The new director of the Missouri Department of Health and Senior Services said lowering the maternal mortality rate and increasing overall patient care in rural areas is among her priorities.
Gov. Mike Parson announced Paula Nickelson as the director of the Department of Health and Senior Services in June. Nickelson has been acting director of the department for the past year.
As the director, she mitigates current health problems in Missouri and identifies the public health budget and policy needed to accomplish the department's goals.
Missouri is consistently among the states with the highest rates of maternal mortality, which is the death of pregnant people from pre- or post-birth complications. However, many of these deaths are preventable with the right resources in health care.
The department is also working to understand what it would cost to offer services such as injury prevention, infectious disease prevention and maternal and child health care at each local public health agency, Nickelson said. The process is called a costing initiative.
Missouri Business Alert interviewed Nickelson about how public health affects the state’s economy and how the department is working to address maternal mortality.
The following conversation has been edited for length and clarity.
Missouri Business Alert: In what ways do you consider the economy in your decision-making?
Paula Nickelson: People easily think about hospitals and employment in terms of the economy.
What people don't recognize from an economic development perspective is that it's difficult to keep a company in a small rural community that doesn't have birthing facilities, because employees don't want to come in as readily if they don't have that access for their families and growing families. So there's a tremendous impact on the economy.
MBA: In your opinion, what additional infrastructure could be useful to help lower the maternal mortality rate?
Nickelson: One of the things that we're very conscious of is birthing facilities are very far apart. Certainly expanded use of doulas, midwives or certified nurse midwives when that physician care is not available could be useful. But just in general, the public health and health care workforce – but also specific to OBGYN types of responsibilities – is really at a crisis place in this state and nationally. We've been working very hard with our interagency partners to work on real maternal health care issues, as well as the workforce issues.
MBA: Health is an expansive subject. Could you share some insight into how you decide what the health department focuses on?
Nickelson: We're about 80% federally funded. So, often it is driven by what the funder wants to occur. We work very hard when we apply for those federal funds to customize them to what Missouri's needs are. But there is some level at which we have to be responsive to the federal funding.
"Our philosophy is that nobody is safe until everybody's safe. And so we want that level of service across every state and local public health agency in the state."Director Paula Nickelson
We do a very extensive State Health Assessment – every five years, I believe it is – looking at what the counties say their needs are. We’re in the process of redoing that at this point. Then every five years, in conjunction with that, we do a State Health Improvement Plan. So that really sort of does an overarching drive of what we're doing statewide. And then as a department, we just finished our five-year strategic plan of how we're going to fit into that State Health Improvement Plan.
MBA: Is there a way toward increasing state funding for the health department?
Nickelson: The costing initiative is to say to policymakers in a few years, 'if you want the entire state to have this level of access in every county, this is what it will cost.' And we have never taken that approach. In the past, we have never been that evidence-based and that scientific in the approach. So we're very optimistic that our policymakers will say, 'yeah, we want a better place to live.'
MBA: What do you hope to accomplish as director?
Nickelson: Our philosophy is that nobody is safe until everybody's safe. And so we want that level of service across every state and local public health agency in the state. I would say secondly, a goal for us is the workforce. We're working very hard on increasing physician residencies, increasing the availability of physicians across disciplines, but mostly in the primary care disciplines of internal med, family med, psychiatry, pediatrics and OBGYN, because that's really where everybody begins and then they seek specialty care of some sort.
We're also really dedicated to restoring the public trust, because until the public understands that we are a resource and trust us as a resource, then we can't really be as successful as we want to be either.
