Tag Archives: public health

Unhealthy Indiana

Yesterday, the IBJ reported the latest data on public health indicators, under a headline that telegraphed the results: “Indiana public health continues to slide.”

When the most recent data is compared to previous studies, it becomes quite clear that Hoosiers are moving in the wrong direction. We are fatter, more sedentary, more diabetic. Hoosiers smoke more than citizens elsewhere, and more of our babies die in infancy.

Not exactly a distinction we would choose.

Furthermore, since our policymakers seem to care a lot more about money than about Hoosier health and well-being, it may be useful to point out that poor health drives up costs. As the IBJ pointed out, Indiana employers spend more per worker on healthcare than employers elsewhere in the country. And that doesn’t include the costs of sick days or reduced productivity as a consequence of health issues. (Forgive me for an indelicate observation: Indiana legislators determined to keep business taxes low don’t seem to understand that the added costs incurred by reason of an unhealthy workforce are just as much a part of business overhead as state income or property taxes.)

No–true to our Hoosier Heritage, which is nothing if not shortsighted–State government is perfectly content to shift health costs to employers, and keep Indiana’s public health spending low. And it is low. In 2012, Indiana ranked 49th out of 50 states in per person spending on public health, despite the fact that preventative public health measures like immunization and screenings demonstrably and dramatically lower overall health costs.

To add insult to injury, Governor Pence has signaled that he will not expand Medicaid in order to participate in the Affordable Care Act, aka “Obamacare.” As I have previously noted, there is no rational basis for that decision; it rests entirely upon a perceived political need to pander to a rabid GOP base motivated solely by an unreasoning hatred of President Obama and anything he supports.

If Indiana opts to participate, an estimated 450,000 Hoosiers would benefit. And here’s the kicker: if Indiana does participate, the federal government will pay all the costs for the first three years. The state’s portion would then phase in gradually, topping out  at 10% in 2020.

And if we don’t participate? Well, poor people have this pesky habit of getting sick anyway. And we already pay to treat them–frequently, in the least cost-effective way, when they appear at hospital emergency rooms. When uninsured folks are treated there, the costs of their un-reimbursed care drives up the premiums of those with insurance. If the hospital is public, our taxes go up. If the hospitals still can’t recover their costs, they cut healthcare workers or reduce services. The 10% Indiana would eventually have to pay to cover far more people is unlikely to be more than we are actually paying now in a variety of ways–it would just be more visible and much more cost-effective.

Indiana certainly wouldn’t want to do something that was actually cost-effective.

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To Your Health…..

Federalism has many virtues, but it also makes some problems more difficult to solve. I don’t care how much your local city council cares about air pollution, there isn’t a whole lot they–or even your state legislature, assuming you have a more enlightened one than we do here in Indiana–can do about it. Health policies likewise tend to require state or national action; there isn’t a lot that local communities can do.

But there are some things we can do locally, and there really isn’t any excuse for failing to do them. Cities and states can encourage healthy lifestyles and physical fitness by providing well-tended parks, by increasing bike lanes, and by banning smoking in public places. These measures not only promote public health, they ultimately save money by reducing Medicaid and similar costs.

The Ballard Administration has at least responded to calls for additional bike lanes (although those downtown, where I live, are considerably less than optimal–the ones on New York Street were evidently painted by someone who was drunk or otherwise seriously incapacitated). Otherwise, not so much. Far from expanding opportunities for recreation, our parks have been shamefully neglected. And worst of all, Ballard has consistently blocked efforts to ban smoking in public places.

The Mayor’s refusal to honor his campaign promise to sign a smoking-ban ordinance is particularly galling, not just because he did a 180-degree turn on the issue once he was elected, but because smoking bans are a low-cost, highly effective way to improve public health.

There are essentially two arguments against smoking bans. Bar owners worry that business will suffer if customers cannot smoke in their establishments. Other opponents of the bans argue that no one has to patronize a bar or restaurant–that if smoke bothers you, you can just go somewhere else.  The evidence from other cities that have passed these bans should comfort the bar owners–far from diminishing, in many places business actually improved when nonsmoking customers weren’t assaulted by the smell of  “eau de stale cigarette.” And the argument about choice ignores the very real health hazard smoking poses for employees. (When asked about the impact on workers, Mayor Ballard dismissed employees as “transients” whose health clearly was not a concern.)

Hint: Telling hard-working waiters and bartenders that they should just get another job if smoke bothers them ignores the realities of the current job market, among other things.

Cities are in a world of fiscal hurt right now. At a time when there isn’t money to do many of the things that would improve our neighborhoods, a smoking ban is a virtually cost-free way to improve public health and make our public spaces more pleasant at the same time. Polls show an overwhelming majority of residents favoring such a ban, and in fact, when he ran for Mayor, Ballard supported the policy.

All of this makes the Mayor’s current, stubborn opposition hard to understand. If he has reasons for his abrupt about-face, he has yet to articulate them.

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