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Monday, May 18, 2015

Ind. Gov't. - State of Indiana ranks at or near the bottom in public health and environment

Following on a lengthy list of earlier ILB entries on Indiana's health care crisis, Maureen Groppe of the Star Washington Bureau puts it all today in what is a lengthy, really shocking front-page Star story about the state of our State. Some quotes:

WASHINGTON – When southeastern Indiana became the face of the nation's opioid addiction epidemic, people asked, "Why Scott County?"

But the county's unprecedented HIV outbreak — the first in the nation linked to the injection of oral painkillers — revealed underlying issues in Indiana long noted by public health experts that suggest it could happen elsewhere in the state.

The addiction epidemic has hit Indiana harder than other states, and Indiana has less of a public health infrastructure to deal with the crisis. It ranks among the states with the fewest drug treatment providers and the lowest public health spending.

Other obstacles include the state's previous ban on needle exchange programs, its moratorium on methadone treatment clinics and a criminal justice approach to the problem, instead of one focused on treatment. * * *

When Mitch Daniels first campaigned for governor in 2004, he said Indiana was leaving tens of millions of dollars on the table while other states had mobilized to compete for health care grants from the federal government. During his time in office, his administration tried to rebuild relationships with the Centers for Disease Control and Prevention.

Indiana briefly moved up from last place in per-capita CDC funding in 2008 to as high as 35th in 2010. But it has been back at the bottom since 2012, according to annual rankings from Trust for America's Health in Washington.

Indiana also ranks low — 44th — in the per-capita amount of its own money spent on public health.

Beth Meyerson, co-director of the Rural Center for AIDS/STD Prevention at Indiana University, said the HIV outbreak in Scott County revealed "we're not prepared and our system is kind of broken down."

"I often say that (the Indiana State Department of Health) is fighting the good fight with two hands tied behind their backs," she said. "We really have a notion in the Midwest of 'pull yourself up by the bootstraps' and there isn't a very good communitarian notion of care." * * *

Low public health funding affects a state's ability to detect problems such as an HIV outbreak and to address them quickly, said Jeff Levi, executive director of Trust for America's Health and an HIV expert. "But some of the issues associated with this have less to do with money and more to do with policy and appropriate policy response."

He said the biggest obstacle was the state's previous ban on needle exchange programs, as well as a lack of access to substance abuse treatment. * * *

McCaffrey, the head of Mental Health America of Indiana, said many steps are needed to address the problem. But, for the first time, all the stakeholders in the criminal justice, public health and mental health communities have come together to say "we need to figure out how to provide treatment," he said.

"That has never happened before in Indiana," he said. "We have a history of just locking people up."

Still, the emergency response teams trying to figure out how to control what's happening in Indiana are realizing that substance abuse treatment in Indiana is very minimal and the system can't turn on a dime.

What is evident, health experts says, is that communities with warning signs shouldn't think that what happened in Scott County is an anomaly.

"I really don't think we're unique," said Scott County's Bridgewater. "We just happened to be first."

A second story today by reporter Groppe asks "What counties could be next for HIV outbreak?" A sample:
After the Scott County outbreak, the Centers for Disease Control and Prevention encouraged health departments across the country to identify and track both HIV and hepatitis C cases, and to also look at overdose deaths, drug arrests and drug treatment admissions.

"The situation in Indiana should serve as a warning that we cannot let down our guard against these deadly infections," said Dr. Jonathan Mermin, director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the CDC.

"Are state regulators hurting Hoosiers' lungs?" is the headline to another front-page Star story this morning, this one reported by Ryan Sabalow. A few quotes from the lengthy story:
Public health researchers say more than 1,000 studies have proved that breathing ozone reduces the ability of even the healthiest lungs to draw in air. Sufferers of bronchitis, emphysema, pneumonia and asthma are particularly at risk, especially the elderly and children, and especially those who live closest to pollution centers, as the Sparks family does.

But the state's top air-quality regulators, with extensive backgrounds in heavy industry, are fighting efforts to further limit ozone pollution. They say the consensus science behind the proposed regulatory changes can't be trusted. Nor, they say, should Hoosiers put much stock in the abysmal rankings that groups such as the American Lung Association give Indiana for its ozone levels.

They're pushing back against the U.S. Environmental Protection Agency's proposal to lower ozone levels and downplaying what medical researchers say is an unacceptable public health risk posed by current EPA standards.

They insist that asthma sufferers such as Damien and London won't be helped much, if at all, by the proposed new rules. Instead, they say the proposal will only kill jobs and diminish the quality of life in Indiana — maybe even for Damien and London.

"Raising the cost of living for Hoosiers without obtaining a corresponding increase in their quality of life, especially in documented health improvements, decreases the overall quality of life for the Hoosiers we are here to protect," Indiana Department of Environmental Management Commissioner Tom Easterly said in a prepared statement.

Such positions have sparked an old-fashioned jobs-vs.-regulation battle. Four public health doctors interviewed by The Indianapolis Star described the science behind Easterly's arguments as "specious" and nothing more than "mirages." One called the arguments "simplistic." Another, "misleading." One brushed it all aside as "Chamber of Commerce talking points." * * *

Indiana is consistently ranked low in air quality. The American Lung Association's 2015 State of the Air Report, released in April, gave "F" or "D" grades to 16 of the 29 Indiana counties that conduct air-quality monitoring.

The group gave "F" grades to heavily populated Lake, Marion, St. Joseph and Vanderburgh counties. Allen County received a "D."

Stephen Jay, a professor of medicine and public health at Indiana University School of Medicine, says the economic costs of ozone are profound. The EPA estimates that the new standard could save up to $38 billion in health care costs and lost productivity.

Posted by Marcia Oddi on May 18, 2015 08:27 AM
Posted to Environment | Indiana Government