What is the relationship between public policy and private behavior? Nowhere is that more interesting to study than on the issue of health.
In what should come as a surprise to absolutely no one, Indiana has slipped to the bottom 10 among states in the 23rd annual report on the nation’s health by the United Health Foundation. Our attention to health matters has always placed us low on the list, and this year we dropped four places to 41st. For the sixth year, Vermont was rated the healthiest state, and Louisiana and Mississippi tied for last.
In one way, the report is misleading. Most of the criteria used – such as obesity, sedentary habits and smoking rates – are measures of individual behavior, and those have nothing to do with where people live. People choose to smoke or not, live sedentary or active lives, eat healthy or unhealthy foods. And people in Indiana as well as Vermont and Louisiana have to live with the consequences of their decisions.
And even some of the measured factors not tied to private choice need to be taken with a grain of salt. Public health funding on a per capita basis is low here compared with other states, for example. But that statistic doesn’t take the relative cost of living into account; what $1 buys here will buy more or less in other states. And Indiana has the “second-to-worst air pollution in the U.S.” But what percentage of people live in the high-pollution urban areas here as opposed to other states?
It is worth talking about public policy despite that fact that health is mostly our individual responsibilities and changing our own behavior is something no one else can do for us. But humans are social creatures. We take many of our cues about what to do by watching what others do.
How much money the state dedicates to public health funding, for example, tells Hoosiers how committed public officials are to our collective well-being. And how the money is spent – whether mostly on combating disease or on promoting wellness, for example – tells us what the state’s priorities are. How much public attention is paid to health can influence how much attention to it we pay in private.
Bad behavior – when there is enough of it – can create more bad behavior.
Gamblers like to see other gamblers around them. Smokers are comforted by the presence of other smokers. The more gambling and smoking is decreased by public policy efforts, the more people who will give up gambling and smoking on their own.
We’re on our own but in it together, in other words. Our poor health ranking reminds us we can do better.