Most health outcomes are decided not in a clinical setting, says Allison Adams, but by a host of other factors like stable housing, food security and education. Adams, a registered nurse and public health administrator, will soon take the helm of The Foundation for a Healthy Kentucky. Ben Chandler (Foundation for a Healthy Kentucky) Recognizing the “true social drivers” of health is a necessary step in addressing Kentucky’s health needs, she said.  Adams is succeeding Ben Chandler as the nonprofit’s CEO and president. Chandler, a former state attorney general and congressman, is retiring Dec. 31. Adams, from Maysville, sat down with the Kentucky Lantern to discuss her goals for the organization — and the state of health in the commonwealth. Among her plans is continuing to advocate for creation of a state all-payers claim database that she says could help advocates and policymakers “see the bigger picture” of health in Kentucky. Eighteen states already mandate such databases which include “medical claims, pharmacy claims, dental claims, and eligibility and provider files collected from private and public payers,” according to the Agency for Healthcare Research and Quality. Here’s more of what Adams had to say, edited for length and clarity.  Kentucky Lantern: What do you want your leadership of the Foundation for a Healthy Kentucky to be defined by? Allison Adams: I would like my leadership to be defined as a leader who listens and also brings people — and maybe unlikely partners — together. The foundation’s mission of addressing the unmet health needs of Kentuckians by developing and influencing policy and reducing health risk and disparities, and then promoting health equity, is quite broad. Given its 23 year history, we have learned more over those years. We’ve learned that health care — and health — is not just an insurance card that allows people to get health care when they need it. We have evolved in understanding the social determinants of health. That can’t be done in the four walls of a health care institution, no matter what institution it is. Most of those determinants of health are outside and in the community.  I see our role as listening to people’s needs and also bringing what we hear, in an unbiased way, to start developing what really can move the health needle in the state of Kentucky. That’s going to take partners convening hard conversations. I want to be able to be seen as  a leader in partner-building and finding common ground to improve Kentucky’s health outcomes. We are committed to continuing to advocate for health care data transparency. Kentucky needs a holistic picture of where and how our health care dollars are spent. We have, specifically over the last couple of terms, advocated for an all payers claims database, which is something that can help (us) see the bigger picture, what claims are being paid for health care, where are people getting their health care?  If Kentucky policy makers, legislators, had the ability to have a database that’s quality, comprehensive data, the Foundation for a Healthy Kentucky believes that, out of that, evolves better health care policy.  KL: What do you think is the greatest health need facing Kentucky?  AA: I think the greatest need, simply, is to recognize — and then start doing something about — the fact that 80% of our health outcomes are not due to what happens inside a patient-doctor or patient-provider relationship.  We have to step up our game and really tie back to the true social drivers of health: housing security, quality education, good paying jobs, food security, food access.  We really have to think about the pyramid of basic needs, if we’re going to have a true impact on our health outcomes.  Action is definitely the greatest need, but until there’s universal acknowledgement, there’s rarely going to be universal action.  KL: What about mental health?  AA: When I think about mental health, I think that we have to be ready to come together on common ground and really acknowledge the role that all types of discrimination play in mental health. We talk about diseases of despair. We talk about people’s work. We talk about not having access to education or not having access to opportunities.  Absent opportunities, you start to struggle mentally. When you have discrimination of all types, it starts to play a toll on you mentally and understanding your place in space and in the geographic or the socioeconomic group in which you find yourself. When you talk about the physical and the mental, I think we also need to start talking about: you can’t separate the two. They are part of your body.   KL: You said the greatest need is acknowledgement and then action on the social determinants of health. Who does that? Does that happen in Frankfort? Is that leaders like yourself talking about it more? AA: We as health advocates have to amplify our voice by fostering the trust and collaboration with equity advocates and community leaders that have those lived experiences. And so it really is all of the above.  The leader advocates are the conduit for amplifying the voices of the impacted to the people of power who have the opportunity to make change. I try not to think of the ‘big P’ policymakers as the people that we should absolutely rely on to make change. I think that as you’re building that trust in community leaders and you begin to talk, then you also have the ability to be rethinking what ‘little P’ policies mean, like policies inside organizations, inside workforces, places of work, inside your family household, inside school — those are all places where policy change happens as well.  KL: What is Kentucky doing really well to address health gaps and needs that people have?  AA: We have to continue to lift up Kentucky’s leadership in being one of the very few southeastern states who expanded Medicaid.   The fact that Kentucky expanded Medicaid in a geographic area of the United States that does not and still struggles to have expanded Medicaid, we have essentially eliminated a fear of seeking care in a lot of Kentuckians. It was done several years ago, but the benefit continues year after year, and we have to protect that. That’s important.  KL: Your background includes a lot of experience working at — and with — local health departments. What role do health departments play in Kentucky’s overall health, and what do those departments need from the state at large to meet their goals?  AA: The health departments are essentially the chief health strategists in every community. There’s a health department presence in all 120 counties, and they are a central tie to developing a comprehensive public health system in the community.  Communication is key, and then also the expectation is that every Kentuckian has and should have access to a quality public health system under the leadership of their local health department. We need to make sure that … the health departments are funded to do their work.  KL: In recent years, we’ve seen a large amount of distrust of health care professionals, made worse during the COVID-19 pandemic. How can Kentucky leaders like yourself mend that trust in the years ahead?  AA: When you have an element of mistrust, you have to double down to earn the trust back. You just have to double down. For every mistruth out there, you’ve got to combat it with multiple truths. That’s hard, and it’s time consuming, it’s resource intensive, but it’s absolutely necessary. How we do that is going back to our roots — speaking with people, giving them the time they need, listening to them, meeting them where they’re at.  KL: Your tenure is set to overlap with a new leader of the U.S. Department of Health and Human Services. The person up for confirmation is famously skeptical of vaccines, among other things. Are you bracing for a trickle-down effect from that national-level distrust of vaccines? If so, what impact could that have on Kentuckians’ overall health and wellbeing?  AA: When you’re in public health, you always plan for the worst. I would be silly if I didn’t think that there was going to be some kind of impact. I think the impact that it will (have) remains to be seen.  I also remain hopeful that there’s a team around every leader that can also say, ‘did you think about this or have another way of thinking about something?’  There are people who are still around who remember having someone seriously impacted — or death — related to a vaccine-preventable disease. So, the short answer is, yes. We have to brace ourselves. Yes, we have to be thinking about what that looks like.  If I’m just going to answer it on a vaccine stage, I’m hopeful that if mandates go away, the choice remains, and we’re able to have our public health impact and awareness.  We have vaccines available in our communities that are not mandated, and many people take them, and so it’s just a matter of doing more awareness about the vaccine availability.  KL: How does the Foundation for a Healthy Kentucky choose which specific issues to take a more public stance on? I am thinking of how the foundation came out against Amendment 2, the “school choice” measure, before the election, specifically.  AA: We want to stay true to our mission. So, anything that is jeopardizing (the) health of our community, if it is potentially risking health, or if it’s furthering disparities, or if it’s reducing equity, we’ll take a good look at it.  There are the social determinants, and there are ones that have huge health impacts that we want to protect, that we see as sacred in promoting good health, and that’s education, that’s food access, that’s quality housing and meaningful work with quality wages. When you have those things in place, we know that positive health impacts pursue.  Anything that would jeopardize equity in respect to those social drivers of health, we would take a stand on. KL: What do you do in your daily life to foster a healthy lifestyle and/or good mental health?  AA: I try not to go a day without getting 10,000 steps. I do my best to make sure that happens outside. When I’m walking, I have the opportunity to look around, be grateful for the state I live in and the beauty that it provides wherever I find myself.  But, also, I have to acknowledge that even getting 10,000 steps is a privilege to many Kentuckians. It’s not just as simple to say, ‘go walk 10,000 steps.’ That is often not acknowledged, that even just thinking that you can safely walk outside is a privilege.  YOU MAKE OUR WORK POSSIBLE. The post A conversation with the new president of the Foundation for a Healthy Kentucky appeared first on The Lexington Times.