A Spotlight Q&A With Public Health Expert Dr. Eric Hulsey
Opioid-related deaths are up nationwide. But that doesn’t stop Dr. Eric Hulsey, Senior Technical Advisor with Vital Strategies, from working tirelessly behind the scenes crunching numbers to prevent drug overdoses and improve public health overall.
Eric Hulsey, Doctor of Public Health, wakes up each day wanting to change the world. As Senior Technical Advisor of Drug Use Epidemiology and Data for Vital Strategies’ Overdose Prevention Program, making things right and fair for the vulnerable matters a lot to this Pittsburgh-area husband and father of twins.
Twenty years ago, as a family therapist, he laid the groundwork for a career that would drive innovation for individuals as well as for systems. Relentlessly asking tough questions, advocating for the use of clinical evidence to effect change, Hulsey established himself in the public health sphere as a thought leader and change maker.
Hulsey earned his doctorate degree from the University of Pittsburgh in 2008. Since then, he has served as Scientific Director for IRETA, the Institute for Research, Education and Training in Addictions, where he remains active on its Board of Directors. He moved on to become Manager of Behavioral Health Analytics with Allegheny County, a role he filled until late 2019. Just recently, Hulsey began working with Vital Strategies. He’s a past Board President for Prevention Point Pittsburgh and has served on the Board of Onala, a recovery community organization in Pittsburgh.
Hulsey was gracious enough to take time out of his incredibly busy schedule to chat with me over the phone in the autumn of 2019. Our conversation, which follows, has been edited and condensed for clarity.
Tell us about your past work on opioids with the Allegheny County Health Department.
I was volunteering with Prevention Point Pittsburgh almost 15 years ago and doing overdose prevention trainings around town and looking at the County’s autopsy data. 2014 saw more overdose deaths in Allegheny County than in every other year. 2015 came and it was higher than every other previous year.
We were shouting from the mountaintop that, “Hey, it’s 200 people this year,” when it used to be a 100 per year back in the ‘90s. This was a real issue, and it seemed like it wasn’t on the radar of local decision makers.
When I came on with the County in 2015, I said, “Wouldn’t it be great to do an analysis and provide a foundation for stakeholders in the community on which they could base their decisions to reduce overdose risks?” So I had an opportunity to ask many of the questions I had wanted to ask for the past 10 years.
For example, we know when someone gets out of jail that they are at an increased risk of overdose. So, I said, let’s take a look at the number of people who overdosed following incarceration in the County Jail and how long it was from the time of jail release. We didn’t have a good sense about who might be at risk upon jail entry, but we could ask, “Is there an opportunity for intervention here?”
We figured out that about a fifth of the people who were dying in our communities had been in the County Jail in the year prior to the overdose. If they died, they died in the weeks after jail release.
We packaged that information, shared it with the health services staff in the jail—who were champions—and they collaborated internally and made the decision to begin giving out naloxone to individuals upon release back in October 2016.
We also showed that one in 20 people in Allegheny County had encountered the publicly funded mental health system, yet one in three people who died of a drug overdose had a publicly funded mental health treatment experience in the past year.
So, when people and the media speak pejoratively about “drug addicts” and use stigmatizing language, it may reflect a failure to recognize that many people at risk of overdose may also be experiencing mental illness. It also suggests that community mental health treatment presents us another opportunity for overdose prevention activities.
How do organizations use the information you’ve helped put together?
The County has this incredible integrated data warehouse. It’s a resource for the government, community, universities, municipalities and organizations to collaborate to better serve vulnerable County residents. It can be used to figure out where overdoses–and many other things–have occurred around the County, to whom, which systems people may have encountered prior to an overdose, and which communities may be experiencing higher rates, in order to guide targeted prevention efforts.
What’s happening in public health right now?
The science is maturing. Now we understand that there are many different kinds of social factors that affect people’s health.
Advocates state that housing is health care. There is now emerging evidence that stable housing does lead to improved health and, at the same time, reduces medical costs through less frequent emergency visits while increasing the use of primary care.
As we learn more about how other factors like housing quality, mental illness, criminal justice involvement, child welfare involvement, poverty, food insecurity and the environment affect a person’s physical well-being, it begs the question, “What are we doing with this information?”
We are in an era where it is more feasible to integrate these various data sources to better understand how interventions that are different from conventional healthcare might improve a person’s health. It seems to be helping bridge the gap a bit between public or population health and healthcare, and how health systems conceptualize the way they deliver services. That is the future, and [it’s] what many have recognized all along.
Talk more about the relationship between housing and health.
Think about respiratory conditions in children: we might observe that areas of condensed industrial air pollution in Pittsburgh might be associated with the frequency of asthma-related admissions to the hospital. If it is not possible to stop the pollution, might it be possible to help support the child and family to relocate?
In the work you’ve done, how can data help people in these situations?
Data can be integrated to help clinicians appreciate non-medical factors that might be affecting their patients’ health, and also to effectively connect them with relevant community resources.
See, there’s “big data,” and it’s great that people are talking about it, though it sometimes sounds intimidating. But then there’s the application of it.
You can do all the mathematics and computer science you want, but if it doesn’t relate to the context in which you’re working and the science of implementing interventions in the health space, who cares what you do with mega data?
You can do all the mathematics and computer science you want, but if it doesn’t relate to the context in which you’re working and the science of implementing interventions in the health space, who cares what you do with mega data?Dr. Eric Hulsey
That’s the only way in my life I’m conservative: with data and what we can claim from it. I’m very much an applied person. I wake up in the morning and I try to make the world a little better. I don’t care how fancy someone’s data is. You can use data very simply and end up making radical change, or you can have the most complex data that could be as predictive as anything, but what does it matter if you can’t do anything to make positive change with it?
This idea of waking up in the morning and wanting to make the world a better place: where does that come from?
I’ve had some activist tendencies, but I feel very privileged that I’ve had clinical and systems administration experiences in the past and that I’ve had the opportunity to work with integrated data and learn from an exceptional analytic team—analyzing data, performing evaluations, asking critical questions, trying to develop evidence for sound public policy decisions and challenging conventional wisdom.
I’ve been able to merge all that together. So I guess that’s how I look at it, and that’s what makes my work meaningful.
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