When Nick Doffin, Lake County’s Health Administrator, considers the new levels of funding his department must budget in the wake of a new funding formula approved by the Indiana legislature, he imagines the possibilities.

“It’s a lot of money,” he said, with an almost imperceivable lift in his normally stoic voice. Budgeting for the best use of what will turn out to be more than $15 million over the next two years, and then, hopefully continuing forward, is a little overwhelming.

The funding, made possible through the passage of Senate Bill 4 into law in May, comes as a result of the findings of a study by a health commission created by Gov. Eric Holcomb to study Indiana’s approach to public health. Indiana’s 92 counties had the option to opt into the program by Sept. 1. At least 85 counties had done so a week prior to the deadline.

Lake County will receive about $4.7 million in 2024. The figure is half of what the state legislature has authorized moving forward. That figure more than doubles in 2025 when the full amount goes into effect. Currently, the county health department receives about $196,000 a year from the state to fund certain services. The current funding will be rolled into the new funding. The state funding is unrelated to department revenue generated from the property tax levy.

“We are going to try to increase some of the programming that we do now and add to it programming we are not currently participating in,” Doffin said.

“We’ve had deficiencies for years. Nobody’s kept a list,” Doffin said. Tackling deficiencies has been a bandage approach, he said. If a grant becomes available, an issue can be addressed. If the grant dries up, the program goes away as well.

One of the office’s main focuses will be maternal and child health. Doffin said the office has not had the manpower to adequately address the issue. At one time, the department had a grant that enabled it to partner with clinics to provide maternal and child health care, but once that grant funding dried up, the department did not have the resources to continue, and it fell by the wayside.

“We need to get them in these programs and make sure they have good outcomes,” Doffin said. He would like to use some of the funds to operate maternal and child health clinics internally this time, one in north Lake County and one servicing the county’s southern region.

“The outcome isn’t something you will see next year … It’s down the road,” Doffin said.

Programs offering maternal and child health clinics are long-term solutions to address the problem of high infant and maternal mortality rates that have dogged the county and the state.

According to the Centers for Disease Control, Indiana has the ninth highest infant mortality rate in the nation at a rate of 6.7 deaths per 1,000 live births compared to the national average of 5.4 deaths per 1,000 live births. Indiana also has the third highest maternal mortality rate, with 44 maternal deaths for every 100,000 live births, with even higher rates among Black women. In its most recent annual report, the Indiana Maternal Mortality Review Committee reported 92 deaths of women during pregnancy and up to one year postpartum in 2020, with 79% listed as preventable.

Lake County ranks equally poorly in the state when it comes to infant mortality rates where it is rated ninth worst out of Indiana’s 92 counties with a stable rate of eight infant deaths per year per 1,000 live births, according to Indiana Department of Health Infant Mortality and Birth Outcomes for the year 2021, the most recent year for which statistics were released.

In contrast, Porter County’s infant mortality rate is 3.7 infant deaths per year per 1,000 live births, the lowest in the state.

Porter County Health Administrator Carrie Gschwind said via email the public funding built into the bill will allow counties to decide how to best serve their residents to ensure that each individual has access to core public health services, no matter where in the county they live.Porter County stands to receive a minimum of $1.6 million in 2024 and a minimum of $3.3 million in 2025 if all counties opt in. The Porter County Health Department currently receives about $135,768 a year from the state.

“In Porter County, we are very fortunate that we currently offer nearly all of the core services. Therefore, we are in a position to make the services that we currently offer more robust while assessing any gaps that exist,” she said.

The department currently is working with Pyrce Health Care Group to conduct a public health needs assessment.

“We plan to use the results of this assessment to determine who to build-up our current programming, what programs need to be added internally and what collaboration and or partnerships need to be made,” Gschwind said. The results of the assessment are expected in November and are expected to be implemented in 2024.

“One specific core service in need of development is care coordination. We will add a care coordinator to our staff to ensure connection to care and assistance for all residents starting this year. We will also add a Grants and Contracts specialist to handle sub-grants and contracts that come from our collaborations and partnerships,” she said.

By the end of 2024, the department will develop local key performance indicators (KPIs) for all of the core public health services and will look to be able to show a positive impact on local health outcomes across the board in future years, Gschwind said.

Matt Doyle, Methodist Hospitals President and CEO, said the system fully supports any efforts to improve public health funding in Indiana.

“Methodist Hospitals’ most recent Community Health Needs Assessment, conducted in 2022, found heart disease, diabetes, obesity and mental health issues to be top health concerns among the residents of our communities.

“And we know that maternal and infant mortality rates are much higher in our communities than in the state and nation as a while. These are barriers to good health that we work hard to address via our hospital services and our community outreach programs,” Doyle said.

Among the recommendations in Methodist’s latest CHNA is maintaining current programs regarding infant mortality and increasing education on the subject. The survey data did not register this as a top health concern; however, secondary data show it to be a significant problem in Methodist’s service area.

Methodist’s CHNA is a comprehensive review of health data and community input on health issues relevant to the community served by Methodist Hospitals. The assessment covers a large range of topics, but is not a complete analysis of any one issue. Rather, according to the report, the data helps to identify priorities which lead to productive community discussion and the creation of goals and objections.

What the assessment found is mental health, smoking and tobacco use, drug and alcohol abuse to be the top concerns among 18-to-34-year-olds. In the 35 to 55 age group, mental health also was cited as a top priority along with concerns about overweight and obesity, heart disease, and diabetes. Those 55 and older were concerned about heart disease, diabetes, obesity and aging and older adult needs.

Doyle said he is hopeful the increased funding will address the barriers identified in the CHNA and have a positive impact on the health of patients and families in Methodists’ service areas.

At least 60% of the revenue must be spent on core public health service such as communicable disease prevention and control; vital statistics; tobacco prevention and cessation; supporting student health; child fatality review; suicide and overdose fatality review; maternal and child health; testing and counseling for HIV, hepatitis C and other sexually transmitted infections; tuberculosis control and case management; emergency preparedness; referrals to clinical care; prevention and reduction of chronic diseases; screening and case management for child lead position exposure; health promotion and education for preventing trauma and injury; and access to childhood and adult immunizations, according to the statute.

No more than 40% of the funds can be spent on food protection; pet and vector control and abatement; inspection and testing of public and semipublic pools; residential onsite sewage system permitting and inspections; decontamination of property used to illegally manufacture a controlled substance; sanitary inspections and surveys of public buildings; and sanitary operation of tattoo parlors and body piercing facilities and those where eyelash extensions are applied.

Professor Ellen Szarleta, director of the Center for Urban Excellence at Indiana University Northwest, said the funding level is a significant change and how those revenues will be used will have to be considered at the local level.

“The funding is at a level that we have not seen before,” Szarleta said. “It’s something I think is a response to a couple different things. People are looking closely and carefully at what public health means after the pandemic; what resources are needed not only for an emergency situation and ensuring good health in general in the region, the state and then in the nation.”

Public health has been reconsidered across the nation after the pandemic, she said. Officials are questioning what infrastructure is needed to best ensure public health across the board and looking to who can best implement what is needed.

She said the report commissioned by Holcomb summarized that the state needs additional public funding across the board to help improve health metrics in the state and local level.

“The first step is starting to rethink what that infrastructure should looking like. I don’t think this is seen as an end point, it’s seen as the beginning of public health being more effectively implemented and funded across the state,” Szarleta said.

The state legislature used a fact-based approach to reconsider public health, drawing on commission results and Indiana state public health assessments.

“I think it’s a very good foundation for improving infrastructure we have,” she said.

Matters like infant and maternal mortality, chronic illness, and others the state hopes to tackle with the increased investment in public health are decades-long problems to address, she said.

“Based on the facts coming out of the study, it clearly points to long term public health concerns,” Szarleta said.

The approach in many ways creates an opportunity to have conversations across the state and across county lines on what those health needs are and possibly focus on the ways in which we are more similar than we are different when it comes to public health.

Communicable diseases don’t respect boundaries, Szarleta said. Socioeconomic issues may appear different between rural, suburban and urban areas, but many of the top health concerns and issues are the same.

“For me, I think one of the more important things that we can take away from this is it’s going to heighten the conversation around public health what does public health mean, how do we think about and value public health and what is the role of all the actors,” Szarleta said.

Local health departments can’t bear all it all, nor can state or federal officials.

“Some things local health departments can certainly do better. They know their communities. They are right in their communities.

“The report said there is a big gap in what is needed now and in future. I don’t know what the state is thinking about, but I don’t think they would make an investment like this without recognizing it needs to be sustained in long run,” Szarleta said.

cnapoleon@chicagotribune.com