In September 2013, the Allegheny County Health Department (ACHD) welcomed Karen Hacker, MD, MPH, as its new director. Before moving to Pittsburgh, Dr. Hacker was executive director of the Institute for Community Health, a community research organization within the Cambridge Health Alliance (CHA) in Boston. She was also the senior medical director at CHA and served as an associate professor of medicine at Harvard Medical School and School of Public Health. Dr. Hacker is also secretary to the Allegheny County Board of Health.
To help Courier readers get to know Dr. Hacker, we asked her a few questions. We also asked her to weigh in on smoking, this month’s health issue.
What led you to Pittsburgh and to ACHD?
I was interested in a different type of challenge. I’m particularly interested in the relationship between public health and the health care delivery system, particularly in this Affordable Care Act era. I wanted a leadership position where I could really have an impact, and I wanted to be in an urban environment. I saw in this position a potential for great alignment among academics, the community and government players. That this health department is run at the county level was appealing because it gives public health a chance be a real leader in a larger community.
Why did you choose to work in public health?
I grew up in a family with a history of community activism. At a young age, I really felt like I wanted to make a difference. I was always involved in community and volunteer activities and continued to be so through college and in medical school. I did my medical residency in a public hospital. I worked with many different populations and with community health centers. During my fellowship, I started school-based health centers. I enjoyed building programs and seeing the impact of those programs. It was all very appealing.
What do you hope to accomplish in Pittsburgh through this position?
I’d really like to reinvigorate the health department. We want high quality results and excellent customer service. We want to be leaders in public health. I wasn’t hired to do “business as usual.”
There are a lot of potential partners in the community—not just from the health sector, but from the environmental and transportation sectors, which can provide a big net to bring people together to think about a social movement.
I’m particularly interested in obesity, physical activity and health care access. Another interest for me is health equality. I’m new here, so I’m still trying to understand the community—its historical roots, what is going on today, who the leaders are, who the appropriate community partners are and what the appropriate interventions are. We have obvious racial, economic and geographic disparities in the county. I’ve been trying to spend a lot of time out of the office meeting people and understanding the county.
Other areas are also very pressing—storm water issues, air quality, etc.
Can you speak to health disparities with regard to cigarette smoking in Allegheny County?
According to a 2009 Allegheny County public health survey, 24 percent of male and 23 percent of female adults smoke. A large disparity exists between the rate of African American and White smokers. In the county, 35 percent of African American adults smoke and 22 percent of Whites smoke. There are dramatic disparities in education with regard to smoking. People with the lowest amount of education smoked at a much higher rate than those with college degrees. The same was true for economic disparities—lower-income populations had a much higher rate of smoking, despite taxes on tobacco products. Higher-income populations had a much lower rate of smoking. That says a lot.
One challenge now is how to get to people who smoke despite public health efforts. I don’t know enough yet about access to cessation programs through health insurance programs here, but I do think we need targeted interventions. With cigarettes, we need to create an environment where smoking isn’t accepted. But we also need to be able to offer help to people who want to quit. We need to offer opportunities that don’t cost much and that are easy to access.
We have had success in reducing the number of smokers at a broad level, but we need ways to target the specific groups of people who are still smoking. We can’t take our foot off the gas just yet!
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