New health chair of Appalachian Ky. economic group says he’s a conductor, not a director; deflects query on mining’s health effects

By Melissa Patrick
Kentucky Health News

Dr. William Hacker, a former state health commissioner, is the new chair of the Community Health Advisory Council for Shaping Our Appalachian Region, a non-profit organization created last year by Democratic Gov. Steve Beshear and Republican U.S. Rep. Harold “Hal” Rogers of the 5th District to improve Appalachian Kentucky’s economy.

Dr. William Hacker

So, what does that mean for Hacker? And for a region with some of the worst health in the nation, so bad that it is a drag on the economy?

Hacker said in an interview with Kentucky Health News that he was still learning about his responsibilities, but felt that one of the most important skills he brings to this role is his ability to network.

“What I’m assuming my primary role will be is not so much (to be) the director as it is being the orchestra conductor,” he said.

He added later, “If I can use my platform to bring people together so that they can share resources, share energy, share knowledge, share success stories. … Even if we don’t have any new dollars to spend, we may be able to have better outcomes if we know what works and make that translational across communities. … As the old African saying goes: If you want to go fast, go alone. If you want to go far, go together.”

Hacker, a native of Clay County, practiced as a pediatrician in Corbin for 18 years, spent six years with Appalachian Regional Healthcare and was the medical director for a health insurance plan.

“I have a lifelong interest in Kentucky in general, and Eastern Kentucky in particular,” he said. “My roots are in Eastern Kentucky.”

He began his career in public health in 2001 when he joined the state health department’s Maternal and Child Health division. After 9/11/01, he established the state’s first public-health disaster preparedness program. In 2004, Republican Gov. Ernie Fletcher named him commissioner, a position he kept under Beshear until he retired in 2011. Hacker holds a clinical professorship at the University of Kentucky Department of Pediatrics and is an associate professor at UK’s College of Public Health.

As an active volunteer, he said that many of his current activities “deal with core issues that help address prosperity in terms of education, of economic development and of health.”

With SOAR, Hacker succeeds Dr. Nikki Stone of Hazard, who left the position after the final report of her Health Working Group, which initially set two priorities: coordinated health program in schools and a study of the health effects of large-scale surface mining, which research has suggested could be significant.

When the recommendations of the health group and working groups addressing other issues were published last fall, the mining-study recommendation wasn’t included in the list, which was limited to shorter-term recommendations, but it was mentioned in the health group’s report. Some other working groups continued to meet over the winter, but the health group did not.

A representative from the federal Centers for Disease Control and Prevention, after spending three months at the SOAR Pikeville office evaluating the recommendations, announced at the May 11 “Strategy Summit” that SOAR’s health focus should be on substance abuse, obesity and diabetes, with no mention of the top two recommendations made by the people in the region.

Asked if he agreed with the CDC recommendations, Hacker said, “Clearly those are three issues that need to be addressed,” but he added, “I don’t want to be a disease-focused program, I want to be a community-focused program that leverages all assets and resources available to deal with the social determinants of health, while also addressing those three issues.”

The CDC defines social determinants of health as “the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness.”

Hacker said, “The core issue of poor health, really, is not so much health, as education and economic opportunity. The tripod of prosperity is good education, good economic opportunity and good health. If you have these three components, then you can build within your community, you can recruit industry and you have an educated workforce that is healthy.”

“So it is the chicken and egg thing: How do you get economic opportunity to prosper in a place that has poor health outcomes? Which comes first, and how do we do that?,” he mused, while commending Rogers and Beshear on their efforts to maximize federal, state and local resources to address these core problems within Appalachia.

Hacker said that one such resource is the CDC’s commitment to provide a person for one year to help bridge SOAR activities with federal resources, programs and activities. Lt. Cmdr. Jenna Meyer has already been assigned to this role and is working from SOAR’s Pikeville headquarters. Meyer said she was unable to comment.

Hacker remains optimistic. “I have never seen the leadership being provided that is comparable to what Congressman Rogers and Gov. Beshear have brought to bear on the SOAR activity,” he said. “I am very hopeful that SOAR will be perceived 20 years from now as a turning point in improving the prosperity of Eastern Kentucky.”

Hacker said one of the Advisory Council’s greatest challenges is the responsibility of “distilling down” an actionable program to improve the long-term prosperity of the region from a list of so many valid, scientifically based issues that need to be addressed.

Asked if determining the health effects of large-scale surface mining would be one of his priorities, Hacker didn’t answer directly: “Any contamination of the environment is unhealthy and should be avoided when possible, whether we are talking about heavy metals or whether we are talking about second-hand cigarette smoke.

“Within the million people who live in the SOAR area, coal mining is a very important part of some communities, but not for others. So, I will certainly listen and receive input from all concerns of the communities.”

He said later of SOAR, “We need to tackle issues that have the broadest reach and the greatest impact.”

As for the recommendation for a coordinated children’s health program, Hacker said he recognized its importance, but noted that improving health was more complex than simply changing behaviors, and emphasized the importance of getting families out of poverty as a means of improving children’s health.

He also noted that “grass-roots engagement is critical to any long-term success,” reflecting on a saying of Dr. Gil Friedell, founding chair of UK’s Markey Cancer Center, ” If the problem is in the community, then solution is in the community.”

The Advisory Council decided at its first meeting Aug. 10 that each of the 11 SOAR issue groups should focus on how they could contribute to bringing more jobs to Kentucky’s 54 Appalachian counties. It was also established that each of the issue groups would hold an annual roundtable to ensure community involvement.

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