The meeting was one of 13 public forums held across Allegheny County last fall as part of a new public health campaign to inform and engage residents in local health issues that had attracted little media attention. And after Hacker assured reporters her department was monitoring Ebola developments in the country, they left the building, taking their camera crews with them.
Had they stayed, they would’ve been briefed on chronic diseases and which ones pose widespread health threats in the neighborhood. They would’ve heard residents and community health organizations confess their health needs. And they would’ve caught a glimpse of how a new focus on improving local health data and community engagement is changing the way public health is practiced in Allegheny County.
Not business as usual
Using data to drive decisions, seeking public input, assessing local health needs and engaging communities to improve their well being are a departure from the way public health has been practiced in the past, not only in Allegheny County, but in many places throughout the nation. Historically, public health departments were created to control infectious diseases, many of which are now contained, such as polio and whooping cough.
Plenty of serious health concerns, such as rising rates of obesity and access to adequate healthcare, are found in communities across America today. And chronic disease and other issues are well documented nationally by data gathered with instruments such as the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention.
But local health departments and their data systems have been slow to adapt. “It’s a change in what the nature of public health is all about,” says Donald Burke, dean of the University of Pittsburgh’s Graduate School of Public Health. “Our emphasis has to be on chronic diseases: smoking, cardiovascular disease, cancers. Things like that are not the same discrete events like infectious diseases. Public health has changed to where we are more acutely aware of obesity, diabetes and chronic disease, and we still don’t have systems in place to deal with them. [Hacker] has made them priorities even though the resource base she inherited didn’t allow for doing that well.”
The Health Department had struggled for years to maintain good statistical databases, which made it difficult to make informed decisions on public health priorities based on firm local data, says Burke. It didn’t, for example, have an epidemiologist or a chronic disease unit — basic infrastructure needed to effectively address serious illnesses such as cancer and cardiovascular disease.
“I was not happy with the direction of the health department,” says Allegheny County Chief Executive Rich Fitzgerald. “That’s why we did a national search to try to bring someone to the health department who could really transform it and be active in the community in addressing personal health, environmental health and all the aspects of public health that the health department is tasked to do.”
Hacker took the job midway through 2013. And the former Harvard Medical School professor and executive director of a public health research organization in Boston considers her hiring as evidence of the county’s willingness to embrace reform. “There are plenty of health departments around that want the health director to do what health directors have done for years, which is: nothing creative, just take care of the business that shows up on your front door. I was very clear about my vision and my intention to not do business as usual, and everyone has supported that.”
When Hacker came into office in September of 2013, the most recent and relevant county-level heath data she had to work with came from a 2009-10 University of Pittsburgh School of Public Health survey of 5,000 residents modeled after the CDC’s national survey system.
The data revealed that there are parts of Allegheny County that are much healthier than others. And there are pockets of under-resourced communities where nearly all of the indicators of chronic disease are high.
“It became pretty evident very quickly for me that there were some absolute obvious priorities, and those include disparities. We have very evident disparities or health inequalities in our county,” Hacker says. “They’re racial, but they’re also geographic.”
Many of the indicators for chronic disease also remain high in the region.
Some 23 percent of county residents still identified themselves as current smokers, which is much higher than the 19.6 percent national rate, according to the latest CDC data.
Obesity and physical inactivity levels remain high in a region that celebrates pierogies and sandwiches overflowing with French fries. Some 62 percent of Allegheny County residents are obese or overweight.
And while some measures of air quality have improved in recent years, the county fails to meet federal Clean Air Act standards for ground-level ozone, which exacerbates asthma and other respiratory ailments.
Prevention drives reform
As troubling as some county health indicators are, the problems they identify are preventable, and Hacker spent her first year in office reforming the department in ways she believes will better address them.
She created bureaus to focus on specific aspects of public health in a department that previously had none. She expanded the capacity of the Office of Epidemiology and Biostatistics to better provide timely and accurate county– specific health data critical to identifying priorities, informing intervention and measuring progress. And when she found that the department of 370 people was supervised by a single deputy, she hired four more.
The Health Department is also working toward earning certification by the Public Health Accreditation Board, which for the first time would require the county to adopt national public health standards.
Updating and improving the department’s data collection and analysis is another initiative. The department analyzed and compiled existing data specific to each district in the county and presented the data in the series of community meetings as part of its recent “Our Health, Our Voice” campaign. The meetings, such as the October gathering in Turtle Creek, allowed residents to see community-specific data and talk about their health concerns and needs with public health officials. The data and public input will inform the first large-scale community needs assessment done in the county.
And in January of last year, the health department took the reins of a “Live Well” public health campaign launched by Fitzgerald with a diverse group of nonprofits, community health organizations and other stakeholders as partners. The campaign hopes to engage communities large and small in improving the health of residents by creating wellness strategies and events around evidence-based practices for increasing physical activity.
Changing health-related behaviors is a tall order, but one Hacker says is possible with the right support. “I find partnerships and team building to be successful strategies. The energy that they bring makes a difference.”
Local foundations have expressed a willingness to lend their resources to the cause. Local research universities have shared their expertise and shown interest in collaborating. The region’s hospitals and others in the healthcare delivery network have been supportive. And none have bristled at the notion of working with a newcomer from Massachusetts.
“I think the potential for change is very high,” Hacker says. “There are almost always challenges as an outsider. But I haven’t experienced that, and I think that speaks to the desire to improve and change. Are the ingredients here? I think they’re here.”