Alaska's chief medical officer points to unmet health care needs

Alaska's top health official discussed the implications of the COVID-19 pandemic, the lessons learned and the need for Alaska to be ready for future public health emergencies.

Dr. Anne Zink, chief medical officer for the Alaska Department of Health, was the speaker at the Beyond COVID: Pandemic Preparedness in the Circumpolar North conference on April 27 at the Sheet'ka Kwaan Naa Kahidi community house in Sitka.

Zink, an emergency health physician in Palmer, became the state's chief medical officer in July 2019, just in time for the onset of the pandemic six months later.

"I've often been saying how we respond out of this pandemic is going to be as important as how we responded during this pandemic," Zink told the conference, sponsored by the Sitka Sound Science Center.

"The lessons that we take from this and how we move forward are going to be fundamental to our health care system, to our public health system."

Even before COVID, many in Alaska had unmet needs for health care.

"Could they afford the care where they're going to go bankrupt because they couldn't pay for their heart attack? ... What's their mental and physical health? What's their economic stability? I can't tell you how many times I had different academic people (say), 'I don't understand why this person went to work sick,' and I'm like, 'Because they can't feed their family if they don't go to work.' That is all a part of it," she said.

More than 80% of American health care funding goes toward acute and specialty care, she said, while just 3% is devoted to prevention.

"That's just how our system is set up," she said. "In this country, we spend more per capita on health care than any other industrialized nation, and our life expectancy is lower than every other industrialized country and rapidly plummeting. So how do we shift that narrative? ... Because it's not just a health question. It's an economic question. ... Healthy economies are built with healthy people."

Early in the pandemic, she said, Alaska was effectively cut off from national virus testing.

"We can talk about equity in this very generalized term. But if we as a state are completely cut out of all of the national testing, that's not equitable, and we need to find ways to make sure that states have access to being able to test and looking at per capita numbers," Zink said.

She recalled pushing back against an effort to shutter the port of Seattle - through which most of the state's food passes - early in the pandemic.

Despite her title as chief medical officer, Zink said, her office carries little power beyond influence and suggestion.

"Most other states have local health departments that do a lot ... and have actual health authority on health measures," Zink said. "Alaska doesn't have that. We're very centralized in our public health, yet we have very little authority ... I sometimes joke I have the authority to Zoom and that's it - and I use that authority widely."

Alaska is "very much a home rule state. And so it's the city council, it's the community, it's the mayors and it's the tribes who have the authority. Same with schools," she said.

She was grateful for collaboration from Alaska's 229 federally recognized tribes during the pandemic. Impacts from the 1918 flu epidemic that killed millions worldwide are still evident in much of Alaska, Zink said. "Every epidemic and pandemic has disproportionately affected particularly Alaska Native people."

Zink told the crowd she prefers to address statewide health issues as they exist now.

"I'm less worried about the next pandemic; I'm more worried about my next shift. What are we doing in our health care? What are we doing in health today that makes us healthy and well today, and how do we remember the cultural and historical trauma and resilience of what's happened moving forward?"

She called attention to the Department of Health's "Fresh Start" campaign, which aims to decrease the prevalence of preventable illness.

"It is a kind of a diabetes prevention, weight loss, blood pressure activity, chewing tobacco, smoking and diabetes and sugar management (program)," she said. "This essentially allows any Alaskan to connect to all of these existing free programs that were actually in existence before it. We just packaged them up and tried to make it easier to access."

More information is available at freshstart.alaska.gov.