On August 18, 2021, Governor Eric J. Holcomb established by executive order the Governor's Public Health Review Commission to study Indiana's public health system. The Governor’s Public Health Commission was co-chaired by former state Sen. Luke Kenley, who has spent decades managing complex issues and budgets for the state, and Dr. Judy Monroe, who served as Indiana’s state health commissioner from 2005 to 2010. Former State Health Commissioner Dr. Kris Box was appointed the Commission’s secretary. Congresswoman Susan Brooks, who formerly represented the Fifth Congressional District, served as a non-voting citizen advisor and brought a wealth of federal experience in preparedness, the public health workforce, and more.
- Commission Members
Judith A. Monroe, MD, FAAFP, former State Health Commissioner
Hon. Luke Kenley, JD, former State Senator
Kristina M. Box, MD, FACOG, current State Health Commissioner
Hon. Susan Brooks, JD
Non-voting Citizen Advisor
Virginia Caine, MD
Director and Chief Medical Officer, Marion County Public Health Department
David J. Welsh, MD, MBA
Ripley County Local Health Officer
Mindy Waldron, REHS
Allen County Public Health Administrator
Paul K. Halverson, DrPH, FACHE
Founding Dean, Indiana University Fairbanks School of Public Health
Hannah L. Maxey, PhD, MPH, RDH
Associate Professor and Director of IU Bowen Center for Health Workforce Research & Policy
Brian C. Tabor
President of Indiana Hospital Association
President and Chief Executive Officer of Indiana Minority Health Coalition
Cara Veale, DHS, OTR, FACHE
Chief Executive Officer at Indiana Rural Health Association
Kim Irwin, MPH
Administrator of Indiana Public Health Association
Hon. Mark Bardsley
Grant County Commissioner
Hon. Bob Courtney, CPA
City of Madison Mayor
Hon. Dennis Dawes, MHA
Hendricks County Commissioner
- Public Comment
The Governor's Public Health Commission actively sought input from the public through an online REDCap form. A summary of the comments was read into the record at each meeting and shared with members for their review. Those summaries are included in the meeting notes below.
- Listening Tours
Seven listening tours were held around the state to solicit public input. The tour opened with a brief presentation on the Commission and an overview of public health, but the majority of time was allocated to taking public testimony. Listening tours were over the lunch hour to maximize the opportunity for participation. Each speaker was allotted three minutes for verbal comments on one of the subject areas under review by the Commission, but written testimony was also accepted. The summaries from the listening tours can be found in the April and May meeting notes below.
Listening tour locations and dates
Listening tour slideshow and hearing guidelines
- GPHC Report
The Governor's Public Health Commission report is now available and includes recommendations for improvements in six workstreams: funding; workforce; governance and infrastructure; data and analytics; emergency preparedness; and childhood and adolescent health. Those recommendations will form the basis of proposed legislation for the 2023 legislative session.
View the Aug. 4, 2022, news brief recording here.
Governor’s Public Health Commission Six Areas of Focus
The Governor's Public Health Commission held its final meeting on June 30, 2022 at the Indiana State Library in the History Reference Room. The Commission adopted the draft report with amendments and directed staff to finalize the report for submission to the Governor. Pursuant to Executive Order 21-21, the Commission sunsets upon the delivery of the written report to the Governor and the Indiana Department of Health.
Recordings of the meetings are available below and at the Department's YouTube channel: https://www.youtube.com/c/IndianaDepartmentofHealth.
Meeting agenda - updated 9/15
Indiana's Public Health System Review (2020) conducted by IU Fairbanks School of Public Health
Public Health COVID-19 Impact Assessment: Lessons learned and compelling needs (2021) published by National Academy of Medicine report
Dr. Box's presentation on Public Health and Indiana's rankings
Dr. Halverson's presentation on Indiana's Public Health system
Bowen Center and IU Fairbanks School of Public Health combined presentation (Courtney Medlock and Dr. Valerie Yeager)
Commission Engagement Plan and Listening Tour
de Beaumont Foundation Report: Staffing Up (2021)
Public Health Governance and Funding Presentations
Finance annotated bibliography
Public comment synopsis
Indiana Local Health Department Duties and Responsibilities as compiled by the Indiana Local Health Department Managers Association (October 2021)
Governance and Infrastructure Presentation
Foundational Public Health Services (FPHS) and Public Health Modernization: Background Report (November 30, 2021)
Public comment synopsis
Stakeholder meeting presentation (Dr. Box and Co-Chair Kenley)
Data and Integration presentation
CDC article on Data Modernization Initiative / strategic implementation plan
Annotated bibliography of resources consulted
Public comment synopsis
Next meeting format and Emergency Preparedness presentations
Trust For America's Health report - 2022 Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism
Public comment synopsis
(Draft) Workforce recommendations
(Draft) Governance, infrastructure, and services recommendations
(Draft) Data and information integration recommendations
Foundational Public Health Services fact sheet (2022 revision)
Public comment synopsis
Public Listening Tour Synopsis - Jasper, New Castle, Huntington
(Draft) Childhood and adolescent health integration recommendations
(Draft) Emergency preparedness recommendations
(Draft) Funding recommendations
Public comment synopsis
Public Listening Tour Synopsis - Seymour, Monticello, Whiting, Plainfield
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 95 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.