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St. Louis County's new health director wants to focus on all of a patient's needs

Dr. Kanika Cunningham, St. Louis County Director of Public Health, on Wednesday, Jan. 4, 2023, at the county health department’s headquarters in Berkely.
Sarah Fentem
St. Louis Public Radio
Dr. Kanika Cunningham sits in her office at the St. Louis County Health Department's John C. Murphy Health Center in Berkeley.

St. Louis County has a new health director. Dr. Kanika Cunningham started this month after previously serving as a public health officer with the department.

Cunningham, a St. Louis native, is a family medicine provider at Family Care Health Center in St. Louis. The community health organization operates two clinics that offer care to patients regardless of their insurance status or ability to pay.

St. Louis Public Radio’s Sarah Fentem spoke with Cunningham about how her work there is shaping her plans to address addiction, sexually transmitted diseases and the coronavirus pandemic among residents in St. Louis County.

Sarah Fentem: How has the work that you've done at a community health center as a primary care physician shown you what people need? What’s something that a lot of people that aren't working on the ground wouldn't know about?

Kanika Cunningham: People need that compassionate care. Thinking about the social determinants of health and not just focusing on that one aspect … that medication list, but, you know, access to housing and food and getting the bills paid — the gas, electricity, all of that — actually goes into health, believe it or not.

If I didn't address what was going on in someone's social life … it’s huge. And so I think that's one thing that I took away from them that yes, I love to practice medicine, how I deliver care. But I have to also take a step beyond and look at the other things that can affect someone's health and their mental health as well.

I have to acknowledge the burnout factor among clinical staff but also among public health departments. So one thing internally, I do want to make sure that I have a focus on workforce investment and development, because our staff have burned out.

Fentem: A lot of the work you did before you got here was treating patients with addiction. As somebody who has experience in that field, what do you think the county should be doing?

Cunningham: Our system that we have in place for somebody to navigate who uses drugs is awful.

I think some people focus on, you know, one aspect, treatment only, and not recognize the individual in which there are some people who may want to continue to use. We do know that this is a chronic disease, and it may take someone 3,456 times before they can achieve what they say is recovery in their eyes.

We need to, you know, not only give Narcan out and talk about treatment, increased access to treatment, quality treatment, I would say that evidence-based practices, but also incorporate harm reduction principles, meeting people where they are for somebody who continues to use. We can't forget about that individual.

Fentem: During the pandemic, there was — to put it mildly — a lot of contention between the health department and people in the county, and the county council as well.What can we learn from those very high-profile disagreements?

Cunningham: I wasn't inside with, you know, the health department and all of that [when that happened], but there was a lot of tension. So I hope to build relationships and establish new partnerships and trust, and move forward in a positive way with the county council and with Dr. Page’s office. So that's my hope.

Fentem: How much does the county health department work with Dr. Mati Hlatshwayo Davis at the city health department? I know during the pandemic, those two departments teamed up a lot. Do you think that that tradition will continue even as we move out of the pandemic?

Cunningham: We’re actually good friends in real life! You have two women who are actually good friends who care about the community and the public. So of course, we are going to continue to work together.

And I think what the pandemic showed was that when both of us come together for the sake of the community, look at the great things that we can do together as health departments.

Fentem: I'm going to stay on the topic of the pandemic. As we move almost to the third anniversary of when we saw the first coronavirus cases here in the United States, how has the game plan changed?

Cunningham: So I don't foresee us making any significant changes with how we approach it. We're still going to make this a priority to address it. Because we're coming up on this third anniversary, but it’s still present. We're not completely out of this yet.

And my hope is for my health department to continue to remain a leader in a region with bringing evidence-based, you know, information and data to the forefront to help protect our community.

[But also] Yes, we have COVID, we havempox, but you have to think aboutour other STIs: gonorrhea, chlamydia, syphilis, congenital syphilis. We have influenza, RSV, so we have other emerging infectious diseases that we need to continue to monitor. Sexual health is really important.

We have to think about pregnant moms and our babies. We don't spend enough time talking about maternal morbidity and mortality as it relates to pregnancy and the postpartum period.

So yes, we have the pandemic, we have COVID-19, but we have all of those other health issues as important to the health and well-being of families, and not just the individual person. So I do hope to continue to, you know, incorporate that into our work here. Because, you know, as a physician as a primary care doctor, I care about the entire individual, the whole person.

Fentem: Are there anything else you'd like to add before we go?

Cunningham: I'm from St. Louis. This is my hometown!

One thing I want people to know about me is that I love my community. And so I do understand a lot of the issues and so I hope people will join me, as I, you know, enter this role of being a director and collaborating with me because I love my community.

Sarah Fentem is the health reporter at St. Louis Public Radio.