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Governor Puts His Heart into Making Hoosiers Healthier

By Richard Feldman, MD

Gov. Mitch Daniels is a bold, controversial figure whose actions have drawn both criticism and praise.

I'll leave judging his performance to others. But I must admit I'm favorably impressed with one aspect: His concern for improving the miserable health status of Indiana. I first heard this in his inaugural address.

Subsequently, he launched his INShape initiative aimed at addressing the unhealthy lifestyles of Hoosiers. He proclaimed the Downtown government complex smoke-free and then did the improbable: He proposed a cigarette tax increase in an election year for the stated purpose of reducing teenage smoking.

Daniels understands that the poor health of Hoosiers is directly related to our high cost of health care and is a detriment to economic development. We all should be concerned. Sure, we've had past governors who had moments of public health brilliance. But we now have a governor who has placed the health of Hoosiers on his short list of priorities. That's a first in my political memory.

It's unfortunate that his cigarette tax failed in the legislature this session. Gov. Daniels was right: Increasing the cigarette tax is one of the most effective measures to curb teen smoking and discourage children from initiating a deadly lifelong addiction.

But the effect of an increased cigarette tax on youth decays over time. The only proven way to make sustained reductions in teen smoking is through an adequately funded comprehensive statewide program of prevention and cessation initiatives. When this program is combined with a cigarette tax, the synergy produces even greater results.

Unfortunately, the statewide tobacco prevention program is limping along after the legislature reduced funding by 67 percent a few years ago. The INShape initiative is a good beginning to address Indiana's unhealthy lifestyle afflictions, but it lacks a number of elements that would make it a substantive public health program with a reasonable probability of ultimate success.

Here is a plan to make INShape and our state tobacco prevention and cessation program truly successful: Next year the governor proposes a $1 increase in the cigarette tax. That brings in added state revenue of about $339 million a year and decreases the youth smoking rate by 18 percent and adult smoking by more than 4 percent. The legislature allocates $279 million for important purposes -- Medicaid, economic development, or whatever. Another $24 million is assigned to the tobacco prevention program to make it whole again. This would recreate Indiana's immensely successful, once nationally recognized tobacco control initiative.

That leaves $36 million to transform INShape into a comprehensive, community-based program led by the Department of Health. The program is in need of a coordinating "Healthy Communities" civic entity in each county, an intensive media campaign designed to produce cultural change, and the delivery of initiatives and messages concerning healthy lifestyles that reach people in every aspect of their daily lives.

Independent governmental and nonprofit programs like FitCity and the Ruth Lilly initiatives could be brought into this larger coordinated effort. Public health programs designed to create enduring changes in attitudes and behaviors need sustained adequate funding, social marketing, and intensive coordinated programming to be significantly effective. It's up to government to provide that financial support and leadership. I think Gov. Daniels can pull this off. He appears to be the man, at least regarding the politics of health.

Feldman, M.D., is director of medical education and family medicine residency at St. Francis Hospitals and health Centers and is a former state health commissioner. Contact him at richard.feldman@ssfhs.org.