First, a bit of good news from a report by the nonprofit Trust for America's Health on support for public health efforts nationwide and state-by-state. Indiana's per capita spending on public health rose by 9.7% from 2017 to 2018, according to the Trust. But that increase didn't change Indiana's ranking as 49th among the states in public health spending.

Indiana devoted $17.58 per person to such tasks as fighting infectious disease, giving citizens the information they need to avert chronic illness and helping local health departments respond to foodborne illnesses, weather emergencies and the rise in deaths from suicide, alcoholism and drug misuse. By comparison, Alaska, which ranked No. 1 among the states, spent $63.28 per person.

Mindy Waldron, Fort Wayne-Allen County Department of Health administrator, said Indiana's public-health-spending rank has been at or near the bottom for perhaps 20 years.

Health Commissioner Deborah McMahan isn't surprised the state remained so comparatively low. Most states are scrambling to add resources to deal with the drug epidemic, she said; Indiana just isn't increasing its spending as fast.

Though Allen County received a grant for its syringe-exchange program, Waldron said area health departments haven't seen increases in state funding that would help them keep up with core local functions, such as inspection of food facilities; inspection of residential and commercial septic systems; maintenance of birth and death records; managing general environmental challenges such as bedbugs and mosquito control; and immunizations and other efforts to deal with infectious diseases.

The core work gets done, Waldron said, but it's a struggle.

"We don't have enough money to do the programs we're required to do," she said.

Not that underspending on public health is just a Hoosier problem. Efforts to fund prevention, preparedness and other community health efforts are chronically underfunded nationwide, the Trust reported, representing just 2.5% of all health care spending.

"Such underfunding flouts overwhelming evidence of the life-saving cost-effectiveness of programs that prevent diseases and injuries and prepare for disasters and health emergencies," the report said. "Public health interventions, such as childhood vaccinations, school-based violence prevention programs and indoor smoking bans, improve health outcomes and prevent illness and death." And, the report adds, "such interventions save money."

Indiana, which also has disturbing rankings on such problems as obesity, tobacco use and the prevalence and availability of treatment for mental illness, could have taken on a number of those deficiencies by raising the tax on cigarettes and e-cigarettes. But that effort went nowhere during this year's legislative session.

A proposed $2-a-pack tax increase not only could have discouraged smoking — the state's No. 1 health problem — but could have raised revenue to funnel back to embattled local health departments. Indiana, with its myriad funding needs, could have gained ground on spending without cutting other programs.

"It's embarrassing," McMahansaid Thursday of the state's continued poor ranking. "What a missed opportunity."

Unless, of course, you're OK with remaining in 49th place.

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