By the Kristina M. Box, MD, FACOG and The Honorable Luke Kenley.
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, 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. But it also 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.
Indiana Gov. Eric J. Holcomb has recognized the importance of public health through numerous initiatives designed to address the opioid epidemic, reduce Indiana’s infant and maternal mortality rates, and create easier access to mental health services. The two-year-long COVID-19 pandemic added a new emphasis to the state’s work and led to an Executive Order in August that established a 15-member commission to analyze Indiana’s current public health system, identify strengths and weaknesses, and make recommendations to improve the delivery of public health services to ensure that every Hoosier has equal access to these essential public health services, regardless of who they are or where they live or work.
“Indiana has 94 local health departments, but not all of them are created equal in terms of their resources, and that leads to inequities in how public health services are delivered across the state,” said State Health Commissioner Kris Box, M.D., FACOG. “By taking a deeper dive into foundational aspects of public health, the commission will be able to identify opportunities to improve so that we can better protect the health of Hoosiers.”
Box said workforce shortages, chronic underfunding and an aging infrastructure are just part of the equation.
Multiple studies document public health return on investment, some as high as 14-to-1. In an era of increasing health care costs, keeping people healthy from the start is important so that they do not need costly interventions later.
The commission is co-chaired by Dr. Judy Monroe, a former Indiana health commissioner who now serves as president and CEO of the CDC Foundation, and former state Sen. Luke Kenley, who guided many state budgets to passage. Former Congresswoman Susan Brooks serves as the citizen advisor, and members include representatives from hospitals, rural health, local health departments, minority health organizations, workforce, academic, and local governments.
During monthly public meetings conducted since September, it has closely examined six key areas of focus: governance and services, funding, workforce, emergency preparedness, data analytics, and the integration of childhood and adolescent health services. The commission also has hosted seven listening tours across the state, from Whiting to Jasper, to gather public and stakeholder input about the challenges public health faces.
That input, as well as the Commission’s deep dives into its focus areas, will culminate in a report to the Governor this summer and the development of legislation designed to address some of public health’s most pressing needs.
To learn more about the Commission’s work, visit www.in.gov/gphc.