HEALTHCARE LEADER: A Conversation with Paul K. Halverson, DrPH, FACHE

LYNNE JETER

HEALTHCARE LEADER: A Conversation with Paul K. Halverson, DrPH, FACHE | Paul Halverson, State Health Officer, Arkansas Department of Health, Arkansas State Board of Health, Association of State and Territorial Health Officials

State Health Officer, Director, Arkansas Department of Health

A former hospital administrator, university professor and Centers for Disease Control and Prevention leader, Paul K. Halverson, DrPH, FACHE, has shown his insightful flexibility adapting to changing situations. Republican Gov. Mike Huckabee appointed Halverson director of the Arkansas Department of Health in 2005. Democrat Gov. Mike Beebe reappointed him to the post in 2007.
 

As director of the Arkansas Department of Health and the state health officer, Paul K. Halverson, PhD, provides senior scientific and executive leadership for the agency with nearly 5,000 personnel, with a budget of more than $400 million providing public health services and regulation delivered throughout the state in nearly 100 different locations. He also serves as executive officer of the Arkansas State Board of Health and president of the Association of State and Territorial Health Officials.

Before locating to Arkansas, Halverson served for nearly seven years as a member of the Senior Biomedical Research Service at the Centers for Disease Control and Prevention in Atlanta. As director of the Division of Public Health Systems Development and Research, he was responsible for strengthening the effectiveness of public health systems throughout the world. Working with national practice partners, Halverson led the development and implementation of the National Public Health Performance Standards Program, the deployment of the National Health Alert Network, the advancement of the National Public Health Leadership Institute and supported the development of state and regional leadership and management education programs throughout the country. Halverson also worked with colleagues in both practice and academia to develop a national agenda for public health systems research, including the development of a special interest group at Academy Health for the advancement of public health systems research. In his last year at CDC, Halverson provided leadership for its Futures Initiative and was the principal architect of the Health Systems Workgroup Report.

Prior to his appointment at CDC, Halverson was a professor at the University of North Carolina School of Public Health in the Department of Health Policy and Administration. While there, he served as associate director of the doctoral program in public health leadership and was the senior health policy advisor to the North Carolina State Health Director. For nearly 15 years before UNC, Halverson served as a hospital administrator in Arizona, Minnesota and Michigan.

In five years, he’s been a steady hand in a sea of change as the Department of Health was merged with the Department of Human Services—and then de-merged—and has risen as a major player in the development of the state’s new trauma care system.  
 
Halverson remains focused on the state’s main strategic objectives—improving access to care, decreasing injury mortality and morbidity, decreasing infant mortality, increasing physical activity, and improving oral health. Medical News of Arkansas discussed with Halverson what the medical community needs to know going into 2011.
 
Chronic disease and obesity are at the top of the mortality list, yet injury remains the leading cause of death for Arkansans ages 1 to 44. To what do you attribute this troubling statistic?
This is a national trend that’s very pronounced in Arkansas. It’s a difficult issue to crack and frankly, public health organizations worldwide have struggled with it. Unfortunately, Arkansas has maintained a mortality rate almost 50 percent higher than the U.S. average for automobile accidents, and here’s why: One, we have a high percentage of rural roads in our state. People in rural areas tend to drive more, and roads in rural areas aren’t in as good repair as those in urban areas. Two, the lack of an effective trauma system in Arkansas has taken its toll.
 
We’re so pleased with the governor’s leadership and the support of the legislature to build a statewide trauma system (enacted last year). Probably within 18 to 24 months, we’ll go from not having any trauma centers certified in our state and being the last in the nation to not have a trauma center, to having more accredited trauma centers than most states. We’re pretty excited about the potential to save lives and reduce long-term disability. We’ve already seen some real improvements from hospitals that are taking steps to implement trauma-related protocols for screening and treating patients, and we already have grants going out to EMS providers throughout state.
 
We still have a number of challenges. We still have a high percentage of injuries from all-terrain vehicle accidents. We still have a substantially higher than average burn mortality rate from fire-related injuries. We’re still among states without a mandatory motorcycle helmet law. Those things contribute to injury.
 
We now have a newly implemented graduated driver’s license bill, and primary seat belt law – both will have a substantial impact on reducing accident-related deaths. Helping reduce poisoning by prescription drugs remains a high priority that we’ll look at in 2012.
 
What steps are being taken to reduce the infant mortality rate?
That’s a huge issue for us. It’s really a shame in this day and age that we have the number of babies dying before their first birthday as we do, and there are several reasons for that.
 
Looking at the bigger picture surrounding principle priorities in terms of diseases, what’s interesting and cuts across all the issues we face is the area around health disparities. Arkansas has pronounced disparities. In fact, a recent analysis looking at the difference in life expectancy between the state’s best/worst counties was quite revealing, amazing and disappointing. For example, there’s more than a 10-year difference between the life expectancy of a baby born in Benton County compared to Phillips County. That’s a wide gap for two communities not much more than 200 miles apart as the crow flies.
 
Part of the reason is related to low birth weight, which is greatly influenced by teen mothers. Unfortunately, our teen birth rate is 50 percent higher than the national average! Among ways to reduce the teen birth rate is to assure the availability of education, family planning and a host of other services that will allow families to ensure that pregnancies are planned, and babies are given the greatest opportunities for healthful living. Prenatal care is so important, as is not smoking.
 
We know a number of things make a difference in reducing the infant mortality rate, such as putting the baby to sleep on its back to substantially reduce the incidence of SIDs. We’ve also discovered through collaboration with the medical examiner’s office that bed-sharing is an issue. Babies are suffocated or crushed. We advocate that babies need cribs and to be placed on their back. Good nutrition and access to quality medical care are other elements.
 
How is Arkansas addressing the obesity issue?
Promoting increased physical activity is so important to helping us address obesity issues. People of all ages—children, of course—should be active and have nutritious meals to help reduce obesity. It’s the key to maintaining a high quality of life and to reduce difficulties with the normal activities of daily living. It’s a critical part of reducing the likelihood of complications related to chronic disease.
 
One program that’s been famously successful--the Blue & You Fitness Challenge-- that started as a competition between Blue Cross & Blue Shield and the Arkansas Department of Health, challenges employees to become more physically active. It’s now turned into a national movement with Blue Cross working with governments and non-government organizations across the country. 
 
We’re also promoting worksite wellness. I recently had the opportunity to speak to CEOs about “presenteeism,” one of the most difficult issues we face. It refers to people who show up for work but aren’t all there, either because of physical ailments or disabilities or having other things on their mind taking away from the mental alertness of their job. It restricts an employee’s ability to be as productive as possible. As employers, if we can do more to encourage employees to be more physically fit, we can actually improve the bottom line, the overall productivity of employees and their quality of life. It all fits together—good business, good health.
 
In the second of this 2-part series, we’ll discuss additional initiatives, such as the ACT 1220 Program to establish health emphasis in schools, steps being taken to reduce infectious disease, oral health promotion, and other public health issues. To summarize, how would you rate the state’s progress addressing health concerns? 
Seeing progress is the most exciting part of the job. Five years ago, Arkansas was ranked 49th in overall health status. I’m so pleased that by 2009, we’d risen to 40th, not only because of what public health officials have done, but because of what we’ve all collectively agreed needs to be done to improve the health of our state. We have a very positive relationship with doctors, dentists, nurses, and other healthcare providers, along with the support of Gov. Beebe and state lawmakers. It’s exciting to work for a governor who understands the importance of public health in our state, and we’re optimistic about continuing this progress in our state.