Paul K. Halverson, founding dean of the IU Richard M. Fairbanks School of Public Health at IUPUI, has crisscrossed Indiana in the last six months to discuss opportunities for improving the health of Hoosiers. Reducing tobacco use tops his list of steps that could be taken to achieve that goal.
Other members of the Alliance for a Healthier Indiana joined Halverson on trips to more than 30 town hall meetings.
Alliance for a Healthier Indiana was formed in response to Indiana's 38th-place ranking in the nation for the overall health of its citizens. Members include the Indiana Hospital Association, the Indiana Chamber of Commerce, the Indiana State Medical Association, Anthem Blue Cross and Blue Shield, and the Fairbanks School of Public Health.
As bad as the 38th-place ranking is, the state ranks worse than that for several specific health measures, including 40th in obesity, 41st in percentage of smokers, 42nd in infant mortality and 49th in public health funding.
Those are all pressing health challenges, but Halverson said one stands out above the rest: tobacco use. In fact, Halverson said, tobacco use makes those other health issues worse.
That's why the alliance made reducing tobacco use its first priority.
"Tobacco use in Indiana is 50 percent higher than the national average, and that tracks to all of these terrible health statistics that we have," Halverson said. "When you ask what we could do that would have the greatest impact on health, quality of life and prosperity in Indiana, it all comes right back to tobacco."
Tobacco alone accounts for more than 11,100 excess deaths annually in Indiana, he said. "The opioid crisis is horrible. People dying of addiction and overdoses is terrible. But the number of those deaths is one-tenth the number of people who die each year from tobacco-related diseases."
Tobacco's impact on Indiana's economy is also substantial, Halverson said. Statistics show:
- There would be 175,000 more jobs in Indiana if businesses weren't restrained by the higher costs and lower productivity caused by smoking.
- The total annual cost to employers for each employee who smokes is $6,230, caused by higher health care expenses and lower productivity.
- The annual tax burden for each Indiana household due to increased health care costs caused by smoking is $1,125.
The good news about reducing tobacco use is that "we know how to do it," Halverson said. "We know that if there is the political will to actually change the tobacco use rate in Indiana, we could do it. There is no question it would work. The science is clear -- the research is absolutely clear."
Political will is needed because the first and most important step in reducing tobacco use is raising the price of the product, he said. In the case of cigarettes, that could be accomplished by raising the tax on a pack of cigarettes by $2.
"I know no one likes taxes," Halverson said. "I don't like taxes either. But think of it as a way to reduce tobacco use for people who want to quit."
Increase the price of the product, and it will drive people away from smoking. It works every time, Halverson said. "We will have far fewer smokers and an improvement in the state's overall health."
Raising the tax on cigarettes has to be accompanied by an increase in public health funding to, among other things, support an increase in tobacco prevention and cessation programs, Halverson said.
"Tobacco is a very addictive substance. The average person tries to quit 11 times before they are successful," Halverson said. "It's not ethical for us to just say, 'let's raise the price' and walk away. We need to raise the price, but then make services available to help people quit."
A third step is to raise the legal age at which people can purchase tobacco from 18 to 21, a move that's already been made by six other states and over 300 cities, Halverson said.
In Indiana, 95 percent of adult smokers start smoking before age 21. Most smokers would never take up the habit if access to tobacco were delayed until after 21.
Through the town hall meetings, the alliance hopes to not only generate an awareness of health challenges in Indiana but demonstrate the commitment people have to improving the health of their community, Halverson said.