Governor's Public Health Commission
A state investment in local public health
Governor Eric J. Holcomb established the Governor's Public Health Commission in August 2021 and charged it with examining the strengths and weaknesses of Indiana's public health system and making recommendations for improvements.
The commission's report released in July 2022 focuses on six workstreams: governance, infrastructure and services; funding; workforce; data and information integration; emergency preparedness and childhood and adolescent health.
The goal is to ensure that every Hoosier has access to the core public health services that allow them to achieve their optimal health and wellbeing.
Governance, Infrastructure, and Services
- What does a local health department do?
Public health focuses on preventing injury, illness and premature deaths, as well as treating infectious diseases and preventing them from spreading.
Indiana has 94 local health departments that provide public health services. Those duties include birth and death certificates, disease control and prevention, ensuring safe housing and water, food protection and inspection, and help in case of a disaster. These are just a few of the core services required by IC 16-20-1.
One of the goals of the Governor’s Public Health Commission is to ensure that these services and other core public health services are available in every county.
- Will this impact my community?
Public health services are delivered unevenly across the state, which means where you live can impact your access to core services that can improve your health. These differences affect all Hoosiers. For example, Indiana’s high rates of smoking and obesity contribute to our high rates of diabetes, heart and lung disease, and cancer. More focus and investment on public health promotion and prevention activities will lead to better outcomes in these areas and many others.
The goal is to help local health departments work with local businesses, healthcare providers, schools, and other government and non-governmental organizations to locally promote and improve public health. This will be established through community partnerships and collaboration, with the Indiana Department of Health providing more financial and technical assistance.
- Will there be local representatives on the local health board?
The recommendations allow for local health boards to provide more ways for others to get involved, particularly professionals with a background in a public health field, members of the public, or representatives from some cities and towns, depending on the county’s population.
- What other support would IDOH provide?
The overall goal is to provide technical assistance, training, and expertise at the regional and district level to the 94 LHDs across the state. Examples of that support may include collecting and analyzing data, legal consultation, training and grant writing and acquisition. We would also plan to support LHDs that would like to be accredited, meaning that they are certified to meet national public health standards while building health and equity by the Public Health Accreditation Board.
- How does public health funding in Indiana compare to other states?
According to Trust for America’s Health rankings, Indiana in 2021 ranked 45th in the nation for state government public health funding. The average spending on public health per person statewide is $55, well below the national average of $91. Within our state, local funding per person varies widely from $1.25 to $83. The lack of public health funding contributes to poor health, which can lead to the decreased life expectancy that we see across our state.
- How much money is needed?
The commission has proposed increasing Indiana’s public health spending from $55 per person to closer to $91, the national average. That would bring Indiana’s public health investment more in line with other states and lead to improvements in Hoosier health and safety. Increased funding would help ensure the delivery of core public health services in every county. The funding would also help IDOH better support local health department at the regional and district levels. The bulk of this increased funding would go directly to local health departments to implement programming at the local level that best reflects the needs and priorities of their communities.
- How much money would go to local health departments?
Local health departments are currently funded primarily by local property taxes but also receive a limited appropriation from the state. Under this proposal, they would be eligible to receive additional state funding based on various factors to help improve public health services available in their jurisdictions. Local officials would vote whether to take this funding every five years, and by accepting, agree to have their local health department provide the core public health services.
- How will the money be spent?
The goal is to deliver core public health services in every county. This may include adding staff for a variety of roles, depending on the area of need, from disease prevention and education to food protection and preventing substance abuse. This could also include partnerships with community-based organizations. Increased public health funding would allow LHDs to better address the specific needs of their communities to achieve the best health and wellbeing for their counties so all Hoosiers can reach their optimal health.
For example, life expectancy varies by as many as nine years in Indiana, depending on in the county where you live. Increased public health funding would allow local health departments to better address the needs of their communities to achieve the best health and wellbeing for all Hoosiers.
- What other ways could funding be increased?
The IDOH is committed to helping local health departments find other money, including more grants and insurance reimbursement for patient care services. There are more federal dollars that we can access, but those won’t be enough to meet all the need.
- Will this raise taxes to pay for the funding increase?
Most local health departments’ current budgets are funded by property taxes. IDOH will work with the legislature to establish the budget to support this investment in public health. Ultimately, the Indiana General Assembly will set the state budget for the next two years and determine how the budget is funded.
- How can the state help the local health departments’ workforce?
The IDOH has partnered with the IU Fairbanks School of Public Health to conduct a statewide public health workforce assessment to better understand the needs of the local public health workforce. The survey will help identify what positions exist, identify gaps, and help determine what is needed to make positions attractive to recruit and retain staff.
We also will work to increase partnerships with existing healthcare providers and organizations to focus on recruitment, training, and retention.
- How can small and large counties use data?
With the right tools, data can be used to inform and help set priorities through public health assessments and to track the success of public health programs. IDOH has found that access to data, as well as the ability to coordinate data with health systems and other public health partners, looks different across the state.
We need to build a better system for collecting and sharing local health information and ensuring the security and privacy of that data. For example, one county may show high rates of smoking, while a neighboring county has a particularly high rate of substance abuse. That information can help direct the focus of partnerships and the allocation of resources in the community.
Having timely and consistent data also can help provide more information to the public to increase awareness and measure progress.
- How will you make sure health data is protected?
Throughout our work, we have highlighted the importance of ensuring confidentiality and maintaining data privacy. The Commission emphasized this goal in its final report and recommended the state health department continue working with experts to identify ways to enhance privacy and security. Part of this initiative includes modernizing some paper-based processes. Some of this work has already begun, and it’s important during that process that security upgrades to protect privacy are at the top of the list. All data will be presented as totals and not broken down by individuals to make sure that it is not identifiable.
- What can be done to make sure we don’t have a situation like COVID where we didn’t have enough PPE and other supplies?
The plan recommends setting up a state strategic stockpile of personal protective equipment and other medical supplies to make sure we have these critical supplies available when needed and that hospitals are tracking capacity. This will complement other efforts, such as the national strategic stockpile.
- What other improvements are needed?
Many people don’t know that trauma is the number one cause of death for Hoosiers ages 1-44. It’s critical that emergency services arrive quickly, that EMS personnel are trained, and that a hospital system is available to improve outcomes from a health emergency. This is particularly true in rural areas where there are shortfalls in trauma care.
Indiana needs more EMS support and cooperation to increase trauma response and emergency preparedness.
- What role do schools play in improving childhood and adolescent health?
Schools already do a lot to support the health of their students. But many schools have limited access to school nurses, so a goal is to increase the number of school nurses. This can help ensure that vision and hearing screenings required by state law are available at every school. It also can increase access to services that support whole-child wellness, including oral health and immunizations, while maintaining parental and guardian consent.
- Will this help improve Indiana’s infant mortality rate?
Helping more Hoosier babies reach their first birthday has been a priority for public health for many years. And while we are making progress, these recommendations are about more than infant mortality and safe sleep. While those continue to be on top of the public health list of priorities, this program aims at improving whole-child wellness as they grow.
- What about health emergencies and helping kids in school?
We want to improve access to emergency medications while maintaining appropriate parental consent guidelines. Parents are the decision makers when it comes to their child’s health. This would be an effort to improve access to important services that can make a vital difference in a child’s health and education. This would be an effort to improve access to potential life-saving medications such as epinephrine for a severe allergic reaction, an albuterol inhaler for severe asthma, or naloxone to reverse a drug overdose.
- Will this impact physical education requirements?
This initiative doesn’t change any school requirements, but is a focus on how better health education, nutrition and physical activity can improve a child’s health and therefore their ability to learn. Studies show that removing the barriers to good health also improves a child’s performance in school.