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After six years as director of the Allegheny County Health Department Dr. Karen Hacker is leaving Pittsburgh for a job at the Centers for Disease Control and Prevention.

During her high profile tenure, she’s taken on the opioid crisis, and the enforcement of industrial air pollution violations in the county, including most notably, U.S.Steel’s Clairton Coke Works, the largest coke-making facility in North America.

The Allegheny Front’s Kara Holsopple talked with Oliver Morrison, environment reporter for PublicSource about his recent story of Hacker’s time at the department, what she’s learned and her legacy. 

LISTEN to Kara Holsopple and Oliver Morrison’s conversation:

Kara Holsopple: From your interview, and your story, it seems like Karen Hacker had a lot of ambitious plans or ideas when she came in as the director of the Allegheny County Health Department, but there were legal obstacles. Tell me about some of them. 

Oliver Morrison: Well, she’s always been really interested in chronic diseases, like cardiovascular disease and diabetes. She had an idea that is really common across the country: Let’s do something about smoking by raising the taxes on smoking. Let’s prohibit people from smoking inside. However, she found out that’s the state’s responsibility and that she doesn’t have much authority over that. So that’s one example of the way she was limited.

KH: How about when it comes to environmental issues? You report that when she looked into pollution at the Clairton Coke Works, she wondered if her department could shut the plant down.

OM: She was told early on that she had to be careful about how she used her resources, because there were a lot of these limitations.  She said, “This is the biggest polluter. What can we do about it, can we shut it down? What are some of our different options?”

Hacker realized early on in her department that the legal team wasn’t ready to take on that challenge. She needed to replace them. She needed a bigger, better legal team, and they needed to slowly start ratcheting up the pressure. She couldn’t just go in and shut it down. That that wasn’t possible, because if [they had done that], they would have had to put all of their resources into a court battle for 20 years, and probably wouldn’t have won. 

KH: She’s described as a reformer, and someone who took over a dysfunctional agency. What was the health department like when she came in?

OM: So according to everyone I talked to, it was just really disorganized. [The Allegheny County Health Department] didn’t have any heads of departments, so that meant the person at the center of the agency had to do everything.

They were also lacking some really basic information, like they didn’t know where in the county there were particular diseases. They couldn’t access that data, and get it to people.

If any of the people listening think about Karen Hacker, at a time that they’ve seen her in public recently, probably one of the things they most remember is her putting on her PowerPoint slide of these maps of the county…where she talks about cancer rates and heart disease rates across the county, and looks at where in the county these problems are occurring.

Hacker found trends such as that the low income, African-American population has been suffering, but also that a lot of health problems have moved down towards the Mon Valley. So she’s been able to organize the department better, and access more data, so that we know a lot more about the health issues in the county. 

KH: So what kind of progress has she been able to make?

OM: One of the things I think she points to is the decrease in blood lead levels in children.

A big crisis that happened in 2016 was that the lead in the Pittsburgh water supply was above the EPA threshold. She took all that data that she’d gathered, and helped say “Hey, where should we be changing lead lines? Where does it matter the most?” She pointed to street by street where children were showing the most elevated lead levels. That’s led to a decline in those levels. 

KH: Wasn’t lead coming from lead paint in their homes?

OM: Yes, actually. But there was a public outcry about lead in the water because this was following the crisis in Flint. We were out of compliance with the lead in the water here in Pittsburgh, but still most of the lead was coming from people’s homes. And, actually, Dr. Hacker talks about how frustrated she was that people wouldn’t listen to her because she was saying the biggest problem is with lead in the paint. 

READ MORE: Lead levels in Pittsburgh’s drinking water dipped but remain out of compliance

KH: What did she have to say about air quality progress? 

OM: I think this has probably been the most prominent and controversial part of her legacy. I think what her critics would say is that she moved too slowly. They’re happy now, because she started ratcheting up pressure.

There have been more than $2 million dollars in fines against U.S. Steel for the pollution at Clairton Coke Works and surrounding facilities, which is the most that there’s ever been. Hacker’s doing more than has ever been done before. I think that her critics would say that it’s still too little. We’re not seeing enough progress, and we’re still seeing pollution that is some of the highest and worst in the nation. 

KH: Dr. Hacker has received a lot of criticism over the years, especially in regards to the Clairton Coke Works. There was a fire on Christmas Eve which impacted air pollution control equipment, and the health department did not notify the Mon Valley community that’s most impacted for several days after that fire. What does she say about that, and about the public’s perception of her? 

OM: I think pretty quickly after that Clairton Coke fire, after they notified the public, and there was a big public backlash, they realized they messed up, and that they needed to get that information to people sooner.

Perversely, all that negative backlash that came out because of the Clairton Coke Works actually changed the political atmosphere. You started to see politicians coming forward. I mean, a lot of her critics would say that this is what enabled her to act, because the political atmosphere changed. People were more upset now. That gave her more room to do things.

You saw a couple of months after that fire, when U.S. Steel was struggling to meet their obligations, for the first time the health department said, “Hey if you don’t do this, we’re going to shut you down.”  That means big money big losses for them. When another fire happened in June, it didn’t take a month this time, it took hours. There was a fire in the morning, [and] by that evening [the health department] sent [U.S. Steel] a legal order saying “Hey, we’re gonna shut you down if you don’t do it this time.” 

One of the things I heard a lot from air quality advocates is that there’s been this pressure from industry, or different people, to not be very aggressive on regulation. Dr. Hacker was really frank. She said sometimes she gets calls from people who think that they can lean on her, and get her to maybe be a little bit less aggressive in some way or another. She says that she’s ethical, and she doesn’t do that. But she’s faced that pressure.

KH: Does Dr. Hacker have any advice for what the public health priorities for the health department or the region should be moving forward? 

OM: One of the most interesting things she said was that she’s in the process of starting to develop a climate action plan at the county level. She’s saying the next health director and future health directors need to look at what are the health consequences of these rising temperatures. There’s going to be potentially more disease.

They think they’ve been getting pollution under control, but that may be harder to get under control as the temperatures rise. Ozone, we know, is a more difficult problem as it gets hotter. There are going to be things like West Nile virus, and more allergies and allergens in the air.

So she is trying to get the county to think about all of these problems that we’re going to be facing increasingly in the future. 

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Read the Oliver Morrison’s article “How Karen Hacker worked to resuscitate the Allegheny County Health Department.”