Dr. Karen Hacker executive director of the Allegheny County Health Department
Dr. Karen Hacker Credit: Photo by John Colombo

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.

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!

This article appears in Jun 18-24, 2014.

14 replies on “On the Record: A conversation with Dr. Karen Hacker, director of the Allegheny County Health Department”

  1. Karen Hacker’s comments essentially supporting fracking should come as no surprise. The position of Health Director is an appointed position by County Exec Rich Fitzgerald who has always made it clear that he expects complete loyalty and subservience to his actions and political attitudes. Fitzgerald, like Corbett, is beholden to the fracking companies. He made that clear in publicly revealed emails in which he demanded campaign funding from the industry, was well rewarded, and is paying back by giving up our public parks to the frackers. Hacker, on the other hand, in her comments before the County Parks Committee discussing fracking in parks, made it clear that she knows nothing about health effects of fracking. Worse, in the above interview, she describes the many scientific studies done showing detrimental health results as “storytelling” and “hearsay”. It’s interesting to note that this is the industry line as well and does not bode well for the health of our community when our Health Director so willingly and eagerly adopts the industry position rather than delving into the research done on fracking and the reports from various medical associations, especially pediatrics, warning us that “danger lies ahead”. Politics must never be allowed to determine medical and health decisions. Unfortunately, that’s exactly what’s happening in Allegheny County.

  2. Karen Hacker is Executive Director of Allegheny County Health Department? Karen’s opinions reflect more in alignment of the Director of Marcellus Sale Coalition and has nothing to do with a health director. Any one interested in the people’s health would ask for a moratorium on slick water hydraulic facturing and not state that storytelling and hearsay is the basis of health studies.
    The large particulate matter has decreased in the air of Allegheny County due to the decrease in coal fired plants but the small particulate matter increases as in low lying ozone for which our area has an overabundance and will increase, the greater the gas drilling activity. Small particulate matter destroys lung cells and penetrates into the blood and thus into the brain. I surely would not want Karen looking after my health and well being, perhaps she is better suited to protect my check book. The love of money is killing us. Renewable energy NOW.

  3. It sounds like the “data” Dr. Hacker has limited her knowledge to is straight from the industry and the person who gave her the job, county executive Fitzgerald. By not investigating and demanding that health impact studies be done, we have what seems to be a case of negligence.

    There have been increasing peer reviewed health studies released this year showing alarming health impacts for people living near ALL drilling activities. Especially CHILDREN.

    You can start here which was read and publicized across the globe last month! http://ehp.niehs.nih.gov/1306722/

    Then we can all read the news today which shows the “storytelling” talking point is straight from the industry play book. Moor proof that many of our governmental leaders are promoting this industry instead of the tax paying citizens. http://stateimpact.npr.org/pennsylvania/20…

    It is unacceptable that the people elected have decided to PROMOTE this toxic industry in the name of “financial benefit” above PROTECTING the tax paying citizens that pay their salaries! There is growing evidence that people (especially children) living near drilling are experiencing the same serious health impacts all over the world. Doctors have said that people who live near natural gas development sites – including well pads and compressor stations – have suffered from skin rashes, nausea, nosebleeds and other ailments. This is why with any other industrial process Environmental along with Health Impact studies are done. Before the entire process is permitted. Now we have contamination of our health, environment and especially our democracy.

    We also have a major case of neglecting to preform “Due diligence” before permitting such activity according to the ruling from our PA Supreme Court in the Act 13 ruling. In the long run, We the taxpayers will be funding this entire boom and bust toxic war on the people!

  4. Any health professional worth their salt will under no circumstances state that fracking makes the air cleaner. That just isn’t possible. Natural gas is not a bridge fuel; you cannot replace one fossil fuel with another and call that a bridge-especially when all the equipment required to produce that gas is all diesel powered. The drill rig itself-diesel engines. The hundreds of semi truck trips, all diesel powered trucks. The compressor stations-diesel powered. Whatever gains there may be using gas over coal is lost in the extraction process, and is highly likely just as bad if not worse.

  5. “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.” Dr. Karen Hacker, Director, Allegheny County Health Department.
    ——-

    Dear Friends:
    I take issue with everything Dr. Hacker has said in her interview. “[R]esearch that we’ve looked at…” What, indeed, has she been “looking at?” More importantly, what didn’t she look at? What did she miss? There is a wealth of peer reviewed, published scientific papers and a record of countless public health issues to consult and consider. Her remarks in response to this significant body of scientific work illustrating the clear threats to the Public’s health from Fracking? “Oh, it isn’t all that bad.” “Amorphous?” That doesn’t sound very scientific to me and does not square up at all with the science or the stats.

    She also states, “There’s a lot of storytelling, a lot of hearsay.” I agree, and the Oil & Gas industry writes the story line that Dr. Hacker so aptly, without foundation, tells.

    What I “looked at,” in print, was Dr. Hacker parroting the same scripted talking points spouted by ACE Rich “Frack’n Fitz” Fitzgerald, provided to him by friendly fracking industry lobbyists, lawyers and corporate officers.

    If Dr. Hacker continues to spout such talking-point baloney, she certainly runs the risk of becoming known as “Dr. Karen ‘The Political Hack’ Hacker” in political pundit and blogger circles.

    So, Dr. Hacker, our Allegheny County Minister of Deciding How Much Poison Corporations Can Shove Up Our Butts & County Economic Development Amorphous Weights & Measures Bureau Chief, has made her position known as to any concern for the impacts of Fracking on the Public’s Health; sadly, not much.

    I am sure that Dr. Hacker’s boss, ACE Frackin Fitz, was quite pleased with her nakedly ludicrous comments in her interview in City Paper (i.e., “a very progressive executive”).

    (See: http://www.pghcitypaper.com/pittsburgh/on-…)

    Just as much as Frack’n Fitz wasn’t pleased with former ACHD director, the late Dr. Bruce Dixon, “who had served in the post for 20 years and subsequently filed a lawsuit claiming wrongful termination.”

    “Dr. Dixon was fired by the County Board of Health, which acted at the request of [ACE, Frackin Fitz], in March 2012”. (P-G, Dixon Obit; 2/20/13)

    That’s newspaper-speak that means in politics-speak: “Frackin Fitz leaned hard on the “independent” board to be rid of Dr. Dixon.”

    “Mr. Fitzgerald reportedly wasn’t happy with how Dr. Dixon handled grading of restaurants, diesel-idling regulations and permits for air pollution, among other issues.”(P-G Dixon Obit; 2/20/13).

    Dr. Dixon, who had the nerve to look solely to the Public’s health, unencumbered by benefits, outweighing any costs, that might flow to Frack’n Fitz’s “job-creator-class” and very “progressive” friends. Dr. Dixon and the Public’s health was getting in the way of power and money; irritating the ruling oligarchy and contributors alike. For that, Dr. Dixon’s directorship under Frack’n Fitz was doomed.

    So, to usher in this “new day” at the Allegheny County Department of Health & Happy, Amorphous Talk, I heard rumors on Grant Street that they are coming up with a new motto to be carved in stone over the ACHD’s front door:

    “We Guard the Public’s Health in an Amorphous Way or, Not at All, Should It Get In the Way of Political Power, Private Wealth, Job Creators and/or the Barest Hint of Some Amorphous Economic Benefit.”

    The ACHD’s new motto is supposedly to commemorate ACE Frackin Fitz’s conformity with his equally politically progressive Fracking ally, Gov. Tom Corbett, and his PA Dept. of Health’s new standard of care; don’t take calls from people who were sickened by drilling operations.

    (See: http://stateimpact.npr.org/pennsylvania/20…)

    Hmmm. I wonder if ACHD Director, Dr. Karen Hacker, might have a pre-signed resignation letter stashed away in Frack’n Fitz’s desk drawer? You know, just in case she should she change her tune? The way she was being so amorphous in the CP interview one would think it a strong possibility.

    If any ACHD employees would be interested, in the strictest of confidence, in leaking any suppressed public health information, my transom is always open.

    Douglas Shields

  6. She totally ignores global warming as a public heath concern! And studies have shown that fracking contributes methane, a greenhouse gas 100x more powerful than CO2. Recent reports clearly show that we are on the brink of catastrophe. Furthermore, studies in 2005 showed that these effects were irreversible. I’m very concerned that she breezed over this entire issue, and one that is clearly in the domain of a public health department. I wonder how she will react when the public starts dropping like flies as they did in Europe in 2003 and Russia a few years back?

  8. So many great posts cover my concerns. She embarrasses herself as a professional by being an industry shill! Must be paying her a fortune to do that!

  10. The fracking companies must make full disclosure of all the chemicals they use in their process of fracking for natural gas. An have full documentation of how their fracking waste is stored and disposed of. They should also be required to have full and complete monitoring of the air around their fracking operations. These requirements are necessary for the public’s safety. The air and water are not static, they flow and move. An we need both to sustain our and other life. With that in mind we should do all we can to not pollute them!

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