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All Health is Local

January 31, 2018
by Jennifer Kaylin

Former Speaker of the U.S. House of Representatives Tip O’Neill once memorably said that all politics is local. Byron Kennedy, the health director for New Haven, holds the same view, but with a twist. Kennedy believes all health is local.

By that he means that health care providers offer care, but they also engage with the community. “You know where and how patients live on a granular level,” Kennedy said. “I like working at the local public health level. It’s different from working at the state or national level, where you don’t really know the community partners.”

Kennedy, M.P.H. ’01, M.D. ’04, Ph.D. ’04, who started in the director’s position in May 2015, sees public health as something of a contact sport. “It’s where the rubber hits the road,” he said. “You engage with the community as well as with your staff and other stakeholders. You need to be ready and willing to answer questions, to defend your budget and to push hard for the things you need to do your job.”

In Kennedy’s relatively short time in charge of New Haven’s health, he’s already faced a series of challenges. A few months into his tenure, 17 people were treated for drug overdoses and three died. The authorities believe the patients had used heroin or, more likely, fentanyl.

In response to the crisis, Kennedy helped produce a robocall, which alerted city residents about what was happening. Then Kennedy directed his staff from the city’s needle exchange program to contact clients, including intra- venous drug users, to warn them in person about the recent overdoses.
He also worked to secure more Narcan, an important tool in the war against heroin abuse because it can save someone who is having a life-threatening reaction. New Haven’s problem was that the city’s stock of Narcan was dangerously low. Whatever existed was supplied to the city’s first responders, but fortunately a generous supply of the drug was located and donated to the city by the state.

Kennedy’s initiation to New Haven didn’t end there. He and his staff immediately had to turn their attention to a heat wave in the summer of 2015. “We got the word out that libraries and schools and water parks were open to cool people down,” Kennedy said. “We told the public to stay hydrated, to stay in cooler environments and not to leave children or pets in cars.”

Kennedy, who is board-certified in preventive medicine, with expertise in community-based approaches aimed at improving the health of vulnerable populations, was public health commissioner for the Monroe County health department in New York before returning to New Haven. His goal for New Haven is to create a more patient-and community-centered environment. To that end, he’s redesigned the department’s clinic to give it “less of a 1960s prison look.” There is now children’s television programming, an X-ray room and other services. It offers evening hours and will soon offer weekend hours, and it treats about 15 patients a day. “The clinic,” Kennedy said, “is the visible sign of what we’re trying to do here.”

Asthma is a chronic health problem in New Haven that concerns Kennedy. The state hospitalization rate for asthma is 14 per 10,000 people. In New Haven, the rate is 75 per 10,000 people. To combat those numbers, Kennedy offers children a summer asthma camp to help them learn how to use their inhalers. His goal is to reduce hospital visits by up to 80 percent and school absenteeism by a third.

Another challenge, one that Kennedy sees as a “major project,” is the health disparities that exist in New Haven along racial and economic lines. “I want to shine a light on those disparities and find ways to eradicate them,” he said.

Kennedy uses an “egalitarian leadership style” that is both “respectful and team-oriented.” He believes in an approach in which everyone contributes. “That approach gives you a fuller perspective of the situation,” he said. “No person is more important than another.” Upon arriving in New Haven, Kennedy said he went on a “learning and listening tour,” always asking the question, “What can I do to be impactful?” Kennedy chose a career in public health rather than one in general practice because “I like problem solving. It’s more limited when your involvement is with one patient at a time.” Something Kennedy learned at the Yale School of Public Health that he’s determined to bring to the New Haven Health Department is an appreciation for data and data analytics. “I want to apply that lens to the health challenges New Haven faces,” he said. “Many public agencies aren’t used to being informed by data routinely. Our department isn’t as robust as it can be. I want to change that.” Kennedy knows he could have chosen a career in medicine that would have been more lucrative and more predictable, but that didn’t appeal to him. “There’s never a dull moment—that’s what I love,” he says about the field he chose. “I have a schedule, but I know that on any day it can change on a dime.”

Read the latest Yale Public Health magazine for insights on global childhood health.

Submitted by Elisabeth Reitman on January 31, 2018