With Allegheny County in the depths of an opioid epidemic and the city of Pittsburgh still grappling with a lead crisis, Dr. Karen Hacker, the Director of the Allegheny County Health Department, has a lot on her plate. Together with the community she is also involved in addressing issues like gun violence, the region’s past and present struggles with air pollution and controlling potentially dangerous odors.

On Thursday, Dr.Hacker spoke about challenges Allegheny County is dealing with during an hour-long and wide-ranging interview with PublicSource. Below are some of the key takeaways from that interview. You can watch the interview in its entirety above.

On Pittsburgh’s lead crisis

“As an industrial, Rust Belt city, I would tell you that lead is pretty much ubiquitous in a number of areas, and that includes not only issues that we have with water but paint that still remains on the walls and also soil because there is a legacy of lead from gasoline, from demolition and even industrial sources and that’s been the problem. But I also want to say that overall in this country we’ve seen a wonderful decrease in the number of children who have actually had high lead levels. We’ve come a long way. It doesn’t mean we don’t still have work to do and I think this is the whole challenge now is how do we keep going? How do we get it down as low as we possibly can?”

On the county’s mandate that requires parents to get their children’s blood tested for lead

We have a regular scheduled call with the pediatric providers in the county and we use that call as a way to discuss [the mandate] with them. We’ve also been working with the American Academy of Pediatrics…We are a little bit lucky here from our perspective in that there are four large practices that cover a very large number of children. Then there are a number of independent practices. Then there are the federally qualified health centers that we’re also in touch with. So it’s our intention to work very closely with all of them in terms of providing them with the information and encouraging them to do the testing.

That means that they have to incorporate [the tests] into those visits that are covered, ask the family if they’re OK with it and they give the tests. Again, there may be situations where the family says they don’t want it and you are supposed to get that in writing. The second piece of this, though, is that they are supposed to be reporting this information either via the laboratory or via themselves if they do the test into the Pennsylvania system that records this information. Lead testing in our state happens to be a reportable event. So all of that information is supposed to be in that system and that is where we get our information from, but only the information from Allegheny County. We do not, for example, get information on neighboring counties. We will be following that information regularly and then reaching out to areas where we may see capillary tests, for example…those are the ones where you stick your finger and get the blood that way, and if they’re elevated we expect them to be validated with something called a venous test which comes out of the vein in the arm. If we see a practice, for example, with an odd number of capillaries that are not being validated we will be reaching out to those practices and trying to work with them to get that moving as well, to try to understand the obstacles and also to try to make sure that those validations are taking place.

On how the mandatory blood tests will work

There are some [medical] practices that will go right to the venous test. That is certainly the option. OK. The insurance companies will pay for either…some practices will actually not do the tests on site but will refer the family to a laboratory. And then there are some practices that actually have a laboratory in the same building, right next door. So for example, our federally qualified health centers will actually have a lab right there, so it’s just go down the hall and get the test there. Some laboratories will do capillary. Some laboratories will do venous. So as far as we’re concerned, we wanted to make the options available because the vast majority of children…will have a negative [capillary] test,and we don’t want to put those children through the venous test if we don’t have to.

On citing dust, dirt and paint chips, and not exclusively water, as sources of lead poisoning

First of all, I want to say that it is extremely difficult, at this point in time, to estimate exactly how much of lead exposure is coming from any of these sources…So I have been talking about all sources and I think it’s important for us to be aware of all sources. The vast amount of cases, nationally, these days, have been primarily due to paint hazards. That doesn’t mean that water is not contributing to it as well. So I think our responsibility is to make people aware of all of the hazards that surround them.

On whether there is hope in reversing the opioid epidemic

I mean I’m ultimately an optimistic person. And we’ll do whatever we can possibly do. But I think it’s important to recognize that addiction is really challenging. And anybody who’s had a loved person, who’s an addicted individual knows it’s a chronic disease. Even if you force a person to go into treatment it doesn’t mean that that person is necessarily going to work through it and be able to do it. I feel that most of what we are doing now is trying to educate the public, trying to keep people from getting addicted in the first place. We’re looking at trying to reduce the volume of opioids that are out there which is through the whole prescription monitoring program today.

I actually had my own acquaintance with an orthopod about a hand injury and we started talking about opioids because as you probably know orthopedics it’s one of the places, right? You get your hip replaced, you have a broken arm, you’re probably going to end up getting opioids to help you with your pain. The question is how much do you get? How long are you getting them for? And I think those are things that are going to help reduce the number of people who are addicted. But we have all these people who are already addicted. And I’m sure you know there isn’t enough treatment and the treatment types don’t work for everybody. Getting into treatment is not the easiest thing…This is, as far as I’m concerned, all hands on deck, we all have to participate in this. It is a terrible epidemic and we are losing far too many people.

On declaring the opioid epidemic a national emergency

In declaring something an emergency crisis, that will often release resources that previously we did not have available to us. And one thing that’s been quite frustrating is we’ve seen this incredible increase in the number of individuals who have died but we have not seen additional dollars flow. So right now, my department for example is purchasing Naloxone, it’s really been based on the generosity of our foundation community to be able to get those resources. There have been some dollars that DHS [the Department of Human Services] has been able to contribute but I don’t have a specific source for those things…I’ve asked many of my own staff including myself to put huge amounts of energy into this, along with everything else we’re doing. So my hope would be that by making this an epidemic that there would be recognition of what is happening at the local level and an increase in resources that we need to fight this epidemic.

On the federal government potentially cutting funding for environmental programs

You know we are waiting with bated breath to see what’s going to happen with the budget at the federal level, particularly as it pertains to the EPA [Environmental Protection Agency]. Our air program, particularly, is extremely vulnerable to those dollars. So if we were to see cuts, yes, it would likely have an effect on how we can do the things we’re doing now and do them effectively well. And choices sometimes need to be made. And that would be really challenging.

I would hope we would be able to work with our advocates to figure out the best use of those funds and more importantly that they be arguing not have these cuts made, because it’s really going to have a huge impact. That’s one impact.

We also get a lot of our dollars at the Health Department, I believe it’s over 60 percent of the dollars that fund our Health Department, are actually from federal dollars that come through the state and then come to us. In the case of the EPA that actually is a direct grant. So our Sexually Transmitted Disease program, our TB [tuberculosis] program, our immunization program, our emergency preparedness program, all of those things are potentially vulnerable if those dollars get cut. The Affordable Care Act, it turns out that there’s actually a fair amount of public health embedded in that…There was this thing called the Public Health Trust Fund in there. And some of those dollars ended up supplanting CDC [the Centers for Disease Control] dollars which is what gives us our money. So, for example, we already got a cut on immunizations. And that is going to have an impact.

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J. Dale Shoemaker was a reporter for PublicSource between 2017 and 2019.