On the Record: A conversation with Dr. Karen Hacker, director of the Allegheny County Health Department | News | Pittsburgh | Pittsburgh City Paper

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On the Record: A conversation with Dr. Karen Hacker, director of the Allegheny County Health Department

"The thing about public health is you do your best to try to see into the future"



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Why do you think that is?

I mean, I know that people complain that it's very challenging with many of the companies that they don't actually let you know what's in their fracking mixtures – so some people talk about proprietary information. The fact is solar and wind isn't up to the point where it's going to make us all very happy with all of our contraptions, so I think there's going to have to be combinations. The hard part about natural gas is it's still based on carbon and it doesn't move us one step closer from our dependency on that.

One other air-quality issue is the Shenango coke plant. I'm interested in your take on whether it's moved into compliance with the consent agreement?

Unfortunately, coal is a dirty business, and as long as we have coal plants or coke plants, this is not a one-shot deal. So you can see this pattern: You go in, you do the consent order, things get better and then they kind of slip. And then you do another one and then they kind of slip and I think that's very frustrating for the community – particularly the advocacy community.

In order to keep the slippage from happening, do you imagine inspecting more regularly?

There are already people who are out there basically every single day doing the inspections ... so they literally stand on top of the batteries and they look at the color of the smoke. They've had very few problems since the consent order, but if you start to see more of those happen, you have to start getting back into legal action.

So is there a different strategy to keep compliance up between consent agreements?

You know, I don't know. I don't know. Obviously – the business people – it's their responsibility to do this.

The hope is the company itself will take the consent agreement more seriously?

Well, that's what they have to do. If they don't comply with the consent agreement, there's additional legal action that can be taken.

And is the difference in the past they haven't pursued that legal action?

I can't speak as much to the past in terms of that. I think there have been other fines levied against them. Some people will say they just consider this the cost of doing business. We use what we have available to us, and I think the advocacy community uses what's available to them so they can get public outrage and they can mount pressure.

But you're not sure if you'll be more aggressive than the health department has been in the past?

Well I think we're being pretty aggressive right now, so I think we're going to do our best to stay on top of it.

I want to switch gears a bit. How's the Affordable Care Act affecting the health department's relationship with hospitals or communities?

We have a scenario in Pennsylvania right now that makes it a little tough because we don't have an expansion of Medicaid. So we continue to have a fairly large group of people that are uninsured. That said, the other thing that the ACA had in it was that they expected hospitals to do needs assessments every three years for their non-profit status. And that, I think, is one of the things that is starting to make hospitals and public health departments start to talk to each other in a different way.

The other piece that is really shifting is this whole construct of population health. It's ‘epidemiology comes to the delivery system.' Because basically what it says is you've got this group of people and now you're responsible for looking at them as a group of people ... doctors don't look at people that way, they look at it as the individual sitting in their office. They don't think about ‘all my diabetics' or ‘all my people with hypertension.' And I think if we're going to control healthcare costs, that this is actually quite a radical change for the healthcare delivery system. So I think it for the first time brings a light into this whole concept of population health which is basically what we've been doing in public health forever. And so now there's a lot going on talking about health and overall policies and making healthy choices the default choice. A lot of that falls into our purview as a health department.

What are the health disparities in the county that are of most concern to you?

The two that have just jumped out – you don't need to be brilliant – are race and geography. Almost every single negative consequence that we have right now -- by and large -- blacks are more at risk than whites. But the other thing is we have a lot of disparities in our geography. We have communities that look dramatically different from other communities.

Are those communities drawn on racial – or socioeconomic – lines?

Probably more socioeconomic. You can almost look at a strip that runs down the Mon Valley and if you look at those communities ... they're really blighted and they didn't get the education, the hospital drivers that the city itself got. And you go out there and they're isolated and their air is not so great and they're property value is really low. And when you look at who's in those communities they have probably the highest proportion of minorities, but I would tell you that the non-minorities in those communities aren't doing so well either.

The restaurant grading system is on the table again.

Hopefully the horse is out of the barn. We've been doing everything we need to plan for it and we've been very methodical in our approach. I would find it very surprising if things shifted at this point.

Is there evidence that restaurant grading systems have positive public health effects?

The particular evidence they've seen in New York is less about do they see less infectious diseases, for example, and more about the fact that over time there are more and more "A's." I don't know that there's evidence right now that there's fewer outbreaks. I do think the restaurant industry is correct is that you go and do an inspection once a year, so you don't know what's happening every single day, but I think there's an inherent incentive in there that I'm hoping will make a difference.

Your predecessor [the late- Dr. Bruce Dixon in a 2009 Pittsburgh Post-Gazette profile said he didn't eat fruits or vegetables because "cows eat vegetables. I eat the cow." What's your stance on vegetables?

[Laughs} That's an interesting comment. I love ‘em!


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