Commentary

Dire health and billions of surplus dollars

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INDIANAPOLIS — If you live in Carmel or Noblesville, statistically you’ll live about nine years longer than someone in Scottsburg, and about six years longer than a Hoosier living in Gas City.

In the television age of Hoosier politics there have been seismic reports that brought along middling change. The Indiana School Reorganization Act of 1959 reduced the number of school districts from 966 to 402, yet even today there are 53 school corporations with fewer than 1,000 students.

In 2007 came the Kernan-Shepard Indiana Commission on Local Government Reform, which had been convened by then-Gov. Mitch Daniels. The commission recommended 27 changes, ranging from child welfare funding to reorganization of school districts. It created one major shift: Property tax assessment duties were moved from all but 13 of the state’s 1,005 townships to county offices.

On Aug. 1, the Governor’s Public Health Commission released its 107-page report in the aftermath of the COVID-19 pandemic. “It is clear that COVID-19 pandemic tested our public health system in a way that we have not seen since the 1918 influenza pandemic,” the commission noted in its letter to Gov. Eric Holcomb, who created the body. “It became apparent to us as we dove deeper into this work that funding, governance structure, and workforce would be at the heart of many of the challenges of our public health system.”

In its executive summary, the commission observed: “In fact, most of the life expectancy gains achieved during the 20th Century -— approximately 25 of 30 additional years — are attributable to public health programs and interventions focused on preventing people from getting sick or injured in the first place and on promoting wellness by encouraging healthy behaviors.”

The commission noted that the longevity gains of the last century, however, are threatened by contemporary public health challenges involving addiction, suicide, smoking, obesity and diseases that have vaccine, though a growing number of Hoosiers are neglecting.

“In fact,” the commission observed, “life expectancy in Indiana has been declining since 2010, when it peaked at 77.5 years. Indiana’s life expectancy in 2019 was 77 years, almost two years below the U.S. average of 78.8, placing us 40th in the nation. Of even greater concern is that difference between the Indiana county with the highest life expectancy and the county with the lowest life expectancy is almost nine years. This is clear evidence of the health disparities that exist across our state.”

According to senior demographer Matt Kinghorn of the Indiana Business Research Center at IU, “In 1984, the life expectancy at birth for residents of Hamilton County was 1.1 years longer than for those living in Scott County. As of 2018, the gap between these two has grown to nearly nine years.

Indiana EMS runs have almost doubled as the Baby Boom generation ages, from 758,115 in 2018 to 1,258,158 in 2021. However, the number of ambulances and EMS providers has decreased from 24,145 in 2018 to 23,070 in 2021.

A third of Indiana counties are more than 45 minutes from the nearest trauma center. Some 33 counties are without a OB-GYN delivery room.

“Indiana ranks very favorably in economics, opportunity, education, and public safety,” said commission Co-Chair Luke Kenley, who said he has been “shocked” by the growing disparities. “However, our public health metrics rank us amongst the lowest in the nation. Business and industry require a healthy workforce for our Indiana economy to continue to grow.”

In its conclusion, the commission recommended $240 million in increased annual spending to “lift funding for county public health departments to the national average.”

Indiana ranks 48th in the nation for public health funding, spending approximately $55 per Hoosier on public health initiatives or $36 less than the nationwide average of $91 per capita. In the early 1990s Indiana ranked 26th in overall health outcomes; now we rank 40th.

In the upcoming 2023 biennial budget session beginning in January, these proposals will get a robust debate in the General Assembly. “I found it a little bit difficult to swallow,” said Senate President Pro Tem Rodric Bray. “I don’t see us spending $480 million in this next budget on public health. I’m not even sure if we sent that kind of money to local health departments that they would be able to handle it well.”

But here’s a glaring piece of information: Indiana finished the last fiscal year with a record $6.1 billion surplus. Not taking public health to, as Gov. Holcomb would put it, “the next level” is to dodge a central dilemma facing tens of thousands of Hoosier families.

Or as Grant County Commissioner Mark Bardsley put it, “Regarding public health, I’m not satisfied with adequate nor average; we need a foundational commitment that all Hoosiers have excellent public health services in every ZIP code throughout Indiana.” Grant County’s life expectancy is 75.3 years, six years lower than that of Hamilton County.

My comment to Sen. Bray and House Speaker Todd Huston is this: Hoosiers need you to be creative, innovative, and manage the state’s assets beyond building smooth roads, balancing budgets, low business taxes, and sending rebates back to taxpayers. Failure of imagination is not an option.

 

The columnist is managing editor of Howey Politics Indiana/State Affairs at StateAffairs.com/pro/Indiana. Find Howey on Facebook and Twitter @hwypol.

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