INDIANAPOLIS — Health care workers from across the state gathered at the State Capitol late last week to push the General Assembly to fund public health funding — a demand that has repeatedly left lawmakers with hesitation.
Driven by the role of local public health departments in the COVID-19 pandemic, the Governor’s Commission on Public Health sought to analyze the state’s funding shortfalls and find funding solutions.
After opposition from lawmakers, the commission revised its original request from nearly $250 million to a phased grant of $125 million in the first year, followed by full funding in 2025.
Nationally, states spend $91 per capita on public health, but Indiana spends just $55—ranking 45th nationally in terms of spending.
Gov. Eric Holcomb, who called for the commission, said the public health funding proposal didn’t even try to be a leader, just calling for Indiana to be “in the middle.”
“We don’t want to be a national laggard; we don’t want to hang around,” he said. “I rarely shoot in the middle, but we have to start somewhere.”
What funding means for local public health departments
Allen County Health Director Mindy Waldron said Indiana’s poor public health ranking is directly related to its near-bottom state funding. Waldron and hundreds of others rallied Thursday to call for increased state investment during Public Health Day.
Departments like hers rely heavily on local funding — half of which, she says, comes from the county and the rest from various government grants and community foundations.
“Counties all over the state are very different — relying on taxes that only fund part of their budget — and you’re going to do urgent stuff, and you’re not really going to be doing long-term things that might be game-changing,” Waldron said. , preventive things.” .
Having a dedicated source of funding from the state would allow departments to go beyond statute-mandated responsibilities, including inspecting restaurants, licensing tattoo and body piercing parlors or using contact tracing to combat local outbreaks of infectious disease.
“You should be able to eat at one restaurant in one county and then go to the same type of restaurant in an adjacent county (which has) and those rules should be enforced,” Waldron said.
“Similarly, you should see basic public health programs like maternal or child health at the local level. They’re not doing it because there’s no (no) resources to fund them.”
Waldron was part of the committee that found that public health spending varied widely by county — ranging from $83 per capita in Marion County to $1.25 per capita in Shelby County.
Although Fort Wayne is the state’s second-largest city, Waldron says her county is closer to the middle ground—with per capita spending at just over $10.
“Our population should be at least in the top five,” Waldron said. “(But) when you rely on taxes, especially property taxes, it comes and goes.”
With more reliable funding, she said, initiatives such as reducing lead poisoning could have proceeded steadily, rather than starting in the 1970s and restarting over the past five years. Conversely, as attention is lost, so is the money used to fund lead investigation and testing projects.
“We need ongoing funding to do continued good work,” Waldron said. “We’re well below average at this point and it’s going to take a while for us to find our feet and start making a difference in areas like maternal and child health.”
Poor health affects economic development
Holcomb described the state’s poor health as a workforce development problem, noting that a healthier workforce is less costly than an unhealthy workforce at both the micro and macro levels.
“When I sit down and talk to people who are interested in investing in Indiana, the counties are competing with each other. CEOs want to know who values the health of their employees,” Holcomb said. “If you don’t have human capital … they’re going to look elsewhere.”
State Health Commissioner Dr. Kris Box said part of the effort will be educating everyday Hoosiers about public health and why it matters.
“It’s not just masks, it’s not just a pandemic,” Box said. “(It) changed the percentage of the population who smoked, changed the overall infant mortality rate.”
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