Niki Kelly: Applause all around for new public health program

Here’s a big round of applause to the 86 counties that have signed on for Indiana’s enhanced public health funding — and an even bigger congratulations to the Hoosiers that it will help.

When Gov. Eric Holcomb pushed a public health commission following the COVID-19 pandemic, some people — Republicans especially — thought he was crazy to want to double down on what turned into a controversial topic.

But that commission – co-chaired by former Sen. Luke Kenley and former State Health Commissioner Judith Monroe – worked methodically through the data and found that Indiana is tragically behind in almost every health metric. And that’s because Indiana doesn’t spend enough on public health.

While the rest of the nation averages about $91 in public health funding per capita, Indiana is at $55. And the range within that average is startling. Shelby County is at a low of $1.25 and Marion County has a high of $82.71. At least 37 counties have local public health per capita spending of less than $10.

And that lack of money has consequences.

Did I mention that Indiana’s life expectancy is actually going down?

In fact, life expectancy in Indiana has been declining since 2010, when it peaked at 77.5 years. Indiana’s life expectancy in 2019 was 77 years, almost two years below the U.S. average of 78.8, placing us 40th in the nation.

Of even greater concern is the difference between the Indiana county with the highest life expectancy and the county with the lowest life expectancy is almost nine years.

The commission recommended adding $243 million annually in public health funding, and after negotiation, Holcomb received $225 million over two years. While lower than necessary, it was a huge win for the term-limited governor at a time when faith in the public health system has dropped precipitously.

One of the key things to know about this program, called Health First Indiana, isn’t about immunizations. That, of course, has become a flashpoint in the country since the COVID-19 vaccines were introduced.

But public health is about so much more than that.

Under the new program, at least 60% of the new funding has to be spent on preventative core services related to certain key performance indicators.

Some examples include:

  • Chronic disease prevention and reduction
  • Tobacco prevention and cessation
  • Maternal and child health
  • Communicable disease prevention and control
  • Referrals to clinical care
  • Emergency preparedness
  • Fatality review (child, suicide, overdose)

Health departments could offer screenings, lead testing, support groups, clinics, counseling, educational opportunities and more to try to mitigate disease and societal problems that are literally killing Hoosiers.

Larger counties can do some of this on their own, while smaller counties might partner with existing entities.

The remaining 40% of the new funds can go to other health-related issues, such as inspections of restaurants, buildings and tattoo parlors; and on-site sewage permitting.

Those aren’t the sexiest topics, but inappropriate food preparation and unsanitary conditions can make the public sick, and broken septic systems can contaminate water with other illness-causing microbes.

All 92 counties were given the option to receive the new funding and only six turned it down.

My guess is they will sign on soon enough, as their own citizens won’t see the improvements that others will — which will put them at a competitive disadvantage.

Niki Kelly is editor-in-chief of, where this commentary first appeared. She has covered Indiana politics and the Indiana Statehouse since 1999 for publications including the Fort Wayne Journal Gazette. Send comments to [email protected].