A community's quality of life can be measured in a number of ways. None is more important than the health of its residents.

Indiana State Health Commissioner Dr. Kristina Box was in Terre Haute last week to discuss health, wellness and ways communities can work together to improve them both. Box is a former Terre Haute resident and graduate of North Vigo High School. As a physician of more than 30 years, she understands the impact poor health has on individuals, families and the wider community.

When examining the people of Vigo County's health, Box sees the issues in stark fashion. Surveys list the county 83rd out 92 counties in Indiana in overall health of residents. That's primarily because of high smoking and obesity rates, as well as the abuse of drugs and alcohol. And while Vigo County is among the worst areas for unhealthy living, it certainly has lots of company.

"Terre Haute is a microcosm of what the state overall has and that is a lot of poor metrics when we are compared to other states," Box said. "When you look at a lot of the surrounding areas of Terre Haute there is increased substance use disorder, higher smoking rates, some areas higher obesity rates, all of those things that contribute significantly to health."

Vigo County is not alone in its struggles with poor health. Smoking rates are high all over Indiana, with more than one in five Hoosier adults now using tobacco, one of the highest rates in the nation. Meanwhile, the number of youths using vaping products — e-cigarettes — is raising concerns that a new generation of smokers is ready to replace the current one when they become adults.

With smoking a key issue in assessing individual health, ways to target and lower tobacco use are being pursued by health advocates. On the public policy front, they haven't made much progress. But key leaders keep trying.

Among advocates on the state level is the Indiana Chamber of Commerce, which is pushing to lower Indiana's adult smoking levels to less than 15% of the population from the current 21.8%. The positive impact on reducing smoking would be enormous. The Chamber estimates that smoking currently costs $6.2 billion in health care and lost productivity in Indiana.

Among the proposals being pushed on state lawmakers by advocacy organizations such as the Chamber are increasing the cigarette tax and raising the age for purchasing tobacco products to 21. Both measures failed to advance in the recent legislative session. That's unfortunate.

While action doesn't seem imminent on the state level, U.S. Sen. Todd Young, R-Indiana, and allies on Capitol Hill are proposing a federal law raising the tobacco purchasing age to 21. Hopefully that idea will gain more traction on the federal level than it has on the state level.

While smoking appropriately commands much time and energy when trying to improve the health of a community or a state, other problems exist as well. Obesity is a tougher issue than smoking. Opportunities to understand nutrition, eat healthy foods and exercise routinely can be enhanced. But pitfalls abound. It takes persistence, as well as a blend of awareness and good public policy.

Substance abuse is also a major public health issue. It promotes unhealthy lifestyles for abusers and their families. Vigo County has long suffered from this scourge.

As Dr. Box told her local audience, substance abuse has a ripple effect and creates adverse childhood experiences.

"Children are growing up with violence and being exposed to a lot of poverty in certain areas," Box said. "And those adversely affect their health as they go forward then and grow into adults."

It's not easy or pleasant to read all these reports on the poor health. But knowing about and understanding these social problems and the impact they have on a community is a fundamental necessity when engaging in a discussion and planning a strategy for making things better. Many people and organizations are seeking ways to improve the health of our communities. They need our encouragement and support.

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