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Keith Coleman:

Welcome to “Investing in Public Health Infrastructure: Indiana’s Success Story” webinar. It is presented by the government affairs and public relations team at the Association of State and Territorial Health Officials, also known as ASTHO. I am Keith Coleman. I am your host for this webinar. And we’re very excited.

So with that, I’d like to also point out behind the scenes supporting me here today, I have Sarah McDonald. Sarah if you can give us a wave. Sarah is our very dedicated communications intern. And I’m also joined today by Maggie Davis. Maggie if you can give us a wave and hello. Maggie is the Director of State Health Policy here at ASTHO. I will also note that Maggie and I co-authored a case study titled Investing in Indiana’s Public Health Infrastructure Through Community Driven Policy Change, which highlights Indiana’s historic investment and the state’s public health funding and restructuring of its public health system. At the end of today’s discussion, we will drop a link in our chat room to that case studies so that you can share it with others and also read it but basically, it’s a snapshot of what Indiana did to make transformative opportunities for their state health department.

It’s a pleasure to introduce to you our features presenters and colleagues from the great state of Indiana. Dr. Lindsay Weaver is joining us. She is Indiana’s state health official. Welcome Lindsay, Dr. Weaver, and Mr. Luke Kenley, who is the former Indiana State Senator. And I’ll give you both and opportunity to formally introduce yourselves and hear later I will also point out for audience that Dr. Weaver is in the ER room working today. Is that correct? So again, doing some work. And we will basically allow her an opportunity to share some of her successes, but also just be mindful that she’s doing some important work in the ER department currently.

Together, they will share how the governor’s Public Health Commission and the Indiana Department of Health approached community listening sessions formulated recommendations for this awesome work and a successful building of legislative support to reform the public health system throughout the state. We want to make this a very engaging and informative discussion.

So, what we’re going to do today is to revisit a lot of the tried and true principles that led to this transformation in Indiana, we’ll walk you through the steps and the bold decision making that were made. Because we know that this is the time for collaboration, innovation, and out of the box thinking, which is required to help shape public perception, build consensus and drive behavior. So, for this conversation, I’d like to take a bit of a different approach. I think it’s important for and very instructive for us to forego any discussions around, you know, complaining and why things can’t be done. And really spend time today focused on learning from our experts and the key lessons that they learn from their experiences in moving the needle forward.

So, we have a lot of people on the call Dr. Weaver and Senator Kenley. They have unique experiences and expertise. I can tell you that this has been one of our most anticipated webinars, they really want to hear how you were able to do this work. And so, we asked our participants to drop their questions into the Q&A portion of this Zoom feature. And that today at the end of today’s conversation, we will share some of ASTHO resources with you.

I will now turn it over to our panel and ask that they share just a little bit about yourselves and then maybe describe your role in this transformative undertaking. I’ll start with you, Dr. Weaver and then we’ll transition over to Mr. Kinley.

LINDSAY WEAVER:

Hello everybody and thank you so much for having us here today and I do apologize for the background noise. I work this evening but needed to be here ready and prepared to walk into my shift.

So, Lindsay Weaver state Health Commissioner since June. I was the chief medical officer as Senator Kenley, and our former State Health Commissioner, Dr. Box, embarked on this journey of what started with what we call the governor’s Public Health Commission. And really, the goal of the governor’s Public Health Commission was to look at the state of Indiana, and identify where we had opportunities in public health. I was able to contribute specifically to that, as being a continuing to work clinician here in the state.

I always tell people, I feel like the emergency department and public health really collide. This is where people often end up if they’re not able to access the care that they need. If they’re not taking their medications as prescribed. Of course, you know, we find infectious disease outbreaks, often the emergency department as well. So, it’s a lot that a lot of those two things come together. So, I was able to contribute in that way. Bringing our healthcare providers along this journey with us, and also from the data perspective, during the pandemic I worked a lot in my role as a chief medical officer with the Department of Health is how do we better utilize data specifically around transparency and how we get that information to our clinicians to our hospital leadership or healthcare leadership across the state, but also to the citizens of Indiana because we really here, you know, don’t feel it’s our data, we feel it’s our job to help, you know, collect the data and analyze it and then put it out to Hoosiers to Indiana to the world so that they can make decisions about their own health or maybe, you know, from the hospital perspective, how they might plan around to staffing.

Currently, as a state Health Commissioner, I have the amazing job of helping implement all this great work that Senator Kenley and I will continue to talk to you about. So, I’ll turn it over to Senator Kenley. And I’ll have I’m sure a lot more to share.

Keith Coleman:

Thank you, Senator Kenley.

LUKE KENLEY:

Thank you, Dr. Coleman. Well, I was first elected as a state senator in 1992. And I retired in 2017. And over that period of time, I ended up focusing mostly on fiscal matters. And I chaired the Appropriations Committee in the Senate as well as the Tax Committee and was the chair of the state budget committee for a number of years. So, I came at it from a fiscal point of view. Governor Holcomb called me and asked me to serve as a co-chair on the Public Health Commission that he was putting together. And Dr. Box, and Lindsay, Dr. Weaver, were at the health department and they felt through the experiences of the pandemic, that there were really some desperate needs in Indiana to have a much better public health delivery system. And so, they put together, the governor put together a 15 person commission, and I co-chaired it with Dr. Judy Monroe, who is the Executive Director Chair of the CDC Foundation, and she had been a former commissioner health commissioner in Indiana.

And so, we had a really good group of people there. We had experts in the public health arena, and we met for over a year, once a month as a commission. And I have to tell you, that this was apparently such a timely issue and so important that we literally had perfect attendance for every single session of the Commission. And we would meet for about two to three hours at a time, once a month. And so there was a lot of commitment there.

I think one of the good things about that particular effort was that they included, in addition to myself, who was a former legislator at the governor’s request, the we had three local government members on there, and we had two county commissioners and we had a mayor. And those people turned out to be instrumental in terms of the sales after once the commission had reached its results.

And I have to tell you that when Governor Holcomb asked me to do this, and I went to the opening press conference where he and Dr. Box, articulated what the purpose of the commission would be and where we’re going and what things we needed to do. After the commission meeting, or after that press conference. I said to the governor, I said, you know, I’m not sure if you’ve picked the right guy here because I may be opposed to this. And he said, well, that’s kind of why I want you there. So that was a challenge in and of itself.

And I have to tell you that the experience of working with the Commission and our health department, would you in addition to Dr. Weaver and Dr. Box, have a lot of very talented people and this was their chance for their light to shine, so to speak. Their performance was outstanding, but the work of the Commission was very good.

And once we embarked on a plan to try to get the legislature to fund this up and to approve what we were doing, why it turned out to be one of the best four or five things that I did in the in the 25 years, I was in the legislature, and I was involved in welfare reform and property tax reform. And I was the author of the bill that built the Lucas Oil Stadium in our convention center. So, I’ve had a chance to participate in many great activities here in Indiana. And this is just as important as any of those ever were. And I think we’ll have a great lasting effect in Indiana.

So, I’m glad to be with you and your audience, Dr. Coleman, and I’m glad to have a roundtable discussion exchange ideas of questions as this discussion goes along. So, I’ll follow your direction. And in terms of how we deal with this.

Keith Coleman:

So, with that, I thank both of you, again, we’re just going to make this a conversation. And I’m very aware that the people on the line, they don’t want to hear from me, they want to hear directly from you.

But there are a few questions I want to just kick start this conversation with if you don’t mind. The first one is how important would you say your experience as a legislator with many years of experience… how important was that in this process? And then Dr. Weaver, you use the term continuing to work clinician, you know, that’s a great way to describe, you know, the important work that you’re doing now in both roles. But how important is your continuing to work clinician experience? How important was that in this process? So, Senator Kenley, I’ll start with you, if you don’t mind.

LUKE KENLEY:

Well, after, after the first couple of months worth of commission meetings, I could see that this was really an important need in the state of Indiana. And so, my thought process was, well, we’re not going to go anywhere, if we get if we don’t get the legislature to approve this concept. And if we don’t get funding from them. And so my mantra became, how do we get 26 votes in the Indiana Senate? And how do we get 51 votes in the Indiana house? And then how do we get funding for what we’re trying to do? Virtually every tactical and strategic decision that we made, I tended to view from that lens.

And so, for example, early on, there was a discussion about well, should public health be delivered through state aid offices located throughout the state itself by the state? Or should we continue with our county health department issues and use the counties as part of this? So there was a structural question right up front, that had a lot of significance there are.

And my feeling was, is I looked at my past experiences, as a legislator, we had a pretty successful program in Indiana, that as to how we do road funding, and the model that we had for road funding was that local governments, of course, they had to comply with state regulations and requirements on in terms of how they would do road funding and road building, and so on and so forth. But we let we leave a lot of that to the county governments in the city governments in the state of Indiana, and they get the funds from the state house. And so, they’re very excited to have the responsibility of doing that. And then the funding comes from the state. So it was an 80/20 copay that we had. And I felt like if we would do a model that was somewhat similar to that, that that would be number one, it would kind of fit the political climate in Indiana, that we think the best decisions are made locally closest to the people.

And so, we got to, we added in there, the idea that the state would provide expertise through regional people that would be assigned to like several counties. And so this was…this is the linchpin that kind of gives you the uniformity of direction and as, as the locals are now embarking on using the money that we got for them that Dr. Weaver’s office, she has these liaison people out there working with them to help work with the county commissioners and county council on the vote. And then they choose what they want to do, but the state people are kind of saying they’re giving assistance and saying, Now look, here’s what the numbers say your dashboard looks like. Here’s what some of the problems are in your county. So how are you dealing? And how are you responding to that, and the locals are actually very happy to receive the money.

But the key element is that not only did the counties have to opt in by an actual vote of their county commissioners to participate in this program, but they had to construct the budgets and help put it together. So that gives them a stake in the game that makes their decisions important. And they became much more interested in this whole thing going on.

And then, of course, the political arena over these issues. And coming out of the pandemic, were pretty volatile, no matter which state you’re in, and yet you had that situation. And so, from my experience, as a legislator, there were about 40 or 50 entities or groups like the Manufacturers Association, State Chamber of Commerce, the hospital association, the doctors association, that they lobby, the State House, and they have an interest there.

And so, Dr. Box, and I embarked on making presentations from the Commission to them, after we’d finished our year of deliberations. And so, we made 40. Well, we made almost 50 presentations, in addition to having seven listening sessions around the state where we would go. And actually, we would receive comments from people and suggestions and advice or opinions. And we did not correct anybody on any misstatement that they made or anything else, we just let them make their presentation. And so we went from there.

Once we had the local somewhat interested in this idea, and I should say that the local government prior to this had to produce the funding for whatever the local health department’s funding is, and in Indiana, frankly, it was embarrassing. And we had a terrible funding record on a per capita basis in Indiana. But it was because it was local government. And of our 92 counties, about 65 of them have less than 50,000 people. So they’re sort of a rural type of a county, they don’t have a lot of resources, they don’t have a lot of taxing ability. And so, with the state, stepping up and doing the 80% on the 80/20 co-funding, this was going to make a dramatic change if we could convince the budget people at the Statehouse that this was worthwhile. So, I knew I’m talking a lot. But these are these are all things that just started.

Keith Coleman:

Very important. And it’s actually going to lead us to a few other questions I see coming in because as you were talking, you hit on a few very key ideas here that others want you to unpack. So, I’m come back to you and let me go to Dr. Weaver and come back to you, particularly around the group or the listening sessions. People want to know about that. They also seemed like they want to know about the funding model and equity in the funding and then how would you negotiate some of those political pitfalls? So, Dr. Weaver, I’ll turn it to you.

LINDSAY WEAVER:

I will say from my perspective, because I’m continuing to talk to legislators that we’ve moved into the implementation of what we’re now calling health first Indiana, that Senator Kenley really, and him and Dr. Box, but Senator Kenley that the fact that he was able to speak the language of the legislators. They knew him. They knew him to be very fiscally responsible; 100% played a difference in all of this.

Before you asked me like how does being a continuing to practice clinician, you know, how does that help all of this, I will say underlying this legislation is that it wasn’t built by the State Department of Health. It wasn’t built just by the Centers, One Health Commission, to doctor or to Senator Kenley’s point, we took the time to really hear from people so we were talking to the local elected officials, the mayors, the county commissioners, the local health department’s, the clinicians, they did the listening tours, they listened to the public. And we listened to the legislators, our legislative legislation changed throughout the session based on their feedback. And so really, we built this all together.

A couple of just data points, I wanted to point out so 70% of our of our county’s local health department funding was coming from the locals. And so you can imagine if you have a county of 6,000, 10,000, people that could never generate enough funding to be able to actually serve the community in the way in the way that they need. And we were ranked 45th in the nation for public health funding.

Senator Kenley was able to make a really good point and point to Hey, under his leadership, look at all these areas that we have funded appropriately in the past, and look how well we’re doing on the national landscape. So, all of those things really played a role into it, when you’re talking to the legislators they wanted to make sure that the majority of the funding went to recall more like you know, health related public health things. So maternal and child health, immunizations, trauma and injury prevention, things like that. So they actually added it to the legislation that at least 60% of the funding has to go to that.

But beyond that it is completely and this answers one of those questions that have come up completely up to the locals how they spend that funding, as long as they’re addressing the core public health services that we outlined in the legislation, which is honestly, in my opinion, as we’ve continued to roll this out. It is brilliant. And it really does look different in every single county in every single community. They’re coming together. Yes, we’re coming in from the data side, from the evidence based medicine side, connecting counties that are doing a really good program, if they’re specifically addressing this specific issue with infant mortality, it will say, Hey, look at this county and see the program that they’re doing. And they’re really seeing great success.

So, from the state side, we’re helping with that, you know, driving them towards the data driving them towards evidence base, but they are making those decisions locally, amongst their county council, the local health board and local health department. So, it really is a community and a partnership.

Keith Coleman:

And the locals, I’m sure appreciate it the fact that you, actually, both you and Senator Kenley pointed out, you wanted their feedback, you wanted them to take ownership with this process. So that was beneficial. I guess the next question I will ask is in June of 2022, the Commission adopted its first draft report, which was finalized and submitted to your governor on August 1, 2022. Can you share with us the core areas of improvement and recommendations for your public health system? Maybe a snapshot of those?

LUKE KENLEY:

You know, Lindsay, can you talk on that a little bit? Because I don’t, I just kept, I kept focusing on how does this relate to the legislature? How do I get the legislators to vote for this? And so sometimes the there’s the separation based on the medical information, I didn’t pay that I paid attention, but I didn’t focus on that.

LINDSAY WEAVER:

Yeah, so I mean, I think the big part of it, and the part that Senator Kenley really focused on was that improvement of funding.

So, we have 6.9 million people here in Indiana, a little bit less than that. And then $6.9 million, is what the state was putting forward to fund for the last 20 plus years without any increase. And so the big thing is that we were asking to significantly increase that, and the legislation ended up passing, that that increased to 75 million this year. So that’s a 1500% increase in funding for local public health, and it’s gonna be 150 million in 2025.

So a significant increase in funding for them to be able to address for public health services, other parts of it, as we recognize, we needed to address our trauma system. And there were some opportunities there. The legislators also appropriated funding specifically for trauma system development, and that work is ongoing. And we just actually granted out funding last week, to hospitals and other trauma systems across the state to improve our trauma system, we acknowledge that there was opportunity for education for our local health officers and administrators who have came out of the report, and we’re actively hosting boot camps so that we’re all working from the same playbook.

I always remind people, you know, we’re not giving public health training very well in our in our in our schools. And so giving people the opportunity to get that education, so that we’re all working locally, and discussed our regional teams that that all of our communities would need some support. And so, we implemented that using Public Health Infrastructure Grant (PHIG) funding. So, we have a northern central and southern team that are providing more public service support data, support, communication support to our local health departments, and also acknowledge that we have a workforce issue.

We have a Health Workforce Committee that we’ll be kicking off this spring, to specifically look, of course, at the public health workforce, but also acknowledge that the entire health workforce needs to be improved if we’re really going to move the needle on these big things, right. So that includes EMS, our nurses, you know, people who are in the home, taking care of people that are on home healthcare, and of course, all the way up to our physicians in our hospital. So that’s just like the key highlights, but there’s 32 recommendations in there.

Keith Coleman:

So, you looked at the entire ecosystem and got everybody gauge. And you mentioned earlier, something about PHIG funding. Can you just maybe describe for those who maybe they’re unfamiliar with.

LINDSAY WEAVER:

Sorry, public health infrastructure grant from the CDC? That’s how we’re using that funding to build out and improve our infrastructure. I keep on telling people, this is a force multiplier, right. So, the Department of Health has not grown. But what is grown, it’s grown the public health workforce at the local level. I suppose somebody else asked about partnerships. We have eight of our counties 86 to 92 counties opted into the funding center county, and I haven’t mentioned that very key piece of the legislation that this they have to opt in at the local level. They have to have that buy in come in at the 80/20…

Keith Coleman:

You’re frozen, but let me go to you, Senator Kenley. As co-chair of this commission, what advice do you have for other jurors? restrictions, who perhaps are considering an assessment of sort of their public health system? What would what advice would you give to them and during your work on this commission, what surprised you most about public health or this entire process and where we are?

LUKE KENLEY:

Well, I think in terms of advice I’ve already hit on this once before, but I think whatever you do, if you’re going to make a significant change or improvement in your system in your state or your region or area, I think I think you have to have, I think you have to target your legislature, as strong as an approval point. And so you have to make you have to convince those folks that this is going to work.

I think, where I was able to help was because of the I’d had so much experience in the legislature, and I’d seen so many models, for example, I noticed one of your questions to snuck in there was how did you provide for equity and funding? Well, I had helped develop a school funding formula about 20 years ago in Indiana with it had a complexity index. And so, what that did was it would weight students in the schools according to their demographics, you know, whether they were raised in poverty, or whether they were from a single parent family and, and things like that. And so, Dr. Box, and Dr. Weaver had some demographical statistics, they used to produce a formula, and we never really even had any debate about that. Because when we talk to legislators, we’d say, well, the methodology of funding out to the different counties is based on the same thing that we do on the school complexity formula. And so everybody was familiar with that. So they just we sort of bypass that step in terms of having an argument.

In a bigger picture, I think, if somebody were to say, well, we need to improve our state on public health. In this way, I think that you need to look at the steps that we took, we had the Public Health Commission, the governor who is a very moderate type of fella, he’s not a real aggressive get out there salesman type of a guy, but he never wavered in his statement, his support for this, he included the state and state message. He never backed off. He talked in generalities, but he never backed off about well, maybe right, maybe we don’t need to do this now. Or something like he just stayed right there.

So initially, we had the support from the top. And then secondly, we had a commission that the report that Lindsay referred to and talked about with the 32 points. I mean, that was a well-developed product after about 14 months worth of meetings. So we had that basis. And then we went out and did the listening tours. And we did the sales tours. And we haven’t even been to the legislature yet before we did all these things. So if somebody were to take all of those steps and layout them as a list of steps to take before you get there, I think that would help each state in terms of achieving a successful conclusion. And so I don’t know that that’s kind of my response there.

You ask one other question, what surprised me the most?

Keith Coleman:

What surprised me most this entire process?

LUKE KENLEY:

Well, I wasn’t too surprised. But there were two things that from my perspective, we should or shouldn’t do. And pretty much everybody else on the commission who were not legislators, they were horrified at the thought of that I was suggesting, and the first one was that, look, you think the easy money is just to raise the cigarette tax because Indiana has a low cigarette tax. And that way you don’t have to argue about where’s the funding going to come from? And I said, that’s a very volatile issue here in Indiana. You don’t want to raise that issue. So we are not going to make any recommendations about not only the cigarette tax, but any other revenue source. We’re just going to say here’s the program we need and it’s the legislatures decision as to how you get the money.

Well, fortunately, we had the money that came from the federal government that was there to kind of help smooth us into that plus, most like many states, we had a fairly robust revenue source overall. And so we were blessed with having money when we normally didn’t have any so that was one thing.

And then the other thing was, and I think it was a surprise the other commission members and they were pretty certain that I was dead wrong on this. But I said, you have to let the locals make the choice as to whether they join or participate or not. And I thought Dr. Box was going to have to be peel off the wall the first time I said that to her. But those are the kinds of debates that you go through.

And actually, it was interesting because of the two county commissioners we had and the mayor that we had both of the county commissioners after our first meeting told me that they were probably going to vote against anything that we did. But over time, they ended up being our biggest allies and they would actually go to our meetings with local government people and make the presentation for us. So you need to take advantage of that portion of your society, even though you think they may not be on the same page as you and rather than ignore them and fight with them, you need to find out what do they want? And what would they buy into. And let them be the salesman.

And one of the big points that was very helpful, particularly these rural areas that no matter where you went, every local elected official is concerned about economic development in his or her area. And in one of the big arguments in favor of bringing economic development to any location within your state is companies that may come in will say to you, what type of medical services do you have in that community? How far is it to the nearest hospital? Do you have EMS services? Do you have this? Do you have that. And so really, you tied it into their favorite topic, which is economic development for their area. And the public health is really it just fits like a glove in there, because it’s a preventive type of medical treatment, as well as providing services.

Keith Coleman:

And Dr. Weaver, I’ll turn to you any recommendations that you would offer to those who are listening, you know, we’re struggling, we don’t think we can get this done. It’s impossible, what would you offer to them?

LINDSAY WEAVER:

I think again, it is the partnerships. And that’s the people who you wouldn’t think about right. So, your healthcare community, they’ll understand the public health people will understand. But back to what Senator Kenley was talking about. Some of our biggest champions were our businesses, our chambers, Farm Bureau, they recognize that this was important.

And I will say healthcare costs were brought up quite frequently. I mean, we weren’t specifically addressing that we knew we have public health opportunities that we were focused on. But they do recognize that our poor health metrics, right, our high smoking rate or high obesity rate, etc. are helping to drive healthcare costs up. And then so we talked a lot about what’s being done to move in front of that and really be in the space of prevention. And that this is where hope that the funding would go. This is where public health plays a big role in that.

We heard from communities that they lost out on new employers coming into their community just because of their health metrics. And now that the counties have opted in now that they have plans on how to address those health metrics, they say that in and of itself will be a difference maker, the health metrics haven’t changed yet. They will, it’s going to take time, everyone knows it’s gonna take time, but the fact that they can now come in behind that and say, we know that we’re high in these health metrics, but here are all the things that our communities working together to address them will be the difference maker, I think that is what continues to drive the conversation is that it really does tie our goals around economic development and quality of life is that public health is a big part of that.

Keith Coleman:

So let me transition here. I want to be respectful of time. But I also want to give the members who have joined us an opportunity to ask their question.

So, our first question comes from Allie. She says, Thanks for the great discussions. I don’t know a lot about Indiana’s public health system. But did you end up needing to navigate tensions between funding public health efforts at the state level and funding for these efforts at the local level? How can we best advocate for local funding without implying that we should take dollars away from state governments to do so? Senator Kenley, I think that is something that you were alluding to and then Dr. Weaver, if you can elaborate. So, Senator Kenley, I’ll toss it to you.

LUKE KENLEY:

Indiana, and this is this may require some fairly sophisticated parsing of an analysis of each state to decide how you do funding and how you do your budgeting. And Indiana within its legislature the budgets are decided primary within the House Ways and Means Committee and the Senate Appropriations Committee. And there is no bill that goes before any other committee, where the other committee, for example, education actually decides how much funding to put into it. So we have a very small group of people who actually make the decision in Indiana about how we’re going to spend our budget and where it comes from.

So, one of the things that your viewers need to take into account is they need to have some kind of an understanding of how budgets are adopted in their state. And where are the control points? And how do you get to the people who are making these decisions.

And for example, my advice to the Commission about don’t advocate for a cigarette tax or some other type of tax was based on my knowledge that the people who are doing the budgets in Indiana, they feel like they have quite a bit of pressure on them in a lot of regards, but they don’t want some outside agent in there telling them how to structure their tax system, it just complicates the situation in a case like this. So, I think somebody who’s involved there needs to be in your state health department or in the governor’s office, or somewhere, someway, somebody needs to be pretty skilled at seeing how appropriations are made and how it works. And so that there may be a fair amount of difference between different states because I’m sure in some states, like the health committee probably has control of some of the budgets that go into the health discussion. So, there’ll be a different process than it is here in Indiana.

LINDSAY WEAVER:

I would just add that we are all about local control here in Indiana, I will say from the public health perspective, it really does matter.

So, when we are looking at our 10 counties with the highest infant mortality rate, we have we recognize looking at the data that what’s driving that infant mortality rate is different in each of those counties. And because this funding is flexible, and it’s driven by the local level, it’s not us from the state side, they’re able to say, Okay, we know exactly, you know, what is the geographic location that’s driving infant mortality, what are the issues surrounding that, who are the partners in that community that we can work with. And so, they’re able to really narrow in and focus.

And our local elected officials and our state elected officials, this is their community, these are these are these people, I always tell people, when we’re going out in the county and around to other counties and talking to people, it’s not stats to them. These are their cousins, their friends, you know, the people that are next to them in the grocery store. And so that means so much more when it’s being driven from that local level. So, from my perspective, I mean, for Indiana, this really was the only way for us to do this.

Keith Coleman:

That’s so important. I have a question from our audience here. I’m going to ask Shannon, I believe that’s your name and see your hand is up, you can come off of mute or come off of camera and ask your question of our panel. And while we wait for Shannon, let me go to perhaps our next question. One, I think it’s very important. Did the community-based organizations receive funds? Or did they have any say in how the money was to be used at the local level?

LINDSAY WEAVER:

I can answer that one. So that’s again, being driven locally. So yes, we know many instances across our state where the counties are giving funding to local community-based organizations, whether that be hospitals or tobacco coalition. I mean, really, it runs, it runs the gamut of all the thing communities, organizations that you can think of. But then again, they’re able to hold that accountability locally, that they are addressing and working on the things that are needed for that county and for that community. They have been at the table. They have been the biggest supporters of this work along with us the entire way.

Keith Coleman:

Senator Kenley you started this with you can’t do this without coalition building. You can’t do this without the local. Right.

Another question that’s coming in. It’s I think for Senator Kenley out What are some words and ways? You talked to people about the importance of the public health to, you know, our elected officials in your state without using, you know, the jargon that we use without, I guess, muddying the water? How did you talk to them? Well, how did you communicate with your colleagues? Because we know that we talk differently in public health. That’s, you know, as a physician, I’m sure Dr. Weaver, she talks differently. How did you talk to your colleagues to get this buy in?

LUKE KENLEY:

You know, I think that’s a pretty perceptive question, actually, because when we had the commission meetings, the people who were working in the healthcare fields would talk the way they normally talked about things, and I was kind of laughing them at the way they talked. And then when I would talk, they were laughing at me, because I wasn’t really focusing on what they were talking about in their mind. And in reality, we were talking about the same thing. It was just such a different perspective.

So, I think the way to achieve that when we after we got to the legislature, and we had, we have super majorities in both the State Senate and the state, House of Representatives on the Republican side. And I met with Dr. Box, I met with leadership in both caucuses on both sides. And they were pretty much on board with this. And they were not nearly as problematic in terms of accepting the idea that this had value.

So we just met with their leadership and ask them to talk to their people. But we had to meet literally, with almost all 70 Republican House members, and all 40 Senate members on a one-on-one basis. And so, I never talked about the experiences of the pandemic, unless they brought it up. And when they talked, or if they brought it up, I would avoid the discussion about, well, vaccinations, I wouldn’t even say the word mandates, or business closings, I never said any of those words, I would say, look, that was an experience, we all went through that hit us up the side of the head, and nobody knew what was going to happen. And so before you think that all your constitutional rights are being washed away, you need to recognize that this was a true emergency. And that what we’re presenting here is more of a baseline proposition that is going to give you a structure in your communities back home, that you could solve these problems on your own with the assistance and the help of the state health department. And not only that, but you can develop some preventive programs, and you can maybe get into the schools and help with young people. But this gives you a forum from which your county and city elected officials can sit down and ask the leaders of the hospital to come man or the some of the doctors to come in, or other medical services delivery people. So this is a platform that you can start to fill the holes on other discussions like Lindsay mentioned earlier on. We didn’t really talk about the cost of healthcare and how it may be too high. But this gives you a place where you can talk about that kind of an issue. And you guys can lead the discussion.

And actually with two or three different legislators they were so hung up on, I don’t know what you’d call the catechism of what all the buzzwords were that they hated about the national discussion about healthcare, I would say to them, Look, because we had staff people in there, and we had some medical people in there, depending on who we’re talking to, I’d say look, if you have a problem, and you’re trying to figure out how you fit this into your legislative, compartmentalized mind as you’re making decisions, here’s my phone number, just call me and I’ll come in here by myself, and we can talk again, and I actually had two or three people that took me up on that, because they wanted to talk about it in that way. And so there really is an art you communicate.

Keith Coleman:

Senator, I’m going to also be selfish as I think, who was someone else had the same question, but basically, in terms of messaging, and I’m very interested in how we communicate about public health, what would you say to someone who’s listening? Don’t do this, don’t say this, don’t communicate like this. Because we do know that in public health communication, there’s a major difference between the way in which we talk to rural communities versus urban communities and so on. But what’s, what are some of the 1, 2, 3 things that you can think of that public health leaders should not do in their messaging? And as we think about it, it is selfish for me to ask because I’m in public health communication. But we’re all just trying to learn here.

LUKE KENLEY:

Well, I think you have to number one, when you’re visiting somebody, particularly in the legislature like that, you have to listen to what they say, and you have to respond in a similar not only in on the same subject, but in, you have to sort of pick up on what their explanation of the issue or the problem is, and you have to talk in their language. Now, I know that sounds a little vague to say it that way. But if you think about it, it really doesn’t.

And I think that the healthcare people are, I found that the people on the Commission, in some cases were so expert at what they knew, and they were so good, that the impression that they would deliver to maybe a legislator, or maybe even to somebody in a public audience, if you’re speaking was, well, this guy’s an expert, or this person is an expert. And so they really, they don’t have any grounding, that speaks to the ordinary person, or they don’t have any common sense. Or they’re too bureaucratic. Or they’re all the things that we’re afraid of coming out of the CDC, when they say, six feet is the right amount of distance you need to have between people. And you’re sitting there as a person, you’re saying, Now, how can you possibly tell me that it’s exactly six feet?

And so, there’s a, in our society, generally, today, we seem to like to disagree with each other about virtually every discussion that we have, I think you just have to get by that you have to you have to articulate that you’re not interested in having that kind of a discussion. And you have to short in the way you talk. And the way you listen. I think a lot of times, we start out with meetings, and somebody would talk for 15 minutes at us before we ever got our first word in sideways about what the issue was. But that was, I think you have to do that when you’re committing getting was somebody that comes from a different premise or a different starting point than you do. Taking away discussion of expertise.

LINDSAY WEAVER:

I was just gonna jump in and add, you know, I think from the from the get go, it is what Senator Kenley said it is first listening. It’s acknowledging that maybe your truth is not their truth. And then it’s identifying where’s the commonality. And the commonality is that the legislators truly want what’s best for their community, they recognize that our life expectancy is going down in Indiana, they recognize that we’re in very low when it comes to these health metrics, you know, obesity, and in smoking, etc. And so we aligned along that.

I think it was like moving past all of these other things and saying, Okay, what do we agree on? And then how do we agree together to do something about that something else we keep on hearing about as well as personal responsibility, right? People choose to do these things they choose to put in these situations. And so, we’ve focused and continue to talk a lot about prevention. How do we keep our one thirds of 1/3 of kids who are overweight and obese from growing into what we have is two thirds of our adults are overweight and obese, and really focusing in that space and not the idea that we’re going to change everybody their behaviors who are already kind of set on pass.

I will say the other if I want to say some buzzwords that I know resonate with me, because I worked in quality. I understand business. And I also know resonates with our legislators, that is accountability. It is transparency, and its return on investment. And so big, some of the key components of our legislation is that they we do have statewide key performance indicators. And all of our counties have to develop their local key performance indicators. So we’re going to be driving outcomes at the state level and the local level.

Keith Coleman:

And that was one of our questions from Denise, about the metrics for the local health department’s reporting back to the state health department. You’ve identified those right, and that’s to show the accountability. And before you get to three important things, and I don’t want to miss out what are though, you can just say those again. So, when we go back to our health department, we know what the three things are.

LINDSAY WEAVER:

Its accountability, right? So how are we going to hold people accountable to be using the funds like in the way they’re intended? So, one, they have to submit their budget and our state budget committee reviews that they are posted up on our website.

Transparency was the second word. We’re 100% transparent with everything that we do. We continue to cop talk to our legislators or local elected officials in our local health departments.

And the last is return on investment. So, it shows me how right now at the local level, how is what they’re doing? How was it, you know, influencing change, to make improvements, and then, you know, talking to people about it’s gonna take a long time before we move those big needles. But here’s where moving the small needles at the local level will drive that big eventual change. So accountability, transparency and return on investment.

Keith Coleman:

Perfect, perfect. Senator Kenley, we have a question in the chat room from Amy. What got you to say yes? You know, we’re always trying to get our elected officials to join us. And but what got you to say yes?

LUKE KENLEY:

I think that it emanated from…We all realized how, what a dramatic experience, the pandemic was for us, and then you take it in the context of, of our kind of our national experience with our healthcare delivery system, and we passed the federal, what we call Obamacare, and that that has continued to be a point of disagreement. And we have not found a way to overcome our differences there and to develop that.

And so, in my mind, the importance of improving ourselves, particularly in the public health arena, and in Indiana, we had such a dismal presentation, it was pretty easy to say, yes, we need to do this. So then, the next question was, how do you do it? How do you possibly convince somebody who just doesn’t want to hear about any of this stuff doesn’t really want to buy into any of these things. So you start to look for the points of commonality. And it took a little time with me, but I think that our process was so thorough, that that kind of assisted people gave people time to come to the conclusion.

Keith Coleman:

And Dr. Weaver, I’ve heard you say we’re stronger together than apart. What inspires or what gives you hope here, because many of us, in public health, you know, we’ve been through COVID, we’ve been through a lot, what makes you continue to have, you know, this aspiration for improving public health? And what advice would you give to the practitioners out here listening and they’re frustrated, or they’ve been, you know, so exhausted.

LINDSAY WEAVER:

I also want to say just about Senator Kenley, he is a brilliant man. And he’s a good listener. And I think that is the point that I would say to people is that even if you disagree, fundamentally 100% with somebody take the time to listen, and understand what they’re worried about, what how, where they think that you’re trying to go right, or what they what they hope for, and really take that into account. I think the 100,000 compromises from where we thought we should go to where we ended up is why we ended up where we’re at, which is really a good place. And that took the time to listen.

What keeps me going and passionate is I believe, when I see those changes, I see them when I take care of my patients, as soon as I walk out the door, I see it in my team, I someone asked a question about the small needles, you know, some of our rural community or communities as they’re collecting the data right now we’re collecting activities from them, and then we’re working with them on their key performance indicators.

I had a local health officer call me and say, we identified four people with undiagnosed High Blood Pressure last week, or you know, a couple of weeks ago, and now all four of them are controlled, that matters that four people matter. So it’s my job, you know, at the state side to say, okay, for people that now have control blood pressure, let’s say we prevented a stroke and all of them have you we equate that to an improvement in outcomes and healthcare costs reduction, just based on that from the work that’s happening at the local level. So that’s what keeps me driving.

I get to meet and see these people in my work in public health officers. I take care of them in the emergency department, and I know that we’re gonna make a difference. And honestly, we don’t have an option. Our numbers continue have gotten worse over the last 10 years. They are not headed in the right direction. And I talked a lot to the legislators about that, too. Like we see things getting worse because we have to stop admiring the problem. We need to do something about it. So I’m excited that the work that Senator Kenley and Dr. Box did all of that work got us to where we’re at today.

Keith Coleman:

Well I can say that, and I’m sure others will agree, the two of you and the entire state of Indiana If you have inspired us, we’re going to go back to our state health departments. And we’re going to try to, you know, live up to what you have set as a framework here. So thank you both.

For those of you who are in the audience, we may not have gotten to all of your questions, but we will be sure to address some of these questions in some form or fashion. I’m going to also ask that we drop in our case study. The case study, basically, it’s a snapshot and summarizes some of the wins in the state of Indiana. So very important work.

Senator Kenley. Dr. Weaver, thank you so much. We really appreciate you sharing your insights. And again, kudos to you for all of the important work that you’re doing. And just continue doing and we look forward to hearing more.

On the screen, you will see additional ASTHO resources. We’ve outlined the ASTHO report and the workforce prospectus. And so that will also be made available to our audience. So thank you to everyone. Thank you so much. On behalf of ASTHO, I thank you for participating. Our website is ASTHO.org. Many, many resources from our state government affairs team and our public relations team and communications team.

And also, I would be remiss if I didn’t say thank you to all of the partners of our public health infrastructure grant, also known as PHIG. We will also make those tools available to you on our website, or you can visit PHInfrastructure.org to find additional resources to help strengthen public health and registered for upcoming events and trainings. You can also sign up for our newsletter. So thank you, everyone. Thank you. Thank you so much. Senator Kenley. Dr. Weaver, thank you. Awesome. So much. Thank you everyone. Goodbye.