By David Slone
Times-Union

WARSAW — Dr. Lindsay Weaver, Indiana Department of Health state health commissioner, visited Kosciusko County Friday as part of her 92-county tour.

With her, she not only brought a number of her staff but also some answers to questions about Health First Indiana.

Approved in this year’s legislative session, HFI is a state initiative created by Senate Enrolled Act 4 to help every Hoosier have access to public health services to achieve their optimal health and well-being. According to the IDH, this funding will help provide for core services including lead screening, food protection, trauma and injury prevention and more. Funding for each county depends on how many opt into it, and county participation is not mandatory.

“It was really important for me and for my team to get out to talk to all of you because we are really excited about the opportunities and the future of health in the state of Indiana, and we also know and recognize that if we’re going to get better and it’s going to get done, it’s going to come from the local level,” Weaver said to the dozens of people invited to the informal discussion at the Kosciusko County Courthouse. “So we’ve actually flipped our entire agency on its head.”

She said they have turned to become what they are describing as the customer service arm of public health in Indiana.

“We know that our health departments are the ones that are out getting it done, so we’re doing everything that we can to support the way the work is happening,” she said.

That includes the HFI funding.

“It was very intentional that counties have the ability to opt-in to this funding, that it wasn’t an automatic thing, and that the counties have the ability to decide how it is you all want to utilize that funding,” Weaver said. “You have to do the four public health services, that’s part of the statute. That’s what public health does anyway … addressing maternal and child health, trauma and injury prevention, chronic disease including obesity prevention, but how you do it and how much funding you put toward those different areas is completely up to you here locally.”

Counties had until Sept. 4 to opt into the funding, with 86 of Indiana’s 92 counties opting in, including Kosciusko County.

“For the last 20-plus years, Kosciusko County has been getting $83,000 a year, which, for your size of population doesn’t go too far really for helping with public health. This year, because the county commissioners opted in, you will be receiving $968,000 to help improve health in your community. If the county commissioners continue to opt in to this funding, next year it will be $1.8 million,” Weaver stated.

She then shared the county’s health metrics and that a lot of information about the HFI funding and health metrics can be found on the website at healthfirstindiana.com.

“We also developed a health score card. Right now it’s just seven metrics, but we expect to expand those as we continue to utilize data so we can make data-driven decisions. And we rank all the counties — 1 being the best health metrics down to 92 being the worst health metrics,” Weaver said.

All in all, she said Kosciusko County does really well comparatively for health metrics. Indiana on the whole performs lower when it comes to health compared to the rest of the nation.

In Indiana, Kosciusko County is 26 for obesity, with 35% of adults being obese. One-third of Indiana kids and adolescents are obese or overweight, while two-thirds of adults are. She suggested that the county could use some of its HFI funds to keep those one-third of kids from becoming that two-thirds of adults.

On the infant mortality rate, Kosciusko County is 33rd with a rate of 6.29 babies per 1,000. For the state, the rate is 6.8. “So better, but still our goal is to be down closer to 5. The national average is 5.5,” Weaver said.

Kosciusko is 22nd for life expectancy, with life expectancy being an average of 77.9 years. The state’s rate is 76.5 years.

As a comparison, she said in Hamilton County, where Carmel is, their life expectancy is 81 years. Scott County, in southeast Indiana, has a life expectancy of 72 years.

The smoking rate in Kosciusko County is 25th, with a rate of 20.1%. The state rate is 21%. She said they have seen the smoking rates go down significantly over many decades, though there is still a ways to go.

As for the suicide rate, it’s 12th in the state; and for years of potential life lost due to injury, Kosciusko is 16. “So that’s people dying of injury at a younger age than would be expected. Often that number is led by suicides and overdoses, but that also includes motor vehicle collisions and farming accidents or industrial accidents,” Weaver said.

The IDH is building out its data team so that they can get better and more data out to everyone, she said.

Kosciusko County Health Officer Dr. William Remington said, “New money is a great thing. It administratively pushes us. We’re use to being austere. For a long time. … All said, we need lots of technical advisory from your team. I’m so glad you are building out that regional support because I think it’s really, really necessary for us to be successful.”

Weaver said the IDH regional teams also are being made to pull the local health departments together so they can share what one another are doing, what’s been successful and what hasn’t been so everyone can learn from each other.

“It’s a lot. This is a growing time, right? But I’m really excited because I think we’ll look back at this time and we’ll say, ‘This was the start. This was the start when Indiana turned the corner and started moving toward a healthier future.”

Asked when the HFI funding will actually become available, Weaver said around Jan. 1 but not on Jan. 1.

K21 Health Foundation CEO Rich Haddad asked, “You mentioned kind of shifting your strategic role to being customer service to the local health departments or local health efforts. Are there some key directives that, this is how customer service is going to play out? You mentioned data collection and sharing. What comes to mind is thematic opportunities to help all the local health communities consider” what efforts to pursue. He asked her what ways she and her team see customer service playing out.

With the HFI legislation, Weaver said there is an accountability piece. The first was that the IDH was to develop state-level key performance indicators, and those have been developed and will go up on the website in the coming weeks. Then the counties have to develop their local key performance indicators by the end of 2024 and then do something to address them.

“So I think, right now, for example, what we’re saying is best practices is really to … pull your community partners and leaders together and sit down” and discuss what each is seeing out in the community, she said. They should discuss the key performance indicators and how they will go about and address them and then address them.

County Commissioner Cary Groninger said, “One of the things I know as a commissioner, we opted into this funding and I think as we try to build out how we are going to implement these funds, I think one of the concerns we have — and I know this is probably more of a legislative question than you – is building out an infrastructure and then all of a sudden the funding gets pulled away. And then we’ve created some good opportunities or things that are making a difference, and then somehow the counties are going to be forced to pay for it. I think that was some of the concerns I heard from my fellow commissioners. We don’t want to get too far out on a limb only for the limb then to be sawed off as far as the funding for it.”

Weaver said Kosciusko County was not the only county to have that concern, and the legislators know that as well.

“They’re hearing the same thing. They’re there to serve all of us, right? And I will say that we talk to legislators a lot and they know we’re not going to turn the data on obesity in a year or two years. They know that this is the long game and that we are investing in the future of Indiana. So, I hear you,” she said.

She said communication is a big part of it and the counties need to show their progress, even if it’s incremently. Success stories need to be shared.

Amy Roe, Kosciusko County community coordinator, asked how the amount of money for the counties determined. Weaver said it’s per capita, and there was additional funding if a county had an especially low life expectancy or a high sociable vulnerability index.

“I’ll tell you why everyone feels like this is such a great investment in local health,” Weaver said. “It’s that, before, most of the funding came from the counties. So there’s very little. I shared with you how much came from the state. Most of the funding came from the counties. If you were a county with 10,000 and less people, you don’t have enough people in your county to generate the tax revenue to be able to properly fund your public health. This evened the playing field. This made sure that the funding got to everybody in some way and kind of made it more on the state side.”

This year the counties have to match the funding of what they’ve paid the last three years. “So they continue to fund how they have been, and then in 2025 it’s an 80-20 match, so the state puts in 80% and the counties have to match a 20%. We have heard and are hoping that the counties will continue to invest how they have so it’s even more of an influx of an investment into your community,” Weaver said.