Health care workers from across the state gathered at the Statehouse Thursday to push the General Assembly on public health funding – a request that has been repeatedly gave lawmakers a break.
The governor’s Public Health Commission, spurred on by the role local public health departments play in the COVID-19 pandemic, sought to analyze the state’s deficit and find funding solutions. After receiving the legislator’s pushback, they revised their initial question down from nearly $250 million to a phased approach that grants $125 million in the first year, followed by the full amount in 2025.
Nationwide, the average state spending per capita on public health is $91, yet Indiana spends only $55, placing it 45th in the nation in funding.
Gov. Eric Holcomb, who asked for the committee, said the public health funding recommendation didn’t even try to be a leader and only asked to bring Indiana to “middle of the pack.”
“We don’t want to be a national laggard; we don’t want to linger any longer,” Holcomb said. “Very rarely I aim for the middle of the pack, but we have to start somewhere.”
What funding means for local health authorities
Mindy Waldron, the Allen County Department of Health administrator, said Indiana’s low public health rankings were directly tied to its nearly low state funding. Waldron and hundreds of others rallied Thursday to demand more state investment on Public Health Day.
Departments, like his own, rely heavily on local funding, half of which he said came from the county and the rest came from various government grants and community foundations.
“Counties are very disparate in the state — relying on tax dollars funding only a portion of their budget — you do the urgent stuff and you really don’t get to the chronic, preventative stuff that could be a game changer,” Waldron said.
Having a dedicated funding source from the state government would allow departments to go beyond their statutory duties, which include inspecting restaurants, permitting tattoo and piercing shops, or using contact tracing to combat outbreaks premises of communicable diseases.
“You should be able to eat at a restaurant in one county and go to the adjacent county (with) the same type of restaurant and the rules should apply,” Waldron said. “Similarly, you should see some of these basic public health programs like maternal or child health at the local level. They don’t do it because there (aren’t) resources to finance them.
The commission, of which Waldron was a member, found that public health spending varied widely from county to county: from $83 per capita in Marion County to $1.25 in Shelby County.
Even though Fort Wayne is the state’s second-largest city, Waldron said his county has moved closer to the core, spending just over $10 per capita.
“We should be at least in the top five with the population we have,” Waldron said. “(But) when you rely on tax money, especially property taxes, they come and go.”
With more reliable funding, he said initiatives like reducing lead poisoning could have continued steadily, rather than starting in the 1970s and starting all over again in the past five years. Instead, with the abandonment of attention, so has the money that funded the lead investigation and testing programs.
“We need substantial funding to do consistent good,” Waldron said. “We’re so below average at this point that it’s going to take a while to catch on and start making a difference in areas like maternal and child health.”
Hoosier’s ill health affects economic development
Holcomb described the state’s ill health as a workforce development issue, noting that a healthier workforce is cheaper than an unhealthy one at both the micro and macro levels.
“When I sit down I talk to people interested in investing in the state of Indiana, the counties are competing against each other. CEOs want to know who values the health of their workforce,” Holcomb said. “If you don’t have the human capital…they’ll look elsewhere.”
State health commissioner Dr. Kris Box said part of the effort would be to educate everyday Hoosiers about public health and its importance.
“It’s not just about masks and it’s not just about a pandemic,” Box said. “(He’s) moving the needle on the percentage of people who smoke, moving the needle on the overall infant mortality rate.”
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