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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"

Not even a year into her post as director of the Allegheny County Health department, Dr. Karen Hacker has faced her share of public health problems: startling obesity rates, an outbreak of lethal fentanyl-laced heroin and public outrage over the environmental effects of industry. Hired after County Executive Rich Fitzgerald ousted the 20-year health department veteran Bruce Dixon, Hacker has been charged with addressing everything from smoking to community violence. The former Harvard Medical School/public health professor – and executive director at the Cambridge-based Institute for Community Health – sat down with City Paper to talk about some of these issues and new directions for the health department.

You've worked in the public health world in a number of cities – what made you seek out a job in a place where fried pierogies and French-fry laden salads are the main food groups?

I'll be honest I just threw my resume in – I didn't think anything was going to happen. My experience has been many of these positions turn out to be political appointments and they're not really looking for other people. What Allegheny County offered was this really interesting scenario where you've got a county health department that is both the county and the city, so you don't have a competition ... you have a very progressive executive and now a progressive mayor. So, from a political scenario, there's interest in moving this forward. And there's still work to be done. The thing about Massachusetts is it's hard to move the needle from 97 to 98. It's a lot easier to move it from 40 to 50.

When you took this office, which was last September, you talked about changing the direction of the health department. Over the past 10 months, how you think the health department's direction has shifted?

The first thing is we've added deputies – so we've actually added some infrastructure. I spent the first six months basically just talking to as many people as I could ... a lot of people who are involved in sustainability efforts – which isn't always thought of as a public health – environment, trails and bikes and fitness folks. The way that the organization was managed before was a very flat organization and I get the impression that the director pretty much made most of the decisions. I get the impression that what I'm doing here is new to people.

There are a huge number of issues a health department could tackle –everything from community violence to smoking cessation. Some are regulatory, some are programmatic. How do you decide where to start?

The first thing I did was start looking at the data to get a familiarity with what is going on the community. Very quickly I started talking about obesity and physical activity, health disparities and the environmental issues. My first hire was the environmental health deputy, and I hope that sent a message to the environmental community that I'm serious about this area, because it's not an area in which I had a lot of experience. The thing about public health is you do your best to try to see into the future, but there are always going to be things that crop up. So when we have a number of heroin deaths, we have to jump in and deal with that. When we have a housing environment that [is] unhealthy, we [have] to deal with that.

What was the data telling you?

Clearly – like you said with the French fries and the salad laughs – there are lots of organizations that are trying to address obesity and physical activity, but the numbers have not gone down for children and adults. But I think that there's a new kind of feeling going on certainly in the Pittsburgh area, if not in the rest of the county, that's really pushing this agenda.

I think with the air issues – this is an issue that's longstanding in this community – there is a very active environmental group focused on everything from coke plants to diesel fuel to fracking ... they're not going to tolerate complacency in this area. And the good news is all the data suggests we're doing better than we've ever done. The bad news is they're still problems. I live in a community where some mornings when I walk out the door it smells like coal.


You said one of the things that attracted you here is this is a relatively well-resourced health department and a community where public health is taken really seriously.

When I mentioned resources I was really talking about the foundation community, which is extremely rare. I will not tell you the health department is extremely well-resourced; it's not. But I do think it's fascinating to see how important public health is to Allegheny County. I've spent more time talking to the press – it's hard for me to believe sometimes that they're really that interested in this.

We're kind of a pure health department: we have a big environmental department, we have housing, we have water, we have plumbing. When you've got all of that under one roof, you think about how those things fit together. And I think that makes it much more clear what a health department does ... I think a lot of people just have no idea what you do in public health. And I think that's tough for resources because when a city's deciding ‘where are we going to put our money?' – ‘we'll just cut the health department; we don't know what they do anyway.'


You mentioned the environment as one of your pillars ... I'm interested in your perspective on the risks of fracking.

The data that I have and the research that we've looked at – the benefit likely outweighs the risk at this point in time. There are risks: They mostly have to do with what happens at the surface and there are differences between dry and wet gas. The wet gas seems to be more problematic in terms of the exposure to benzene and other chemicals like that which are the ones that are particularly related to cancer risk. But in general, and this is where it gets challenging, natural gas is helping to clean up our air. As many of these energy plants switch to natural gas, particularly in places we can't control like Ohio, our air is getting better.

And by ‘benefit' you mean purely the public health benefit?

There's the public health benefit of natural gas ... But I think here there is certainly financial benefit, absolutely. Right now, the health costs of fracking – it's very amorphous.

How do you address concerns form some who might worry that because the county executive in this case has a drilling friendly position that people might not think the health department is an independent voice on fracking?

We do have a board, and the board is appointed by the county exec. So, ultimately, we work together. But if I believed there was a really severe risk, I would say that. I've gone to many of the public forums on this. There's a lot of storytelling, a lot of hearsay. One thing we're doing at the airport is we're monitoring. We're doing the before monitoring and we'll do the after monitoring. We'll be able to say what's actually happening. And unfortunately, given the longevity of fracking, it's really quite surprising there isn't better data out there.

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