On this episode of Kentucky Health, host Dr. Wayne Tuckson welcomes Dr. Steven Stack, the commissioner of the Kentucky Department for Public Health. Dr. Stack gives an update on COVID-19 in the commonwealth in early 2022 but primarily discusses other urgent public health concerns in Kentucky and how his department is addressing them.
Positive News on the Pandemic
When the COVID-19 pandemic struck Kentucky and the rest of the world in spring 2020, Dr. Stack and his colleagues at the state public health department were summoned to act quickly and decisively just months after Stack took the position as commissioner.
After a surge caused by the Omicron variant during late 2021 and into January, COVID-19 positivity rates have started to decline. But Dr. Stack believes that there are still many challenges ahead particularly for healthcare workers – in fact, he believes that staffs at hospitals and clinics may not fully recover from the effects of the pandemic for years to come.
“The longer-term thing I’m most worried about is the impact on the acute care healthcare workforce,” he says. “Because of the strain and distress people have faced – the doctors, the nurses, the therapists and others – there’s been a large number of people who have left the profession of medicine or left healthcare professions and so the workforce is smaller. And the ones who remain are under a great deal of stress because they have to deal with a lot of sick people, and they’re facing death a lot more frequently than they usually would.”
The nursing workforce in particular has declined during the pandemic, Stack notes. He says that Gov. Andy Beshear and other leaders in state government are working to find ways to increase nursing school enrollment and to incentivize recent graduates to remain in Kentucky when they start their careers.
Stack is more optimistic about society in general; although he believes some people may change habits to an extent and that no one will forget the pandemic happened, he does envision a future where many activities return to near-normal levels.
“All pandemics end,” he says. “We will get back to enjoying things, having normal graduations and parties again, so there is a brighter day ahead. But we’ll be different for having had the journey.”
State Public Health Agency Has Many Roles
“With the department for public health, the average person doesn’t really appreciate the breadth of it, because you have no reason to,” Stack says. He explains that the department has over 450 people working in it and also enlists around 2,000 more staff through local public health departments throughout the commonwealth.
The state department has seven divisions, Stack says: Maternal and Child Health; Women’s Health; Laboratory Services; Epidemiology and Infectious Diseases; Prevention; Public Safety; and Administration and Financial Planning. The two laboratories conduct research and perform studies that no other lab in the state is equipped to do, such as newborn screening for all infants born in Kentucky and bioterrorism testing. The public safety division is currently coordinating with other agencies to assist Kentuckians in areas devastated by tornadoes in December 2021.
Stack says that the state public health department works closely with hospitals, clinics, pharmacies, and doctor’s offices in many ways. For example, during the COVID-19 pandemic Stack and his colleagues advised health care administrators about managing resources when the infectious disease spread, helped to secure federal assistance, and coordinated the National Guard to provide assistance to burdened hospitals.
One of Stack’s goals as public health commissioner is to reduce health inequities for Kentuckians. He concedes that many citizens lack access to quality health care and that communities in both urban and rural areas are affected by social determinants such as poor air quality, food insecurity, and poverty that lead to poor health outcomes in residents.
“We have a long way to go, and unfortunately this gets politicized,” he says. “My objective, and our mission at the Department for Public Health, is to ensure that every Kentuckian can reach their full human potential. That’s white, that’s black, Hispanic, rural, urban, it’s Democrat, it’s Republican.”
Stack did not anticipate having to manage a historic pandemic soon after taking the job as public health commissioner, but he credits the department’s workers across the state for going above and beyond their normal duties to help steer Kentucky through very trying times. He hopes that their service has made Kentuckians aware of how important a good public health system is to a functioning society.
“You know, state public health workers put in incredibly long hours and work very, very hard, and do it often with little to no recognition,” he says. “I think one of the biggest joys of this position, which has been a bizarre journey… is that the people who work in public health, the hundreds and thousands of people I describe, feel that the work they’re doing is having the chance to get the attention it warrants, and that their work is being celebrated.
“Most of us do our jobs because we believe it has value, purpose and meaning, not just for a paycheck,” he continues. “And I can just tell you, it has been one of the greatest privileges of my professional life to serve with these teams.”
Efforts to Reduce Kentucky’s Chronic Health Problems
For over 20 years, Kentucky’s public health has been severely affected by an opioid epidemic that has claimed the lives of thousands of the commonwealth’s citizens. Dr. Stack says that overdose deaths rose nationwide during the COVID-19 pandemic from about 71,000 in 2019 to over 100,000 in 2021.
“It’s an escalation that was made worse by the COVID pandemic, but honestly it was also worsened even more so by the fentanyl problem,” Stack says. He describes fentanyl as a synthetic opioid that is far more potent than opioids such as heroin derived from poppy seeds, and he says that many drug dealers mix fentanyl with methamphetamine when they make that commonly used and illegal stimulant. “What happens is that someone gets access to the drug and they use it, and they only have to use it once and it ends their life because it’s so powerful,” he says.
Stack believes that in order to reverse the trend, society needs to recognize that drug users are suffering a physical disease – “It alters their brain chemistry,” he notes. “It takes a prolonged effort to help them get through (addiction), so we need to stop stigmatizing them, find ways to be supportive, and address the problems that go with it, such as homelessness, housing instability, and having social supports and access to treatments and therapies to help them.”
Syringe service programs, which provide clean needles for drug users and also coordinate counseling to help them get into treatment, are available in 40 different local health departments across Kentucky, according to Stack. He encourages viewers to contact one of those programs if they know someone who needs help or if they themselves are in need.
According to 2019 data from the Centers for Disease Control and Prevention, Kentucky ranked second behind Mississippi in cancer mortality rate, with 176.4 deaths per 100,000 people. Stack says that turning the tide in cancer diagnoses and deaths among Kentuckians is a long-term project, but he adds that there are more preventative options than ever before for many types of cancer, including colon cancer and lung cancer that are prevalent in the state.
“For colon cancer screening, for those who don’t have health insurance or don’t have preventive coverage benefits, you can get free Cologuard kits,” he says. The Department of Public Health offers these online or by calling (859) 309-1700 or (877) 597-4655. Likewise, the department promotes taking the human papillomavirus vaccine for women to prevent cervical cancer, and strives to educate citizens about preventive screenings for lung cancer (if eligible) as well as mammographies for breast cancer and prostate exams for prostate cancer.
“I think a big thing we’ve done in Kentucky is, we’ve expanded Medicaid,” Stack says. “When the governor expanded Medicaid and kept it expanded, more than 1.6 million Kentuckians are on Medicaid, and that means those individuals have access to preventive health care services and can go and get these screenings and hopefully keep themselves safe and well.”
For patients who cannot pay the full cost of their prescription medications, Stack recommends contacting the Kentucky Prescription Assistance Program (KPAP) at 1-800-633-8100 or online. “You’ll call, they’ll talk with you and hear your situation, and tell you if you qualify either for financial assistance to get your prescription drugs discounted from pharmaceutical companies or vouchers through pharmaceutical company programs,” he says.
Another public health initiative addresses radon, a colorless, tasteless, and odorless gas produced by uranium in soil or rock as it deteriorates. Radon exposure is the second leading cause of lung cancer in the U.S. behind smoking, and it can be found in many basements and foundations in homes across the state. Stack informs viewers that the state public health department offers free radon testing for all Kentucky homeowners regardless of income. He recommends contacting the local health department and requesting a testing kit. “You can request a kit, they’ll send it to your home, you follow the instructions and send it back, and they’ll analyze it and give you the results,” he says.
Stack says that resources to help folks struggling with mental health problems are lacking, noting that there are only about 100 child psychiatrists in Kentucky and that around three-quarters of that group work in or around Louisville and Lexington. However, he says that the state has recently been awarded a multi-million dollar grant to help enlist primary care physicians to provide mental health services since they are usually the front-line point of contact for patients.
According to Stack, new data from the CDC found that 32.5 percent of Kentuckians are physically inactive, which is a leading cause of diabetes. He also cites recent data identifying Kentucky as a leading state for childhood diabetes (ages 10 to 17) – a very concerning statistic.
“What we really have to do is make physical activity a more regular part of our lives,” Stack says. He adds that many Kentuckians, including himself, need to make better dietary choices. “We need to do a lot more shopping around the perimeter of the grocery store, where the fresh fruits and vegetables and poultry live,” he recommends.
Stack observes that losing around 5 to 10 pounds is often enough to prevent a person who is prediabetic from becoming diabetic. “A little bit goes a long way,” he says.