, including: 

• Administering immunizations
• Providing birth and death certificates
• Responding to communicable disease outbreaks
• Preparing for and responding to health emergencies
• Ensuring that food, pools, and septic systems are safe

As the Commission has found, many of these local health departments face challenges to provide these statutorily required public health services to their communities.

Many have an average of three to six full-time employees to serve tens of thousands of residents, which leads to inequities in how public health services are delivered across the state. Small staffs are required to have expertise in many different areas, or they are forced to pick and choose which services they can offer, especially when a crisis, such as the COVID-19 pandemic, strikes. This compounds the health disparities that persist across Indiana, putting many Hoosiers at greater risk of poor health outcomes.

The Governor’s Public Health Commission has holistically examined the current public health system in six key areas – funding, workforce, governance and infrastructure, data and analytics, emergency preparedness, and the delivery of childhood and adolescent health services – to identify areas of strength and those in need of improvement. Consistent themes that have emerged focus on the need for equitable resources, both in funding and in workforce. Financial resources impact staffing and the services local health departments can provide, therefore affecting a community’s ability to achieve optimal health.

Indiana ranks low

National median funding for health departments is $41 per capita, but at least 37 of Indiana’s 94 local health departments have per capita spending of less than $10. And while Indiana receives high marks in national rankings for its affordability and economic growth, it ranked 40th for public health in U.S. News and World Report’s 2021 Best States ranking. In the Trust for America’s Health’s recent Ready or Not report, Indiana ranked last in the nation for the percentage of residents covered by a comprehensive public health system. 

This leaves many Hoosiers at risk for preventable and treatable costly illnesses that impact not only their individual health, but the health of their communities, and Indiana’s fiscal health as well, as businesses are historically more attracted to places with lower healthcare costs and healthier populations.

As we traveled the state listening to Hoosiers, it is clear that these services are needed to prepare Indiana for the economy of tomorrow.  

Indiana has worked hard to establish a fiscally sound identity.  As the Commission finalizes its report for submission to the Governor, our hope is that the recommendations presented lead to significant, transformative legislation that ensure a safer, better tomorrow for all Hoosiers and make Indiana equally praiseworthy in how it prioritizes the health of its citizens.