The role of expertise, science in public policies in public health crisis
Dr. Donald Westerhausen Jr. and Dr. Richard Kovacs
Indiana Gov. Eric Holcomb should be praised for his political courage in his veto of Senate Bill 5 earlier this year, and the Indiana General Assembly, which overturned the veto, should reconsider the consequences of its action.
SB 5 prevents a local health department from implementing orders more restrictive than those issued by the governor, unless such orders are approved by county or city elected officials. The impetus of the bill was to address perceived inequalities from business and religious interests pertaining to those orders during the ongoing pandemic.
However, this change is critical to the future, as well, because many experts believe another global pandemic is only years to decades away.
Holcomb’s veto of SB 5 demonstrates his support and understanding of the role of expertise and science in developing and executing public policies during a public health emergency.
The Indiana Chapter of the American College of Cardiology represents the entire cardiovascular care team, including the majority of practicing cardiologists in the state. Our members are on the front lines of the COVID-19 pandemic. We also continue to battle the No. 1 cause of death in the United States — heart disease — both when it strikes acutely and in its prevention.
We are concerned that the General Assembly’s interpretation of medical risk and economic benefit is at odds with proven medical science. Look no further than the repeated rejection of an increased cigarette tax, a proven method to save thousands of lives that is supported by the Indiana Chamber of Commerce.
Keeping the community healthy is good for business in both the short and long term. Businesses need a healthy, productive workforce and healthy consumers with purchasing abilities to thrive. Public health experts are uniquely qualified in education, training and experience to ensure conditions in which people and businesses in a community can remain healthy, especially during an emergency.
Indiana statute mandates that members of a local board of health be “knowledgeable in public health” (IC 16-20-2-5) and establishes safeguards to ensure the composition of the board is bipartisan (IC 16-20-2-4). All board members are appointed by elected officials to provide expert scientific guidance on all matters that affect the health of our community, from vaccines to safer workplaces, healthier mothers and babies, to managing emergent circumstances where time and content knowledge are essential in saving lives.
Nationally, we saw during the early portion of the pandemic that the delay in aggressive contact tracing and mitigation cost lives.Time to act in such an emergency is the essence of public health.
Now, this new law allows elected officials, few of whom have medical or health training (as they could not appoint themselves to a local board of health), to overrule orders issued by a local public health department during a public health emergency. We all need to remember that the public interest in public health has always been served by the fact that elected county and city officials select and replace public health officials, just as the public has the power to select and replace elected officials.
Our hope is that the General Assembly will reconsider the wisdom of SB 5 during the next session. Instead, it should consider legislation like House Bill 1244, which addresses business and religious inequality by attempting to create a more targeted approach to ensuring that these interests are treated equally in a public health emergency.
We should celebrate the expertise and knowledge of public health professionals who produced the positive outcomes achieved in Indiana during the pandemic. Any deficiencies should be addressed with a scalpel, not a meat cleaver.
Dr. Donald Westerhausen, of Granger, is president of the Indiana chapter of the American College of Cardiology. Dr. Richard Kovacs, of Indianapolis, is past president of the American College of Cardiology.