Dr. Steven Stack
You were appointed shortly before the pandemic took hold. Can you reflect on those first few months and ramping up a statewide response?
My first day on the job was Feb. 10 and the first patient we announced in Kentucky was March 6. Coming in and meeting a team of 450 public health workers here at the State Department of Public Health over a few weeks and then to suddenly be confronted with a once-in-a-century pandemic was certainly a steep learning curve. We have a wonderful team here, and I have two wonderful deputies, a wonderful chief of sta. and a number of other operational leaders for our divisions who do terrific work supporting public health so, thank goodness, the state was well prepared with those dedicated and talented people. We all learned a great deal together and still are.
Our statewide health systems were already stressed, and I know there was policy reform on the table. What’s the status there?
Unfortunately, here in Kentucky and in many other states, public health has been chronically underfunded and has also faced cuts over the years, which has degraded its ability and readiness to respond quickly to certain crises. That’s an unfortunate reality. Again, it’s other states as well, but in Kentucky we have some very poor public health statistics having to do with how common diabetes is, obesity, untreated hypertension, various types of cancers, substance use disorder, challenges with maternal fetal health and infant mortality rates, so we have a number of areas where a lot of work needs to be done.
Then we also have all the disease surveillance and infection control issues that we deal with — transmitted diseases, tuberculosis, hepatitis and various other infections — all that work with the public health system is unfortunately at substantial reductions in resources devoted to it by state and local governments over the last decade or more, which has been a real challenge. I think the public is seeing now, with COVID-19, just how critical having an infrastructure is, as we’ve had to rebuild a fair amount of it to scale up for this disaster.
"I think the public is seeing now, with COVID-19, just how critical having an infrastructure is, as we’ve had to rebuild a fair amount of it to scale up for this disaster."
So, you’re correct, when I first started this job public health transformation was the single-biggest thing we were facing probably in a generation. About half of the health departments across the state — we have 120 counties and 61 local health departments — faced financial insolvency within two years absent major structural reform, a chunk of which has to do with pension reform related to state government. There were three pieces of legislation that were being reviewed and considered by the legislature earlier this year. The structural one, the primary one, got passed but the COVID pandemic then interrupted and altered the trajectory for some of the financial reforms that had to go with it. We are in the midst of trying to reform the public health system, but we’ll need the legislature to continue to make efforts in future sessions that further advance financial and structural reforms.
You have a business background (Stack earned an MBA in 2017) as well as experience in emergency medicine. How have those skills helped?
In Kentucky, the commissioner for public health is required to be a physician. I have a bias in this of course, but I think having an emergency physician in this role — I think I’m probably the first emergency physician to ever have been state health commissioner for public health — was particularly fortuitous timing, because we are clearly in the midst of a large-scale emergency.
Some of the traits that I trained in and became proficient in have to do with making high-stakes decisions quickly and efficiently with limited data while still being accountable for good results. That’s a different skill set. You don’t have time to have all the information you wish you had or to have all the resources you would like or need, and yet you still have to get the job done. We have to be able to function and operate in that that kind of domain. I was a practicing emergency physician for more than 20 years, and I think that background has been very helpful as we’ve had to navigate this particular crisis.
This role, if you look at it from a management perspective, as I said, encompasses about 450 state employees and traditionally manages close to $400 million worth of federal and state financial resources to support public health programs. That involves running a high-complexity reference laboratory to support the entire state, women’s health programs and supporting healthy childbirth and healthy childhoods, environmental safety inspections and testing — we support the program that inspects restaurants, we do food-safety inspections, milk-safety testing, pool safety, radon testing — as well as preparedness for emergency responses, among other areas. Here in the COVID-19 pandemic, we are the lead agency amongst many other agencies that have roles to play.
In all, there are around 3,000 total public health employees across the state who are supporting all 4.5 million Kentuckians in one way or another, and that’s all done in the context of state government, which of course brings with it additional considerations of interfacing with the legislative branch and working within the structures of the government sector. It’s certainly a large, complex operation, but one that’s doing a lot of good work for Kentucky.
I know you’re in close communication with the governor. What does that relationship look like?
I think we’re very fortunate to have Gov. Andy Beshear in his role. I’ve had the privilege to get to know him over this journey, and it’s an honor to work with and for him. I’ve seen him time after time make the difficult decisions to try to do the very best he can to keep people safe and minimize the harms. There’s health and safety harms — people who get infected can have long-term recoveries, and people can obviously die from this, as well — but there’s also the economic harms and disruptions to our social lives and to our businesses.
I have the privilege to be an advisor to him in my role as health commissioner, and also to observe repeatedly the governor make difficult decisions in the best interest of Kentuckians and not take easy ways out. He’s done the best he can to support every Kentuckian through this.
What would emphasize as we head into the winter months, especially with staying healthy in the workplace?
I know this is frustrating and it sounds like a broken record, but until every one of the 4.5 million Kentuckians can recite this from memory we’ve not succeeded. People have got to stay six feet away from anyone who doesn’t live with them. We have got to wear masks whenever we are out in public and whenever we’re in close contact with anyone outside of our household. Wash or sanitize your hands frequently, and absolutely stay home if you are sick — do not go to school, work or any other activity if you have fever, cough, shortness of air, loss of smell or taste, or any other symptoms that suggest you have an infectious disease.
And of course, if you think you have COVID- 19, get tested please. We have a number of testing options that we support throughout the state that are free — health insurance will cover this and should do so without copay or patient cost sharing. And then if you get a phone call from a contact tracer, please constructively engage with them and partner with them. They are here to help keep people safe. If we were to all do these things, we could really depress this virus a lot more than it currently is and — along with vaccines hopefully beginning to help change the landscape in 2021 — we could get a lot closer to the lives we used to know.