The doctor is in: A Q&A with state Health Commissioner Dr. Howard Zucker

From contaminated drinking water in Hoosick Falls to the Faso-Collins amendment in the U.S. Senate health care proposal, New York has found itself front and center in the national discussion on health care. Leading the state department of health is Commissioner Dr. Howard Zucker, whose resume includes the World Health Organization and the U.S. Department of Health and Human Services. City & State recently spoke with Zucker to discuss his career in public health, the spread of Lyme disease, the state's medical marijuana program and the deepening opioid crisis.

C&S: Your career in public health began as one of the country’s youngest doctors at age 22, giving you a lengthy career in medicine, pediatrics in particular. What effect does that training and experience have on your priorities as commissioner?

HZ: As a pediatric cardiac critical care specialist, I have dealt with life and death emergencies on a daily basis. This has shaped my view towards all issues large and small. As commissioner, I’ve led the department’s response to some very serious public health issues: Legionella, Zika, water quality, Candida auris, antibiotic resistance. Responding quickly and with the appropriate treatment is definitely something I’ve tried to incorporate from my clinical career into the creation of public policy. For anyone in the health care field, empathy and humility should be among the highest priorities. To truly deliver excellent care and develop sound, sustainable policy, you need to understand those whom you are seeking to help … and adjust accordingly. Lastly, never be surprised about anything.

RELATED: New York's single-payer health care debate

C&S: You attended college in Canada for undergraduate studies at McGill University. Did you have any experience with the Canadian health care system while you were there? How has that experience shaped your views on health care in the U.S.?

HZ: During my studies at McGill, I did volunteer at Montreal Shriners Hospital, but it wasn’t really my experience in Canada that shaped my views on health care. I was pretty young then. It was really my work at the World Health Organization and at the Department of Health and Human Services in Washington that helped shape my thinking on health care. At WHO, I had the privilege of traveling to dozens of countries and interacting with many different systems of care on the ground level. Working there taught me about varying health care systems in other countries and the challenges inherent to the provision of high-quality health care in a diverse society. Cultural competence is key, as is the integration of health and healthy lifestyles across government, culture and humanity as a whole, which has been a big priority of mine during my tenure at the Department of Health.

C&S: I’ve been told that a major challenge at the state Department of Health is short staffing throughout the agency. Do you believe the agency has the staffing and resources it needs to do its job effectively?

HZ: The department is committed to improving the health of all New Yorkers while finding efficiencies and protecting taxpayers. Undoubtedly, we have many critical initiatives underway. Ensuring that the department has proper resources to advance the governor’s ambitious agenda is something we take very seriously and manage on a daily basis. Ultimately, we are armed with the staffing and resources needed to protect public health and maintain our position as the nation’s foremost state health department.

“Drinking water quality and the emerging contamination from legacy pollution are the defining issues of our time.”

C&S: Lyme disease and other tick-borne illnesses are gaining greater attention, particularly among state senators. What is your department doing on this issue and is there a sense of the scope and immediacy of the problem?

HZ: Tick-borne illnesses are some of the most rapidly growing vector-borne diseases in New York and across the United States, and the Department of Health is responding with bold action.  At the New York state Department of Health, we actively monitor the tick population and incidences of tick-borne illnesses, such as Lyme disease. Wadsworth Center, the state’s public health laboratory, is on the leading edge of monitoring and research into tick-borne diseases. Their work to extract tick DNA to test for the presence of pathogens and to identify ticks found to be positive for tick-borne diseases helps power the state’s prevention and response activities.  As the number of Lyme cases has increased throughout the state, the department has launched a statewide public awareness campaign to remind New Yorkers of the dangers of ticks and how to prevent and remove them. We encourage people take some simple precautions such as wearing light-colored clothing to make ticks visible, tucking pants into socks and checking for ticks after spending time outdoors. We’ve also created several educational videos on how to properly remove a tick and protect yourself from tick-borne diseases, which are available at the state health department’s website and YouTube channel. Another important activity is the department’s dissemination of best practices and educational materials to local health departments to strengthen their own tick-borne disease surveillance and public outreach activities.

C&S: Where are we as a state in the ongoing opioid crisis?

HZ: Everyone is really focused on the opioid epidemic in our country, and how can they not be?  As part of the Gov. Cuomo’s ongoing efforts to address this public health crisis, New York state continues to take important steps to combat the heroin and opioid epidemic. Thus, we have formed strong collaborations with community partners and with state and local government agencies to build upon the landmark legislation the governor signed into law last year and on this year's investment of over $200 million in additional support for prevention, treatment and recovery programs. This investment by the state will address chemical dependency, expand residential service opportunities and promote public awareness and education to help turn the tide of opioid-related deaths.

The challenge continues to be improving access to lifesaving treatment and expanding support for New Yorkers in recovery and their loved ones. As a member of the governor’s Heroin and Opioid Task Force, I worked with many health care providers, advocates and those in recovery to develop key strategies to prevent people from becoming addicted in the first place, while treating and assisting those who are already trapped in the cycle of abuse. On a national level, proposed cuts to Medicaid funding used to fight the opioid epidemic would have a devastating impact on our state’s ability to help those who are most in need. For individuals struggling with an addiction, or whose loved ones are struggling, they can find help and hope by calling the state’s toll-free, 24-hour, 7-day-a-week HOPEline at 1-877-8-HOPENY (1-877-846-7369) or by texting HOPENY (467369).

RELATED: Medical responses to opioid addiction varies by state

C&S: In the wake of chemicals leeching into the water supply in Hoosick Falls, and a series of other incidents around the country in recent years, water contamination has become a major concern. What more needs to be done to ensure the safety of the state’s drinking water?

HZ: Drinking water quality and the emerging contamination from legacy pollution are the defining issues of our time. While New York feels strongly that as the standard-bearer for health equity among states, the federal government must prioritize and implement uniform, nationwide regulations for unregulated contaminants. We are not waiting for federal action and have taken unprecedented steps to safeguard our most precious natural resource.

At Gov. Cuomo’s direction, New York state has numerous initiatives in place to address these public health and environmental threats that include a record investment of $2 billion under the Clean Water Infrastructure Act of 2017 to upgrade critical municipal drinking water systems, protect drinking water at its source and provide the resources and authority to address known and emerging water quality threats. This significant investment will help aid the work of the statewide Water Quality Rapid Response Team, which convenes the best scientific minds to identify and swiftly address critical drinking water contamination wherever it occurs.

Additionally, Gov. Cuomo’s Drinking Water Quality Council is bringing together legislative and state partners to provide critical guidance in New York’s ongoing commitment to providing clean drinking water for all communities across the state, regardless of their size. Input from the council will be valuable in the formal process of ultimately setting enforceable maximum contaminant levels for current unregulated contaminants like 1,4-dioxane and perfluorinated compounds.

C&S: Medical marijuana is available for some diagnoses in New York currently – will it be made available for post-traumatic stress disorder? The Legislature approved the move, but I understand it’s awaiting the governor’s approval pending input from your agency and the governor’s counsel.

HZ: Since day one of the state’s Medical Marijuana Program, the department has been committed to growing the program responsibly in a manner that best meets the needs of patients across the state. With that commitment in mind, the governor’s office and the Department of Health are currently reviewing legislation that passed both houses of the Legislature that would add PTSD to the list of qualifying conditions for medical marijuana.

Recent enhancements to the program include adding chronic pain as a qualifying condition, permitting home delivery, empowering nurse practitioners and physician assistants to certify patients, publishing a list of registered practitioners who have consented to be listed publicly and the authorization of five additional registered organizations to manufacture and dispense medical marijuana across the state. In fact, after the addition of chronic pain in late March, the number of certified patients in the program has increased by 10,744, or over 72 percent.