By Paula Autry, CEO of Lutheran Hospital The strength of Indiana’s economy—and that of northeast Indiana is linked to many factors. One of the strongest but least discussed linkages is with the health of the Hoosier workforce. And while Indiana ranks highly among other states in business climate, we are 38th of the 50 states in overall health. Why? And, what can we do about it? One of the primary contributors to our poor health is our high smoking rate. Over one million Hoosiers—one in five—smoke. In Allen County the rate is 23 percent. Indiana ranks 9th worst out of the 50 states. While adult and youth smoking have declined in the past decade, they have now stabilized and we are at a dangerous stand-still. We see this trend in our work at Lutheran Hospital of Indiana to promote Hoosier health. The costs to Hoosier health are large and visible. Each year, 11,000 die from smoking-related illness and countless others get sick. Nearly 6,000 kids start smoking each year. There are 12,000 smoking-impacted births each year. The costs to the Hoosier economy are similarly large, but less visible and less well-known. Did you know that Hoosier businesses lose over $3 billion each year in lost productivity? Or that each smoker costs their employer $22 a day in extra business costs or $5,800 per year. Business leaders in our state are rightly concerned. In December, Raise It for Health—a campaign to reduce high rates of smoking in our state—worked with the Indiana Chamber of Commerce to interview 30 Hoosier business leaders from diverse industries. While they were bullish on the Hoosier economy, they saw the poor health of our workforce as creating troubling headwinds. Their top two health concerns were high rates of smoking and obesity. As one business leader put it: “Our state’s health is in the bottom quartile. No one wants to be in the bottom. There is an image issue and there is a competitive issue.” Another said, “A lot of states are doing better than us. Why can’t we do better? If we want to be all we can be – we need to change this.” Another interviewee pointed to a “rich heritage of being unhealthy,” putting a blunt point on a challenge that has long been an issue in our state and in our community. While they all saw the need to continue to invest in employee wellness, they expressed unanimous support for an effective policy to reduce smoking—raising the state’s cigarette tax. As one leader said, “This is something that we can actually do and there is data to support it. It’s a message that the time has come to end smoking in Indiana.” Indiana’s tax rate of 99.5 cents per-pack is below the national average and our state legislature is currently considering a bill to increase it. With just a $1.50 cigarette tax increase, experts estimate that 50,000 Hoosiers will quit smoking and 40,000 kids would never start. Rates of maternal smoking would decline and we would see 10,000 fewer smoking-impacted births over the next five years. Declines would be particularly steep among Hoosiers specifically targeted by the Tobacco Industry, including low-income households, African-Americans and youth. Beyond Hoosier health, the Hoosier economy would benefit. Businesses would have more resources to invest in growth and talent. Our workforce would be larger and more productive. Not to mention, the tax increase would reduce state Medicaid costs and generate greater than $300 million that could be directed to help more Hoosiers quit smoking and address our opioid crisis. A cigarette tax increase, more than any other policy on the table, would help our state move beyond tobacco to a healthier and more productive future.