As my boss Nate Silver wrote Thursday, most people in the U.S. don’t know much about Indiana Gov. Mike Pence, Donald Trump’s vice-presidential pick. That’s likely not the case among public health professionals, given Pence’s rather notorious recent history with public health policy.

Take, for example, an ongoing outbreak of HIV in southern Indiana. From December 2014 to May of this year, 191 cases of HIV, nearly all linked to the injection of the painkiller Opana, were found in Scott County, a rural area near the Kentucky border. Before the outbreak, there had been numerous deaths and known risks from the increase in injection drug use in the area for several years. Pence had long been a vocal opponent of needle exchange programs, which allow drug users to trade in used syringes for sterile ones in order to stop the spread of diseases, despite evidence that they work. Such programs were banned in the state when the outbreak started.

At the end of March last year, four months after the outbreak began, Pence declared a public health emergency, allowing needle exchanges to be opened in Scott County. Scott County Health Officer Dr. R. Kevin Rogers described the program as having “a tremendously positive and dramatic impact” and recently made a successful request to have the program extended until May 2017. At least four other counties have been allowed to start programs as well. Still, Pence hasn’t moved to lift the state ban on funding for needle exchanges and has made it clear in the past that he would veto any bill that tried to lift the ban statewide.

Pence has also shown a deep misunderstanding of basic public health principles in the past. In 2001, he wrote an op-ed declaring that “smoking doesn’t kill.” The evidence? “Two out of three smokers does not die from a smoking related illness.” Diseases are rarely the product of one thing. With lung cancer, for example, there’s a strong genetic component. Some people who don’t smoke will get lung cancer. Many people who do smoke will not. Relative risk, which measures the strength of the relationship between an exposure and a health outcome (smoking and lung cancer in this instance), is a funny thing; it can’t be used to measure the risk for an individual, only a group. And at that macro level, the risk of smoking is quite clear, as this oft-cited American Cancer Society chart shows.

Lung cancer isn’t even the most common negative health outcome from smoking. That distinction goes to vascular diseases that cause heart disease and/or stroke, and chronic obstructive pulmonary disease.

Pence’s home state of Indiana should be particularly concerned about tobacco: 23 percent of adults are smokers, the sixth-highest statewide rate in the United States. Fifteen percent of pregnant women smoke, nearly double the national average, and the state spent $2.93 billion in 2014 on health costs caused by cigarette smoking — more per capita than 31 other states, according to the Campaign for Tobacco-Free Kids. Still, Indiana has a cigarette tax of just 99 cents, lower than 35 other states, despite a wealth of evidence showing that increasing taxes on tobacco reduces smoking rates.

When a tobacco tax hike was proposed this year in Indiana, Pence made it clear that he was not in favor. The tax increase was subsequently taken out of the bill.

All that said, Pence’s track record on public health likely won’t have an effect on the election. Only 37 percent of registered voters said that health care was extremely important to determining who they would vote for this election season, according to a Kaiser Family Foundation poll released Friday.





FiveThirtyEight: Nate Silver speaks with John Dickerson about Mike Pence