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State urged to spend more on public health

Journal Gazette - 6/21/2018

Royal Jordan wanted to be cool.

So, at age 14, he picked up his first cigarette and took a puff. He continued for years, hooked on the tobacco he once was sure would transport him to the center of desirable social circles.

Where it did take him was a very different place, one where he struggles to breathe and often feels as if someone is sitting on his chest.

Jordan, 58, who runs the Urban Youth Empowerment Program for the Fort Wayne Urban League, quit smoking in 2004 ? but only after his doctor first diagnosed him with pneumonia.

"Then he said, 'You've got a spot on your lung,' " Jordan said last week at a forum that included doctors, researchers and public health experts.

"Then he said, 'You have one-third lung function.' Then he said, 'You don't have smoker's cough, that's emphysema.'"

The State of Our Health forum was one of 17 stops on a statewide road show that began in April and ends in October. More than a dozen speakers pushed for more state funding for preventive measures and education initiatives for a variety of concerns including drug abuse, infant mortality and tobacco use.

One of the state's top lawmakers, Senate Pro Tem David Long, R-Fort Wayne, said in an interview last week that millions of dollars are spent each year on public health programs. Still, Long acknowledged, more is needed.

Jordan's story is one members of the Alliance for a Healthier Indiana say shouldn't be repeated. The state doesn't spend enough on public health, they say, and the group of doctors, researchers, advocates and business and political leaders has launched a campaign to raise awareness about public health problems and boost funding for programs that could have helped people like Jordan.

On April 13, the Alliance kicked off the first of the town hall-style meetings designed to foster discussion on how to combat tobacco use, infant mortality, abuse of opioid drugs and obesity.

The road show in Fort Wayne was the fifth stop in the series, and more than a dozen speakers pleaded with attendees to pressure state officials to spend more on preventive medicine and education campaigns.

Figuring out exactly how much is spent in Indiana on public health is tricky, but budget documents show millions of dollars are spent each year to county health departments and initiatives including education programs to prevent cancer. The state's spending plan does not include a line item for public health, but shows nearly $11 million was set aside for fiscal year 2017-18 for community and family health services that include medical reimbursements.

Nearly $3 million was budgeted for health education programs, and $23.3 million was earmarked for services for sexually transmitted diseases.

State money is bolstered by federal funds and a settlement Indiana received as part of a lawsuit by states against cigarette makers.

Long, who was not at the forum, said many states took the settlement money and held it or used it for other projects.

"We put it into health," he said.

There are other examples of the state's willingness to spend money on public health programs, Long said. He pointed to $5 million set aside last year to help align resources and agencies for drug prevention.

Changes to Medicaid rules announced in February create access to treatment and therapies for drug users worth about $80 million, Long said, and the state will spend $20 million on mental health treatment for low-level offenders.

Long, who will retire from the Senate this year, said there always is a need for more money for a variety of things, including public health. However, he said it is nearly impossible to fund everything at a high enough level to satisfy everyone.

He said lawmakers would consider raising the state's cigarette tax, which proponents argue would net $315 million in its first year if it is increased by $1.50 per pack. The state's $1 per pack tax is among the country's lowest.

"The evidence is there for the need for more resources," Long said. "It has to be part of the discussion."

Indiana ranks low among states ? 38th ? on overall health, according to the America's Health Rankings report, which the United Health Foundation publishes annually.

For spending on public health, the report shows Indiana ranks even lower ? 49th. Only Nevada spends less.

"You get what you pay for," Allen County Health Commissioner Dr. Deborah McMahan said. "We are devolving into chronic crisis mode. We need to take this seriously, from a public health perspective."

About half of the Fort Wayne-Allen County Department of Health's approximately $5 million budget comes from local taxes. About $1.2 million comes from fees for things like permits and birth certificates. About 11 percent of the budget comes from local and state grants, according to Administrator Mindy Waldron.

The health rankings incorporate data on premature deaths, infant mortality, drug use, obesity and other areas to compare states and calculate rankings.

Alliance members say the low ranking and modest state spending on public health has hampered their ability to screen, treat and get help to people who are using drugs, have sexually transmitted diseases or want to quit smoking.

Efforts to reach those people before their actions become larger problems is valuable, they say, because health issues can become hazards for employers and the state economy.

Jordan is coping with a life sentence of breathing monitors and inhalers. He thinks public health initiatives such as smoking cessation programs and education campaigns might help others avoid his circumstance.

"My quality of life is totally reduced," he said.

Employers also have to deal with the issue. Sick employees, for example, often are not able to work. If they are not able to work, that's a productivity loss for the business.

Tobacco use, the opioid epidemic and obesity together cost Indiana more than $10 billion in additional health care costs last year, a statement from the Alliance said.

A study by economists with the Integrated Benefits Institute in 2012 showed U.S. employers lost $576 billion in lost productivity and increases in insurance costs.

"Indiana's poor health rankings and paltry funding for public health initiatives are detrimental to Hoosier health and the state's economy," Indiana Chamber of Commerce President and CEO Kevin Brinegar said in a statement. "Poor health rankings contribute to higher health care spending, which poses challenges in both expanding current businesses and recruiting new businesses to the state."

A cigarette tax hike is a priority of the Alliance, which says more than one in five Indiana residents smoke. Raising the price would help 50,000 people quit and prevent 40,000 children from starting, the group says.

The road shows were started as a way to stump for an increase to the tax and other initiatives to stop tobacco use.

"Cigarettes should cost so much that you need a job to smoke," said Jordan, the youth organization leader struggling with emphysema.

Persuading lawmakers to increase the tax or allocate more money to public health could be a tough sell, Paul Halverson, professor and founding dean of the Richard M. Fairbanks School of Public Health at Indiana University Purdue University-Indianapolis, said in an interview.

He said experts have not done a good enough job talking to lawmakers and explaining why the money is needed.

"People really don't understand what public health is," Halverson said.

The road shows are a way to start that discussion and build momentum toward changing public health policy, he said. The events themselves won't change things, but the first step should be talking about what is needed, Halverson said.

"We need to be thinking about how we spend our budget, and spend it wisely to benefit everyone," he said.

Dr. Danita Johnson Hughes is president and CEO of Edgewater Health, which provides treatment for mental health and other disorders in Gary. She spoke at the third road show May 2 in Gary.

Johnson Hughes said more funding for public health would increase access to services she provides such as mental health screenings.

"Access to care is challenging," she said. "We do need to have more conversations about it."

That's the goal, according to Brian Tabor, president of the Indiana Hospital Association.

"It's to start a conversation," he said, referring to the road shows, which end Oct. 12 in Sellersburg. "It's really so important for our state."



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