By: Javacia Harris Bowser

As State Health Officer, Dr. Scott Harris serves as the chief executive of the Alabama Department of Public Health. But he knows that most people have no idea what that means.

“We’re kind of the silent guardians of health,” Dr. Harris says. “Nobody really knows anything about us unless we do something wrong.”

The state health department’s profile was raised during the COVID-19 pandemic, but not in a good way, Dr. Harris says.

“Suddenly, people saw us as partisan and we’re not,” Dr. Harris says. “We’re just here to use science to implement good public health policy.”

The state health department is the statewide agency for governmental public health with facilities in all 67 counties of Alabama. The department has approximately 2500 employees statewide to help provide an array of health-related services to Alabamians.

Before his current role, Dr. Harris was an infectious disease doctor working with HIV patients in North Alabama. In 2015 he took a job as regional health officer and in 2017 he moved to Montgomery, Alabama to take the helm of the state health department.

We had a talk with Dr. Harris about some of the issues affecting health outcomes and healthcare in Alabama and what can be done about the problems that plague our state.

Here are seven things Dr. Harris would like you to know.

Chronic diseases continue to affect our overall health outcomes.

“The burden of chronic disease that our state has is really a big problem and really hard for us to address in a comprehensive way,” Dr. Harris says.

“We have a state that has high rates of obesity, which leads to high rates of hypertension and high rates of diabetes.”

Many Alabamians also lead sedentary lifestyles and don’t have access to healthful foods.

“The burden of chronic disease means that we have poor health outcomes in a lot of ways,” Dr. Harris says. “It shows up in our infant mortality rates, it shows up in things like cervical cancer, and it shows up in things like cardiovascular events.”

Chronic disease makes it harder for people to recover from trauma or have healthy pregnancies. And we saw how pre-existing conditions affected people’s outcomes with COVID.

“And Alabama is a graying state,” Dr. Harris says. “That is, we’re older on average, than America. And that’s particularly true in our rural areas.”

Lack of healthcare access continues to be a problem for Alabama.

Some people in Alabama simply can’t afford healthcare, perhaps due to lack of insurance and not qualifying for Medicaid or Medicare.

In 2019, a higher percentage of Alabama’s population was uninsured than the U.S. (17.5 percent compared to 13.6 percent). And Alabamians between 18-24 years old had the highest percentage of the uninsured population at 24.3 percent.

Many people in rural areas, however, can have trouble getting the care they need even if they can afford to pay for doctor visits.

“We’re a big rural state, so many times people have transportation challenges,” Dr. Harris says. “And we’re seeing rural hospital closures. We’re seeing a lot fewer medical professionals in rural areas. So even if you have insurance, and even if you have transportation, there just may not be anybody in your community or any surrounding county that you can see.”

Alabama is facing healthcare personnel shortages across the board.

Alabama’s nurse shortage continues to make headlines as 20 percent of registered nursing positions are vacant.

Dr. Harris noted that there’s also a shortage of primary care physicians as well as dental and mental health care workers.

Alabama’s Physician Workforce Act was signed into law in June of 2023 to help address the healthcare worker shortage.

Health care workers need to be paid more, Dr. Harris says, but he understands why that’s easier said than done.

“A lot of that has to do with how hospitals in America are financed,” Dr. Harris explains. “Hospitals can’t just raise their salaries when they want to because they kind of have fixed revenues.”

Furthermore, parts of Alabama are seeing few professionals in a variety of fields.

“Rural communities are just losing young people,” Dr. Harris says.

Medicaid expansion could be great for Alabama.

Some states have expanded their Medicaid programs to cover all people with household incomes below a certain level. In states that have expanded Medicaid coverage, you can qualify based on your income alone. But states that have not expanded also consider household size, disability, family status, and other factors. Alabama’s current Medicaid eligibility criteria are more limited than many other states.

If Alabama were to expand its Medicaid program, 204,100 uninsured nonelderly adults would become eligible for coverage, 49% of the state’s uninsured nonelderly adult population.

As of now, Alabama has not chosen to expand Medicaid, a decision left up to lawmakers.  

“That’s ultimately a political decision for them, but what we are very confident speaking about are the benefits of having better coverage,” Dr. Harris says. “We’ve got close to ten years of data now on states that expanded versus states that haven’t expanded and in those states that have expanded, they have better health outcomes.”

And these improved health outcomes run the gamut.

“You have earlier detection of certain types of cancers, and you have earlier detection of things like diabetes and other chronic things that can be worse if they’re not detected early,” Dr. Harris explains. “You have improved infant mortality rates, and you have fewer hospital closures in states that have expanded. We even know that you have fewer medical bankruptcies among the citizenry of the states that have expansion. So there are a lot of health benefits that we can see. But the actual political decision about expansion is up to other people.”

There is some good news. Infant mortality rates are at an all-time low in Alabama.

The state health department has launched several programs to address infant mortality in Alabama. And they’re working.

“We have a number of programs that we’ve implemented that are just trying to make sure that babies are born into a situation that gives them the best possible chance for a good outcome,” Dr. Harris says. “We have programs in many of our health departments that identify women of childbearing age who have chronic diseases like hypertension, diabetes, and try to get them connected to care, so that if they’re pregnant, or if they are to become pregnant, that child is going to have a better outcome.”

Furthermore, the Children’s Health Insurance Program (CHIP) provides low-cost health coverage to children in low income families that earn too much money to qualify for Medicaid. This program was recently expanded to also provide coverage to pregnant people.

The state health department is also working with other state agencies to provide parents with wraparound services such as mental health screening, education about safe sleep practice for baby, and much more.

While Dr. Harris is proud that Alabama’s infant mortality rate is lower than it’s ever been, he knows there is still work to be done.

“The real thing that we’re ashamed of is that there’s a significant disparity between the infant mortality rate in White babies in our state and Black babies in our state,” Dr. Harris says. “Black babies die at a rate that’s more than twice the rate of White babies. And for us, that’s just not acceptable.”

The state health department does more than administer vaccines.

“There’s so many things that we do that most people aren’t aware of,” Dr. Harris says. “Many times, if you think about the health department, you just think of that building where kids go and get their vaccines before school.”

And yes, the health department does that and Dr. Harris acknowledges this is very important work. But he wants people to know that the state health department does much more.

“We’re a big provider of contraception to low-income women and men across the state,” Dr. Harris says.

The department also investigates outbreaks. So if a group of people go to a restaurant and get sick from the food, or if there’s a diarrhea outbreak in the daycare, or a flu outbreak in a nursing home, the state health department figures out what happened and how to prevent it from happening again.

“We’re the agency that makes sure that the food you eat and the milk you drink is safe,” he says.

You probably know that the state health department inspects restaurants, but they also regulate the oyster beds down in Mobile Bay to make sure that the shellfish are safe. They go to Alabama’s dairy farms and make sure that milk production is done in safe and sanitary ways so that the milk supply is protected.

“We’re the folks that handle septic tanks for wastewater disposal in rural parts of the state,” Dr. Harris adds. “And we have emergency preparedness teams that plan every day for how Alabama responds to an emergency,” emergencies like hurricanes, tornadoes, and unbearably hot summers.

“The list goes on and on,” Dr. Harris says.

The Alabama State Health Department is not a partisan group.

In some ways, Dr. Harris understands how public health has become a political issue.

“We use public money to help provide health care and improve outcomes,” he says. “So there’s a political dimension to that. But we’ve never been partisan.”

The state health department isn’t against or for any political party, Dr. Harris says.

“We’re the party of health,” he adds. “That’s how I see us. We’re the party that stands up for whatever is good for the health of Alabamians.”