130083826 Web1 20220213cr Landing Hicks Mike Mug1

Michael Hicks: Adopt the report proposals of the Governor’s Public Health Commission

Last summer, the Governor’s Public Health Commission delivered its final report. The Commission was established to find ways to improve Indiana’s public health system in the wake of the COVID pandemic. It was led by retired Senator Luke Kenley, one of our state’s most consistent fiscal hawks, and Judith Monroe, former state health commissioner. They were joined by experts in local public health departments, the state health department and health professionals.

The 107-page report, available at www.in.gov/gphc, is extraordinarily detailed and likely won’t be read by most Hoosiers. The Commission was charged with making recommendations for better delivery of public health services in ways that make Hoosiers healthier and give them more equitable access to care. The report also looked at the structure of local health departments.

The very first thing Hoosiers need to know is that we are far less healthy than we should be. Our overall health ranking is 40th out of 50 states. Our biggest problems are in areas most amenable to public health interventions. We do poorly in diabetes, obesity, smoking and early death by young people. We have a terrible infant mortality rate, and, across Indiana, health care outcomes vary greatly by income and overall wealth in a community. In the places where a better public health system could do the most good, they are least well supported.

Poor health among Hoosiers makes doing business in Indiana more expensive through higher health insurance costs. As I often mention in this column, poor public health is far from the only cause of our high health care spending in Indiana, but it is one that the legislature can easily address. This report has very detailed changes to legislation and offers 32 detailed recommendations. As I see it, these recommendations do three major things.

First, the recommendations make the role of public health departments more locally focused. Changes to local public health departments will make them more responsive to the needs of schools, first responders and other community groups. They will also instruct local public health offices to focus on coordinating activities such as free clinics in schools or neighborhoods. It is important that these recommendations make the relationship between provinces and the state much more of a partnership than a top-down bureaucracy. The health care needs of each country differ, sometimes dramatically. These recommendations allow local governments to focus on their own local needs.

Second, the recommendations outline a number of steps so that the local public health departments can become better at their work. These include professional standards for employees and more coordination with local health care providers, state agencies and first responders. The proposals range from allowing local health departments to bill Medicaid when they provide clinical services to requiring a common minimum set of services to be provided in each county.

Third, these recommendations will force local health departments to become more efficient in emergency response, health education, and identification of imminent threats to public health. They do this by requiring data sharing, more study groups, and coordination with other agencies and private providers doing this work.

In the wake of COVID, many citizens will view changes to local health departments with some skepticism. So it’s useful to think about what these recommendations don’t do, as well as what they do try to achieve. Nothing in this report from the Commission will change rules about wearing masks or how decisions are made about a pandemic. This is part of another set of rules that have been amended after the pandemic. This is not a major government seizure of the local health departments.

A better way to think about the Commission’s proposals is how they will affect the more mundane day-to-day challenges to public health. I will give two examples. First is the HIV/AIDS crisis in Scott County back in 2014. A local physician noticed an increase in the number of patients, but delays in reporting to and by the local health department as well as delays in analyzing data meant that the reaction slows down significantly. By the time the state fully recognized the problem and acted, the disease had spread significantly.

One estimate in The Lancet (Gonsalves & Crawford, 2018) was that the response delays resulted in as many as 170 additional HIV infections. With lifetime costs of treating HIV as high as $400,000, it was easily a $65 million failure, in just one country. But I think the second example is even more urgent and widespread. A modern, highly trained local health department will be among the first to detect an increase in opioid overdoses or even more dangerous drugs like fentanyl. This is a chronic problem in Indiana and much of the country.

Local health departments such as those proposed in the Commission’s recommendations would be better able to support police, EMS and hospitals. More importantly, they will be able to share data in ways that can limit the spread of the disease. Most importantly, they can also more fully support schools and other local groups that educate citizens about the risks of these drugs. We need these changes now.

Today, in counties that fully fund their local health departments, many of the best practices are already in place. Elsewhere, a small, under-resourced staff is failing to make much of a dent in the myriad health care problems facing Hoosiers. The Commission’s proposals will ensure that all of us have access to effective local health department services.

Of course, the adoption of all these new proposals is not a panacea. It will take some time, perhaps decades, to really improve our poor public health ranking. But the gaps identified during the pandemic are a very good time to take more seriously the challenges facing Indiana in public health. This will of course cost money and take time.

The Commission noted that increasing our state funding to the national average per citizen would cost another $242 million per year. Part of that amount will have to come from state money, and part of it will have to be local money. Everyone needs some “skin in the game” with this problem. But here’s the thing about spending tax dollars on public health: You either pay now or you pay later. Paying now is much cheaper.

Michael J. Hicks is the director of the Center for Business and Economic Research and the George and Frances Ball Distinguished Professor of Economics in the Miller College of Business at Ball State University. Send comments [email protected]

Related Posts