January 27, 2024 • 30 mins
The mission of the Tennessee Department of Health is to protect and improve the health and prosperity of the citizens of the state. Dr. Ralph Alvarado recently celebrated his first full year as commissioner of the health department and presides over challenging times including the continuing presence of Covid 19 among many other public health concerns. Dr. Alvarado spoke with John Clark about important current issues and initiatives including programs you may not have known were part of the many responsibilities of the TN Dept. of Health.
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Episode Transcript
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It's Tennessee Matters on the Tennessee RadioNetwork. Welcome to Tennessee Matters. I'm
John Clark on the Tennessee Radio Network. The mission of the Tennessee Department of
Health is to protect, promise,and improve the health and prosperity of the
state. Celebrating his first year inoffice, and here to tell us all
about it is doctor Ralph Alvarado.Well, doctor Alvarado. Today the seventeenth
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of January, it's your anniversary there. So you know, this show's been
done being recorded on the seventeenth,but it's been aired a couple of days
later. But what a you like? Whatever you like about it so far?
What are you not like? Whathave you done? Just tell us
a little bit about your first year. Yeah, no, it's been uh,
it's been great, you know,one year total. It's it's hard
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to believe. It's gone by prettyquickly. A lot of things that have
already happened. But what I likeabout it is people of Tennessee have been
really great. I mean I camefrom from Kentucky originally and served in the
state Senate there, and you know, normally they're in Kentucky. It's a
bit more it's a bit more tribalof a state. I would say,
if you're going to come into arole in the executive branch, a lot
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of people always look at you alittle bit more skeptically if they don't know
who you are or where you're from. And here in Tennessee, I was
preparing for that kind of a reception, and everybody everyone's been incredibly friendly,
very open. Legislators have been greatto work with, Governor's office, everybody
that I've met, everybody just reallyhappy saying hey, thanks for coming to
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Tennessee, and people are really excitedabout it. So that's been something that's
been a very warm welcome. ButI've also got a great staff within the
department, people that are really committedtowards improving the health of Tennesseeans, and
people that work every day despite allthe difficult situations you have in terms of
trying to find good funding and tryingto, you know, work through a
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lot of people's active problems. Atremendous staff that's very committed and dedicated towards
that. And you know, youoften find people in state government in or
different jobs, they do it fordifferent reasons everyone and health is for a
mission, and they're kind of missiondriven and focused on improving the lives of
people in the state every day.So for me, it's been a lot
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of fun. It's getting to knowthose folks. In a year I've had
a chance to really the first fourto five months, I visited every county
in the state and every health department, every regional office, got to meet
all of our employees and really kindof help refocus the department after coming through
COVID. I think everyone was beatendown in the Department of Health. I
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think they had people on one sidesaying you're doing too much, people on
the other side saying you're not doingenough, and so they were kind of
caught in the middle and just tryingto re energize our department and get back
to our roots of what the peopleexpect from the Department of Health. And
you know, I think we're allyou know, COVID is still out there
and everyone's tired of it, butwe want to turn the page and kind
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of start looking forward and trying toimprove again better health outcomes, increase longevity
for people in Tennessee. Yeah,I would imagine, you know, knowing
out in the hinterlands, you guessto go out into various healthcare, you
learn quite a bit probably from thoseof those out in the more rural areas,
whether we really need health care.You really probably learn a lot from
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them, didn't you. Yeah,I have, And again a lot of
folks there were often the health departmentis the only, right maybe the only
provider of any kind of health care. And so the one thing that Tennessee
is very unique that people may notknow is that we're the only state in
the Union that provides primary health servicesin our health departments. No other state
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does that. You know, there'skind of prevention things that are done,
but not active health care. Andso the General Assembly has charged that I
think we have fifty I want tosay fifty six locations. I think of
our health departments. We wind up, you know, partnering up with a
lot of other kind of non governmentalentities to create what's called a health care
safety net. I think we haveabout I want to say a little over
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thirty thirty one million dollars I thinkit is that we have that provides one
hundred and eighteen primary care and dentalproviders. I think they have more than
three hundred over three hundred and fortythousand encounters. And there's a group called
Project Access which covers now I thinkeighty six of our ninety five counties through
a lot of volunteer clinics, alot of doctors, hospitals, they do
specialty work and sometimes cover surgeries,a lot of work for dental services for
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folks too that do restorative work.And you know, we've tried to do
things to improve our reimbursement rates tothose specialty providers who are helping do surgeries
for patients who may not have insurance, to try to improve heal outcomes,
clinical efficiencies, that kind of stuff, and so but we yeah, you
go to some of these you know, whenever I've gone to some of these
more rural counties off and ask howmany providers do you have here? And
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some of the counties say, youdon't have anyone, We're the only only
provider, or they might have oneor two clinics in the entire county and
that's it, and they're often overwhelmed. So overflow would would come to the
health department to try to get somekind of care, and you know some
of them are also I mean,I thought about Pole County. You get
you know, you got two healthdepartments, one on one side of the
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mountain, one on the other,and when it snows like it is now,
you can't access either side, youbasically, so that little health department
is all that's there. People gothere for, you know, anything that
they might need. So and it'slike like any clinic right now, it's
a lot of workforce issues. Sowe're always trying to find people that are
willing if they want to find bea bit more mission driven, is to
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try to get a lot of folksto come in and work in our health
departments and provide care for people,particularly in rural communities where it's needed the
most. Yeah, I would,I would just saying that to think about
that when you were saying you're,you're you need some help in areas and
workforce forces got to be an issue, then does it? It is?
You know, and it's always it'sfront and center. I mean, I
think everyone's feeling that right now,not only in you know, kind of
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the private health care sector, butin public health as well. We've got
a lot of initiatives. I thinkthe governors, you know, put together
a Rural health Care task Force thathas has met as people from across the
entire state, representing private industry,universities, government, and brought everyone together
to kind of assess and create akind of a recommendations for what we need
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to be doing to improve that.And some of the results were to provide
improvement plans through community health councils andcounty health health councils. They want to
they recommended improving a lot of thetechnical assistance to improve outcomes in our you
know, kind of rural counties,and they want to also build on the
private investment efforts that are happening atthe county level. We want to also
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expand a lot of our provider programs, so things like loan forgiveness, telehealth
consult services, and a lot offinancial incentives to expand a lot of rural
care access for people there. Andactually, the one unique thing we've also
done here in Tennessee, which wasremarkable, I think my predecessor, you
know, Commissioner Pearce had done alongwith the General Assembly, they put a
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big dental pilot program, a majorinvestment of I think almost ninety five million
dollars that were committed over five years. It's you know, they put about
sixty six million dollars into expanding classsizes for dnnists at the University of Tennessee
and at marharry A twenty million dollarsexpanded services for for dentures for seniors,
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and eight million dollars also for providerrecruitment incentives. So we're providing up to
I think for a dentist. Imean, the average dentists coming out of
dental school owes about three hundred thousanddollars in student loans. We're providing one
hundred thousand dollars forgiveness per year fordennis who come and work for the Department
of Health. And so we've expandeda lot of our clinic quotations and students
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and residencies for a lot of thesestudents at UT and Mahara. But again,
over I think over eight thousand encountersalready for people. The are seniors
that need help with their smiles,and we've got dentists coming to us now
saying hey, I heard that aloan forgiveness program. It's one of the
better ones in the country. Andso they sign up to work with us
for three years and can often gettheir student loans paid off, all the
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while having a dentist in a veryrural community where they would otherwise not be
able to see a dentist, andproviding services for people often if they don't
have any insurance for free. Soa lot of neat work that's being done
there. We're really proud of that, and we're going to look at the
end of the five year program tosee how many people have been helped and
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hopefully improve our our dental outcomes forkids and for adults. That's that's great
there, that's fantasticause I know,dental, you know, dental surgery or
dental anything dental leads to other biggerproblems, and so that's great that you
find out out. Oh yeah,yeah, and we remind people. I
mean again, if you're you know, people can have a lot of heart,
you know, they can develop alot of other problems. You're right,
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if your if your mouth is signin good shape, keep in bad
shape. That leads to infections andplammatory responses, a lot of things that
can lead to bigger health problems forpeople. So really crucial. There's a
huge need the big deserts of wherethere's no dentists, and so we're hoping
to start We're attracting people now intoTennessee from out of state. We just
had a doctor who's i think cominghere from Georgia now. And we've got
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our own students that when they're finishingup their programs, once they got a
taste of working in smaller communities,they kind of like it and they go,
hey, you know, I wantto I want to go back.
I mean that's kind of where myroots are. I practice in a small
county for you know, for twentyeight years and enjoy that and it's a
lot of fun. You just youbecome part of the community, and as
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people get exposed to it, youknow, they kind of get back again
to the roots of what it's likebeing a doctor in a small town.
So, yeah, what one areaof that to sake ind to this is
current flu crisis, the current fluand COVID COVID problems that are going on
right now. That's an issue rightnow because it is milli flu season.
What are you looking at right nowfor that? Yeah, So obviously we
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always recommend prevention, right all everything. You always talk about an ounce
of preventions worth of pound of curesis Benjamin Franklin once said. And so
we always recommend prevention so that thebiggest thing people can do obviously just simple
things washing your hands, you know, is if you're going to cough for
sneedes, is to cover your mouth, just because that can spread virus and
things to other people and expose them. But hand washing is always crucial.
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Getting good sleep, drinking plenty offluids, you know, eat and ride,
exercising, all those things prevent infectionsand illness. But also we have
obviously vaccinations available, and so forthe flu. Ever since the flu first
came on the scene, back ofthe Spanish flu back in nineteen eighteen and
nineteen nineteen, you've been doing we'vebeen recommending annual flu vaccines for people.
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About forty percent of our population traditionallyhave gotten the flu vaccines, you know,
and we have people that contract itevery year, and you hear sad
stories of young adults, kids,people that contract it and get very sick,
unexpectedly and often die, and sowe always recommend people take it.
Now, people think of vaccines assomething that's going to prevent you from getting
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the infection, and sometimes that's thecase, but sometimes it's not about you
still may catch it, but itlessens how severe the infection is that's kind
of how COVID vaccines will work.Flu vaccines will work is that, hey,
you still might catch the flu,but you know, your odds of
death or serious illness or hospitalization ismarkedly reduced. And so we always recommend
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that people get those to prevent them. And obviously there's some populations that are
much higher risk than others or someof these So we know COVID in our
older population was very severe, andso we always recommend people over the age
of sixty five to get those thingsdone. But flu in COVID have surged
here in Tennessee. We've had alot of hospitalizations from that, and we
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often will track our numbers based onthose hospitalizations. So I think we're reaching
our peak, hopefully on the backside. But still it's not too late to
get those vaccines. We recommend peopletalk to their providers about, you know,
if they can if they can takethose and what about the COVID Now
you know we're here, we arehearing more about it, a little bit
more about it, and taking avaccine is that something you recommend? Uh?
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Yeah, and we still we stilldo recommend that. I mean,
we're you know we're not necessarily notthey're promoting it, but were recommending it,
and a lot of that space.People often ask why, and I
tell them, you know, there'sa lot of people questioning a lot of
the science right now on on COVIDvaccines, and and I think there's still
a lot of study being done.People have to remember, this is a
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brand new virus, so we're learningeverything on the fly on covid UH,
and we don't know everything there isto know. I always use the example
of someone like you know, GeorgeWashington when he died, he died from
something strap up a lot of titus, which today that's a I put somebody
on a ventilator, steroids, antibiotics, and you can hear them from it
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if you need to emergently do atrade giosity. Back then, the treatment
was blood letting, and so peoplewould blood let you and we can chuckle
about it, but that's all theyneed because that's what they had on their
science at the time. So rightnow, we act on the science that
we have available. Studies say thatthe COVID vaccines recommended to help reduce that
people are worried about potential side effects. We've had millions and millions of people
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that have received it. Obviously,we've got a lot of data on that,
and so based on what we knowfor right now, we're recommending that,
and if things change in the future, then we we'll alter our that.
But we always base all of thethings that we do off of the
current science. You know, Iuse examples of heart failure in beta blockers.
Twenty five years ago, if Igave you a beta blocker with heart
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failure, it was considered malpractice.Today, if I don't give you a
beta blocker, it's malpractice. Whatchanged? I mean, the beta blocker
didn't change, the heart failure didn'tchange. It's just we have twenty five
years of experience and we said,oh, you know what, we should
have been doing it all along.And so I think the same thing applies
for that. Everyone is just soused to modern medicine that we're supposed to
know everything there is to know abouteverything right now, and we don't.
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But what we know right now wedo recommend it. We still recommend it,
and I think what the current numbersare showing us is even six months
of aging up that it's recommended.But we always tell everybody go talk to
your doctor, the person that youtrust in your healthcare world. That's the
person that you should be talking toabout what's right for you and putting that
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out there. But we do recommendthe vaccines currently for people that are out
there, just switch a little bit. Was to certainly to switch quite a
bit. Children and young people insuicide and suicide in general is a big
issue in Tennessee. Can you contendare you doing things about that? Yeah,
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there's I mean so obviously we've seenan uptaking of a lot of mental
health obviously in the country. Ithink everybody can feel it, they can
see it. I often give alot of talks. We talked about a
lot of the information that seeds.Sometimes most of the use that we're getting
these days is not happy news.It's usually pretty negative and a lot of
anger and a lot of those things, and that influences that all the things
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that we have and more people arestaring at phones and kind of isolating themselves.
So one of the things we're seeingis that there's less human interaction,
a lot less. If you askthe average person how many good friends they
have right now, it's a lotless than it was thirty years ago.
And just because we spend more timeson phones and we're isolated, and again
a snowstorm like we're having right now, people are kind of hunkered down and
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not as much interaction with things sometimes, and so that'll place a factor in
it. We do have a growingnumber of suicides in the state. I
mean, there's our pediatric issues Ithink are probably a little bit better on
the latest data, but we doknow that in Tennessee in particular, are
veterans very high suicide rates, muchhigher than the national average, and we
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worry about that. I know we'vebeen working with Commissioner Baker with Veterans Services
about what we can do to helpimprove that. Some of the things that
I've been encouraging everybody is to talkabout the nine eight eight Suicide and Crisis
Lifeline that's available for people that arehaving a mental health crisis. They can
either text or chat and the websiteis nine eight eight lifeline dot org and
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people can log on there. Youknow, right now, if there's ever
an issue. The old number peoplehere of nine to one one, they
know they call that for an emergency. If it's a mental health emergency,
they should call nine eight eight rightaway. If it's for yourself or for
someone else, And the more wecan promote that and hear it, people
can get someone right away and getsome help. And there's always a lot
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at the end of the tunnel.We just have to be able to have
someone show them where that's at sothey can get there. But yeah,
there's a lot, a lot ofwork being done on trying to enhance mental
health services, and we struggle infinding more and more providers who are willing
to practice in that space and help. And you know, our schools are
trying to identify folks that might havethat be able to refer them somewhere.
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We're working in our health departments.We have a couple of contracts with our
Department of Mental Health and subsistant theseservices. Commissioner Marie Williams does tremendous work
with her people in this space.They're contracting with us and helping us find
providers that are willing to embed themselvesin our health departments so if someone comes
in they can see somebody right away. I have a lot of private providers
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and you know, a lot ofthe lab Honors system ETSU or having private
clinics for their hospital systems, andthey're trying to find a way to be
reimbursed, have kind of mental healthintegrated inside of their clinics as well to
provide some of those mental health services. When you come in. You might
be coming in for your arthritis,but hey, you're having an issue that
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day, and they continue right downthe hall to see us specialists. Is
there to help you talk through thingsand manage through a lot of those things.
And so part of it is breakingdown stigma. Part of it is,
you know, you know, ourveterans are taught to be self sufficient
and as though if they're have amental health issue, it's a sign of
weakness, it's not. It's mentalhealth is health. It's part of our
bodies. It's how our bodies respondto things and just it's okay to talk,
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get help and do those kinds ofthings. And so it's a big
issue. It is touching most ofour communities when they do their own health
assessments, identify this as one ofthe major things that's affecting their community,
their kids and adults. And wejust got to find a way to have
interactions and again get back to seeingpeople face to face and lots of things
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that can improve it. But youknow, we always recommend people get help
and not that feel stigma. Andagain to know about nine eight eight.
The more we can promote that,the better nine eight eight, No,
nine eight eight, remember that nineeight eight. Yeah, what about the
ongoing fentanyl crisis that still continues toto hurt us in cities and counties and
small towns everywhere. Yeah, Imean si, So it's a I mean,
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obviously another it's another one of thebig things that we're seeing. Obviously,
it's the scourge of our generation,is how easy it is to get
fentanyl, to the point that it'seven you know, people are willing to
take a sometimes a pill they ifthey find the pills from someone else and
they take it, or we've seenit even in vaping units where kids are
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they're getting a vape from someone theythink they know what they're vaping, and
there's ventanyl inside of it and theyoverdose and die. Our first responders go
to a scene and find someone withpowder and it touches their skin and absorbs
them and they wind up getting overdosesaccidentally. So lots of this stuff that's
out there. The way we're workingwith this, I mean, we have
a division within our department also it'san opioid response kind of team that is
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helping trying to enhance kind of responsetime in communities and helping, you know,
get word out if if we knowthat there's something that's lethal, and
trying to help people to make surethat they don't you know, take a
bad batch of a drug or somethingalong those lines. But a lot of
this is going to be getting peopleinto treatment, and so as much medication
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assisted treatment, as much rehabilitation thatwe can get folks into would help.
There's a lot of our faith basedcommunity works with good things like Celebrate Recovery
and a lot of different kind ofprograms that will help people work through that
and know that sometimes it takes multipleattempts to get someone better. But we
are all also working just in termsof preventing overdoses. I mean even within
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the department. The General Assembly wasable to allocate some funds for us to
be able to distribute Narcan and fentanyltest trips that are available through all local
health departments as well, so thatpeople can now go to a health department
if they want to ask for narcaan. We have Narcan to be given out
to folks and then also fentanyl testtrips were working on things like drug take
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back. So we think about fentanyl, which is an illegal substance. It's
being promoted and being sold by peopleon the street. But even just if
you have extra opiates or extra youwent and had a surgery done and you've
got pain medicine at home, onlyused one or two tablets and the rest
are sitting in a cabinet somewhere.I know that people sometimes if they find
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that we'll steal that, will takeit, we'll use it for other purposes.
And so we have drug takebacks availablethrough law enforcement that you can go
drop off these medications safely. They'llbe incinerated appropriately because people often will flush
that stuff into commodes and then ora water system, which isn't good either,
but that you can take those in, dispose of them safely and not
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have to worry about having that outthere for others to consume or try.
But it is such as a hugeissue and everybody struggles to try to find
ways to try to control it andtry to reduce the side effects of it.
And most of the time with alot of this is that some of
us are wired a certain way thatonce you get your first touch of these
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medications, you automatically have a propensityfor a problem with addiction with it,
and so it's just making sure thatyou know, do you really need this.
Sometimes the strongest medicines aren't always thebest choice to go with, and
we're teaching a lot of our providersto to try other other, you know,
means of trying to control pain insteadof having to use the strongest that
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it's available right out of the gate. But from a fentanyl angle, it's
I tell parents, if you gotto talk to your kids the sooner.
You know, you have to allowsome innocence in life. But if you
can talk to your children as earlyas possible regarding this, you know,
if you've if they're going to juniorhigh, if you haven't had the conversation,
you're probably too late. You gotto talk about vaping, ventyl use,
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all these different things. It's importantfor parents to engage their children on
it, talk about it, andyou know what to do and to avoid
those things. And it's just somany people. We all know somebody who's
been affected or had an issue withit. Right now, is acty codone
still a problem? The acxy codonsout there it's still I mean, it's
still being prescribed. I mean it'sa but I think our medical community,
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I mean, we put out kindof chronic pain guidelines as a department that
we use. It's kind of aguideline for our providers. Our Board of
Medical Examiners, which is an independentboard, but that we provide obviously support
for through the Department of Health.They are they take that very seriously and
so we have a lot of folksthat are watching that carefully. Our numbers
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as a state compared to other statesis still very poor. I think we're
fifth worst right now in terms ofthe amount of opiates that are consumed and
used as a state per capita.So we've got to we're trying to train
our provide our providers right now.Our universities are doing the job of trying
to train them and how to howto manage pain without having to use oxycodone
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or hydro codone and narcotics. Thatshould be the last choice. It's probably
not the best choice for chronic painmanagement, just because it'll provide your relief
for a while, but then asyour body gets accustomed, you need more
to which you have the same painrelief and so we have other means,
and I think the medical community hasresponded realizing kind of what the country has
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gone through in the past, andwe're trying to find ways to change our
new doctors that kind of have adifferent approach on that. So it's it's
you know, it still is outthere, but it's markedly reduced from where
it was before. In closing,I'll ask you, what are the few
things into the Tennessee Department of Healththat people don't maybe not know about,
that people don't know about, yousay, they don't get enough about to
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tell about this or that. Whatare some of those things? Yeah,
no, and I appreciate that question. Is I think a lot of times
everybody thinks that, you know,after COVID, that they just say,
oh, that's where you go toget COVID or if you have a yeah,
you know, an STD or something, you go there for treatment.
And we do. We still dothose things obviously, but we do a
lot of stuff. I mean,there's something as simple as you know,
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again we mentioned in providing healthcare services, so we do a lot of primary
care in our health departments. Notall of them, but you know,
most of the them provide primary careservices, dental services. We birthen death
certificates of voter registration forms. Imean those are done through your health departments.
I mentioned the kind of loan repaymentprograms for a lot of medical professionals
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and kind of address to healthcare shortages. I talked about the Narcan and fentanyl
test strips that we offer, butwe also do family planning. We do
those through telehealth services also, sowe do a lot of telemedicine things,
but live we do a lot ofanybody seeking contraception care. We do a
lot of those services from the Departmentof Health. We have a breastfeeding hotline
for moms that's available twenty four toseven. It's staffed by lactation consultants.
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I think the number for that isa five five four two three sixty six
sixty seven. I think that's correct. But that's like a lactation services we
provide twenty So if a mom's havingdifficulty with then you born at home,
you can call and they can provideyou some help. And with breastfeeding WICK,
which is a program women infinite children. Less than half of the eligible
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Tennessee population is enrolled, so there'sprobably double the people that could that could
use it, and it provides foodsecurity, nutrition, lactation, counseling,
emergency preparedness resources, that kind ofstuff. And you would encourage people right
now when inflation is high and foodprices are high and people might be having
a difficult time making ends meet onthat that there's no reason why you can't
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find help with in the health department. So contact and with can often get
you tied into some of that.And then we have breast and cervical cancer
screens for Tennessee women who are uninsuredor underinsured. We do a lot of
that for women there as well.And again dental services. Those are some
of the things that we kind ofcommonly do that people I think don't even
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know about that. We have alot broader reach really to help a lot
of folks out. But the Departmentof Health is I tell everybody, we
touch everyone in the state, whetherthey know it or not. You go
to a restaurant and you have foodthat's safe to eat, someone has already
tested that for you. That's beenthe Department of Health. That we go
out into the community and double checkto make sure things are being done properly,
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and we do all the licensing andregulation of health providers is done through
the Department of Health, So weoversee doctors and dentists and therapists and anybody
and acapuncturists and you name it.We're overseeing a lot of them to make
sure that things are being done safely, so broad reaching, we touch more
people than they realize, and we'rehere to help, I mean the other
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things. We're just trying to promotegood health. And I've told our department
we're not going to wag our fingerat people and tell them what they should
do, I think, but wehave to try to encourage folks to educate
them. And we rank forty fourthoverall in public health as a state in
the country, and we're very proudof our rankings in Tennessee both when it
comes to football and basketball and fiscalresponsibility and monetary stuff, but we're bottom
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ten when it comes to public healthoutcome. So I'm trying to reignite the
desire from the state and appeal toour pride a little bit to try to
get us into a top ten rankingwhen it comes to public health. And
it's it's going to take a lotof effort in so many ways, but
those are all the things that wedo. We do so much more that
I haven't mentioned people on for probablyhalf an hour, but a lot of
(28:18):
stuff that we do in the DepartmentHealth. You have a very busy department,
that's for sure. Yes you do. We do, and a lot
of very committed people. Yes,yes, it takes people a lot of
people to help you. What websitesshould people go through to find out general
information about the Tennessee Department of Health, Yeah, they just if it is
Google, I mean it just Google. TDH dot org usually built to find
(28:41):
that you can always go to anykind of the MITN apps also will have
information on there. People can signup for Wick for example for that food
issue was talking about with Free Young'sFamilies. There's even an app for a
food shopper type of app that wehave. It's a wik app that people
can go on and find out whenthey go shopping, need help with that,
what's eligible and some of the nutritionalcontents. But the Tennessee Department of
(29:04):
Health, you just google it.It's a huge website tdh dot org and
there's lots of subareas be up belowthat that you can find information regarding the
Department but it's being enourage pople tovisit the site. It's got a lot
of information that you can find thingsabout. Again, Tennessee Department of Health,
(29:25):
Doctor Alvarado, I appreciate your timetoday and I certainly appreciate talking to
you, and it's nice to meetyou. Likewise, I appreciate so much.
Thank you. That's doctor Ralph Alvarado, the Commissioner of the Tennessee Department
of Health. If you have questionsor comments about today's program, you can
email me, John Clark at iHeartMediadot com. Thanks for listening. I'll
talk to you next week right hereon your local radio station on Tennessee Matters.
It's Tennessee Matters on the Tennessee RadioNetwork. Welcome to Tennessee Matters. I'm
John Clark on the Tennessee Radio Network. The mission of the Tennessee Department of
Health is to protect, promise,and improve the health and prosperity of the
state. Celebrating his first year inoffice, and here to tell us all
about it is doctor Ralph Alvarado.Well, doctor Alvarado. Today the seventeenth
(00:25):
of January, it's your anniversary there. So you know, this show's been
done being recorded on the seventeenth,but it's been aired a couple of days
later. But what a you like? Whatever you like about it so far?
What are you not like? Whathave you done? Just tell us
a little bit about your first year. Yeah, no, it's been uh,
it's been great, you know,one year total. It's it's hard
(00:46):
to believe. It's gone by prettyquickly. A lot of things that have
already happened. But what I likeabout it is people of Tennessee have been
really great. I mean I camefrom from Kentucky originally and served in the
state Senate there, and you know, normally they're in Kentucky. It's a
bit more it's a bit more tribalof a state. I would say,
if you're going to come into arole in the executive branch, a lot
(01:07):
of people always look at you alittle bit more skeptically if they don't know
who you are or where you're from. And here in Tennessee, I was
preparing for that kind of a reception, and everybody everyone's been incredibly friendly,
very open. Legislators have been greatto work with, Governor's office, everybody
that I've met, everybody just reallyhappy saying hey, thanks for coming to
(01:29):
Tennessee, and people are really excitedabout it. So that's been something that's
been a very warm welcome. ButI've also got a great staff within the
department, people that are really committedtowards improving the health of Tennesseeans, and
people that work every day despite allthe difficult situations you have in terms of
trying to find good funding and tryingto, you know, work through a
(01:49):
lot of people's active problems. Atremendous staff that's very committed and dedicated towards
that. And you know, youoften find people in state government in or
different jobs, they do it fordifferent reasons everyone and health is for a
mission, and they're kind of missiondriven and focused on improving the lives of
people in the state every day.So for me, it's been a lot
(02:10):
of fun. It's getting to knowthose folks. In a year I've had
a chance to really the first fourto five months, I visited every county
in the state and every health department, every regional office, got to meet
all of our employees and really kindof help refocus the department after coming through
COVID. I think everyone was beatendown in the Department of Health. I
(02:32):
think they had people on one sidesaying you're doing too much, people on
the other side saying you're not doingenough, and so they were kind of
caught in the middle and just tryingto re energize our department and get back
to our roots of what the peopleexpect from the Department of Health. And
you know, I think we're allyou know, COVID is still out there
and everyone's tired of it, butwe want to turn the page and kind
(02:54):
of start looking forward and trying toimprove again better health outcomes, increase longevity
for people in Tennessee. Yeah,I would imagine, you know, knowing
out in the hinterlands, you guessto go out into various healthcare, you
learn quite a bit probably from thoseof those out in the more rural areas,
whether we really need health care.You really probably learn a lot from
(03:15):
them, didn't you. Yeah,I have, And again a lot of
folks there were often the health departmentis the only, right maybe the only
provider of any kind of health care. And so the one thing that Tennessee
is very unique that people may notknow is that we're the only state in
the Union that provides primary health servicesin our health departments. No other state
(03:36):
does that. You know, there'skind of prevention things that are done,
but not active health care. Andso the General Assembly has charged that I
think we have fifty I want tosay fifty six locations. I think of
our health departments. We wind up, you know, partnering up with a
lot of other kind of non governmentalentities to create what's called a health care
safety net. I think we haveabout I want to say a little over
(04:00):
thirty thirty one million dollars I thinkit is that we have that provides one
hundred and eighteen primary care and dentalproviders. I think they have more than
three hundred over three hundred and fortythousand encounters. And there's a group called
Project Access which covers now I thinkeighty six of our ninety five counties through
a lot of volunteer clinics, alot of doctors, hospitals, they do
specialty work and sometimes cover surgeries,a lot of work for dental services for
(04:27):
folks too that do restorative work.And you know, we've tried to do
things to improve our reimbursement rates tothose specialty providers who are helping do surgeries
for patients who may not have insurance, to try to improve heal outcomes,
clinical efficiencies, that kind of stuff, and so but we yeah, you
go to some of these you know, whenever I've gone to some of these
more rural counties off and ask howmany providers do you have here? And
(04:49):
some of the counties say, youdon't have anyone, We're the only only
provider, or they might have oneor two clinics in the entire county and
that's it, and they're often overwhelmed. So overflow would would come to the
health department to try to get somekind of care, and you know some
of them are also I mean,I thought about Pole County. You get
you know, you got two healthdepartments, one on one side of the
(05:11):
mountain, one on the other,and when it snows like it is now,
you can't access either side, youbasically, so that little health department
is all that's there. People gothere for, you know, anything that
they might need. So and it'slike like any clinic right now, it's
a lot of workforce issues. Sowe're always trying to find people that are
willing if they want to find bea bit more mission driven, is to
(05:32):
try to get a lot of folksto come in and work in our health
departments and provide care for people,particularly in rural communities where it's needed the
most. Yeah, I would,I would just saying that to think about
that when you were saying you're,you're you need some help in areas and
workforce forces got to be an issue, then does it? It is?
You know, and it's always it'sfront and center. I mean, I
think everyone's feeling that right now,not only in you know, kind of
(05:57):
the private health care sector, butin public health as well. We've got
a lot of initiatives. I thinkthe governors, you know, put together
a Rural health Care task Force thathas has met as people from across the
entire state, representing private industry,universities, government, and brought everyone together
to kind of assess and create akind of a recommendations for what we need
(06:21):
to be doing to improve that.And some of the results were to provide
improvement plans through community health councils andcounty health health councils. They want to
they recommended improving a lot of thetechnical assistance to improve outcomes in our you
know, kind of rural counties,and they want to also build on the
private investment efforts that are happening atthe county level. We want to also
(06:44):
expand a lot of our provider programs, so things like loan forgiveness, telehealth
consult services, and a lot offinancial incentives to expand a lot of rural
care access for people there. Andactually, the one unique thing we've also
done here in Tennessee, which wasremarkable, I think my predecessor, you
know, Commissioner Pearce had done alongwith the General Assembly, they put a
(07:05):
big dental pilot program, a majorinvestment of I think almost ninety five million
dollars that were committed over five years. It's you know, they put about
sixty six million dollars into expanding classsizes for dnnists at the University of Tennessee
and at marharry A twenty million dollarsexpanded services for for dentures for seniors,
(07:28):
and eight million dollars also for providerrecruitment incentives. So we're providing up to
I think for a dentist. Imean, the average dentists coming out of
dental school owes about three hundred thousanddollars in student loans. We're providing one
hundred thousand dollars forgiveness per year fordennis who come and work for the Department
of Health. And so we've expandeda lot of our clinic quotations and students
(07:50):
and residencies for a lot of thesestudents at UT and Mahara. But again,
over I think over eight thousand encountersalready for people. The are seniors
that need help with their smiles,and we've got dentists coming to us now
saying hey, I heard that aloan forgiveness program. It's one of the
better ones in the country. Andso they sign up to work with us
for three years and can often gettheir student loans paid off, all the
(08:11):
while having a dentist in a veryrural community where they would otherwise not be
able to see a dentist, andproviding services for people often if they don't
have any insurance for free. Soa lot of neat work that's being done
there. We're really proud of that, and we're going to look at the
end of the five year program tosee how many people have been helped and
(08:31):
hopefully improve our our dental outcomes forkids and for adults. That's that's great
there, that's fantasticause I know,dental, you know, dental surgery or
dental anything dental leads to other biggerproblems, and so that's great that you
find out out. Oh yeah,yeah, and we remind people. I
mean again, if you're you know, people can have a lot of heart,
you know, they can develop alot of other problems. You're right,
(08:52):
if your if your mouth is signin good shape, keep in bad
shape. That leads to infections andplammatory responses, a lot of things that
can lead to bigger health problems forpeople. So really crucial. There's a
huge need the big deserts of wherethere's no dentists, and so we're hoping
to start We're attracting people now intoTennessee from out of state. We just
had a doctor who's i think cominghere from Georgia now. And we've got
(09:13):
our own students that when they're finishingup their programs, once they got a
taste of working in smaller communities,they kind of like it and they go,
hey, you know, I wantto I want to go back.
I mean that's kind of where myroots are. I practice in a small
county for you know, for twentyeight years and enjoy that and it's a
lot of fun. You just youbecome part of the community, and as
(09:35):
people get exposed to it, youknow, they kind of get back again
to the roots of what it's likebeing a doctor in a small town.
So, yeah, what one areaof that to sake ind to this is
current flu crisis, the current fluand COVID COVID problems that are going on
right now. That's an issue rightnow because it is milli flu season.
What are you looking at right nowfor that? Yeah, So obviously we
(10:00):
always recommend prevention, right all everything. You always talk about an ounce
of preventions worth of pound of curesis Benjamin Franklin once said. And so
we always recommend prevention so that thebiggest thing people can do obviously just simple
things washing your hands, you know, is if you're going to cough for
sneedes, is to cover your mouth, just because that can spread virus and
things to other people and expose them. But hand washing is always crucial.
(10:22):
Getting good sleep, drinking plenty offluids, you know, eat and ride,
exercising, all those things prevent infectionsand illness. But also we have
obviously vaccinations available, and so forthe flu. Ever since the flu first
came on the scene, back ofthe Spanish flu back in nineteen eighteen and
nineteen nineteen, you've been doing we'vebeen recommending annual flu vaccines for people.
(10:43):
About forty percent of our population traditionallyhave gotten the flu vaccines, you know,
and we have people that contract itevery year, and you hear sad
stories of young adults, kids,people that contract it and get very sick,
unexpectedly and often die, and sowe always recommend people take it.
Now, people think of vaccines assomething that's going to prevent you from getting
(11:05):
the infection, and sometimes that's thecase, but sometimes it's not about you
still may catch it, but itlessens how severe the infection is that's kind
of how COVID vaccines will work.Flu vaccines will work is that, hey,
you still might catch the flu,but you know, your odds of
death or serious illness or hospitalization ismarkedly reduced. And so we always recommend
(11:26):
that people get those to prevent them. And obviously there's some populations that are
much higher risk than others or someof these So we know COVID in our
older population was very severe, andso we always recommend people over the age
of sixty five to get those thingsdone. But flu in COVID have surged
here in Tennessee. We've had alot of hospitalizations from that, and we
(11:48):
often will track our numbers based onthose hospitalizations. So I think we're reaching
our peak, hopefully on the backside. But still it's not too late to
get those vaccines. We recommend peopletalk to their providers about, you know,
if they can if they can takethose and what about the COVID Now
you know we're here, we arehearing more about it, a little bit
more about it, and taking avaccine is that something you recommend? Uh?
(12:11):
Yeah, and we still we stilldo recommend that. I mean,
we're you know we're not necessarily notthey're promoting it, but were recommending it,
and a lot of that space.People often ask why, and I
tell them, you know, there'sa lot of people questioning a lot of
the science right now on on COVIDvaccines, and and I think there's still
a lot of study being done.People have to remember, this is a
(12:31):
brand new virus, so we're learningeverything on the fly on covid UH,
and we don't know everything there isto know. I always use the example
of someone like you know, GeorgeWashington when he died, he died from
something strap up a lot of titus, which today that's a I put somebody
on a ventilator, steroids, antibiotics, and you can hear them from it
(12:52):
if you need to emergently do atrade giosity. Back then, the treatment
was blood letting, and so peoplewould blood let you and we can chuckle
about it, but that's all theyneed because that's what they had on their
science at the time. So rightnow, we act on the science that
we have available. Studies say thatthe COVID vaccines recommended to help reduce that
people are worried about potential side effects. We've had millions and millions of people
(13:16):
that have received it. Obviously,we've got a lot of data on that,
and so based on what we knowfor right now, we're recommending that,
and if things change in the future, then we we'll alter our that.
But we always base all of thethings that we do off of the
current science. You know, Iuse examples of heart failure in beta blockers.
Twenty five years ago, if Igave you a beta blocker with heart
(13:37):
failure, it was considered malpractice.Today, if I don't give you a
beta blocker, it's malpractice. Whatchanged? I mean, the beta blocker
didn't change, the heart failure didn'tchange. It's just we have twenty five
years of experience and we said,oh, you know what, we should
have been doing it all along.And so I think the same thing applies
for that. Everyone is just soused to modern medicine that we're supposed to
know everything there is to know abouteverything right now, and we don't.
(14:00):
But what we know right now wedo recommend it. We still recommend it,
and I think what the current numbersare showing us is even six months
of aging up that it's recommended.But we always tell everybody go talk to
your doctor, the person that youtrust in your healthcare world. That's the
person that you should be talking toabout what's right for you and putting that
(14:20):
out there. But we do recommendthe vaccines currently for people that are out
there, just switch a little bit. Was to certainly to switch quite a
bit. Children and young people insuicide and suicide in general is a big
issue in Tennessee. Can you contendare you doing things about that? Yeah,
(14:45):
there's I mean so obviously we've seenan uptaking of a lot of mental
health obviously in the country. Ithink everybody can feel it, they can
see it. I often give alot of talks. We talked about a
lot of the information that seeds.Sometimes most of the use that we're getting
these days is not happy news.It's usually pretty negative and a lot of
anger and a lot of those things, and that influences that all the things
(15:07):
that we have and more people arestaring at phones and kind of isolating themselves.
So one of the things we're seeingis that there's less human interaction,
a lot less. If you askthe average person how many good friends they
have right now, it's a lotless than it was thirty years ago.
And just because we spend more timeson phones and we're isolated, and again
a snowstorm like we're having right now, people are kind of hunkered down and
(15:31):
not as much interaction with things sometimes, and so that'll place a factor in
it. We do have a growingnumber of suicides in the state. I
mean, there's our pediatric issues Ithink are probably a little bit better on
the latest data, but we doknow that in Tennessee in particular, are
veterans very high suicide rates, muchhigher than the national average, and we
(15:52):
worry about that. I know we'vebeen working with Commissioner Baker with Veterans Services
about what we can do to helpimprove that. Some of the things that
I've been encouraging everybody is to talkabout the nine eight eight Suicide and Crisis
Lifeline that's available for people that arehaving a mental health crisis. They can
either text or chat and the websiteis nine eight eight lifeline dot org and
(16:15):
people can log on there. Youknow, right now, if there's ever
an issue. The old number peoplehere of nine to one one, they
know they call that for an emergency. If it's a mental health emergency,
they should call nine eight eight rightaway. If it's for yourself or for
someone else, And the more wecan promote that and hear it, people
can get someone right away and getsome help. And there's always a lot
(16:37):
at the end of the tunnel.We just have to be able to have
someone show them where that's at sothey can get there. But yeah,
there's a lot, a lot ofwork being done on trying to enhance mental
health services, and we struggle infinding more and more providers who are willing
to practice in that space and help. And you know, our schools are
trying to identify folks that might havethat be able to refer them somewhere.
(17:00):
We're working in our health departments.We have a couple of contracts with our
Department of Mental Health and subsistant theseservices. Commissioner Marie Williams does tremendous work
with her people in this space.They're contracting with us and helping us find
providers that are willing to embed themselvesin our health departments so if someone comes
in they can see somebody right away. I have a lot of private providers
(17:23):
and you know, a lot ofthe lab Honors system ETSU or having private
clinics for their hospital systems, andthey're trying to find a way to be
reimbursed, have kind of mental healthintegrated inside of their clinics as well to
provide some of those mental health services. When you come in. You might
be coming in for your arthritis,but hey, you're having an issue that
(17:44):
day, and they continue right downthe hall to see us specialists. Is
there to help you talk through thingsand manage through a lot of those things.
And so part of it is breakingdown stigma. Part of it is,
you know, you know, ourveterans are taught to be self sufficient
and as though if they're have amental health issue, it's a sign of
weakness, it's not. It's mentalhealth is health. It's part of our
bodies. It's how our bodies respondto things and just it's okay to talk,
(18:10):
get help and do those kinds ofthings. And so it's a big
issue. It is touching most ofour communities when they do their own health
assessments, identify this as one ofthe major things that's affecting their community,
their kids and adults. And wejust got to find a way to have
interactions and again get back to seeingpeople face to face and lots of things
(18:33):
that can improve it. But youknow, we always recommend people get help
and not that feel stigma. Andagain to know about nine eight eight.
The more we can promote that,the better nine eight eight, No,
nine eight eight, remember that nineeight eight. Yeah, what about the
ongoing fentanyl crisis that still continues toto hurt us in cities and counties and
small towns everywhere. Yeah, Imean si, So it's a I mean,
(18:56):
obviously another it's another one of thebig things that we're seeing. Obviously,
it's the scourge of our generation,is how easy it is to get
fentanyl, to the point that it'seven you know, people are willing to
take a sometimes a pill they ifthey find the pills from someone else and
they take it, or we've seenit even in vaping units where kids are
(19:17):
they're getting a vape from someone theythink they know what they're vaping, and
there's ventanyl inside of it and theyoverdose and die. Our first responders go
to a scene and find someone withpowder and it touches their skin and absorbs
them and they wind up getting overdosesaccidentally. So lots of this stuff that's
out there. The way we're workingwith this, I mean, we have
a division within our department also it'san opioid response kind of team that is
(19:41):
helping trying to enhance kind of responsetime in communities and helping, you know,
get word out if if we knowthat there's something that's lethal, and
trying to help people to make surethat they don't you know, take a
bad batch of a drug or somethingalong those lines. But a lot of
this is going to be getting peopleinto treatment, and so as much medication
(20:02):
assisted treatment, as much rehabilitation thatwe can get folks into would help.
There's a lot of our faith basedcommunity works with good things like Celebrate Recovery
and a lot of different kind ofprograms that will help people work through that
and know that sometimes it takes multipleattempts to get someone better. But we
are all also working just in termsof preventing overdoses. I mean even within
(20:23):
the department. The General Assembly wasable to allocate some funds for us to
be able to distribute Narcan and fentanyltest trips that are available through all local
health departments as well, so thatpeople can now go to a health department
if they want to ask for narcaan. We have Narcan to be given out
to folks and then also fentanyl testtrips were working on things like drug take
(20:45):
back. So we think about fentanyl, which is an illegal substance. It's
being promoted and being sold by peopleon the street. But even just if
you have extra opiates or extra youwent and had a surgery done and you've
got pain medicine at home, onlyused one or two tablets and the rest
are sitting in a cabinet somewhere.I know that people sometimes if they find
(21:06):
that we'll steal that, will takeit, we'll use it for other purposes.
And so we have drug takebacks availablethrough law enforcement that you can go
drop off these medications safely. They'llbe incinerated appropriately because people often will flush
that stuff into commodes and then ora water system, which isn't good either,
but that you can take those in, dispose of them safely and not
(21:27):
have to worry about having that outthere for others to consume or try.
But it is such as a hugeissue and everybody struggles to try to find
ways to try to control it andtry to reduce the side effects of it.
And most of the time with alot of this is that some of
us are wired a certain way thatonce you get your first touch of these
(21:51):
medications, you automatically have a propensityfor a problem with addiction with it,
and so it's just making sure thatyou know, do you really need this.
Sometimes the strongest medicines aren't always thebest choice to go with, and
we're teaching a lot of our providersto to try other other, you know,
means of trying to control pain insteadof having to use the strongest that
(22:14):
it's available right out of the gate. But from a fentanyl angle, it's
I tell parents, if you gotto talk to your kids the sooner.
You know, you have to allowsome innocence in life. But if you
can talk to your children as earlyas possible regarding this, you know,
if you've if they're going to juniorhigh, if you haven't had the conversation,
you're probably too late. You gotto talk about vaping, ventyl use,
(22:37):
all these different things. It's importantfor parents to engage their children on
it, talk about it, andyou know what to do and to avoid
those things. And it's just somany people. We all know somebody who's
been affected or had an issue withit. Right now, is acty codone
still a problem? The acxy codonsout there it's still I mean, it's
still being prescribed. I mean it'sa but I think our medical community,
(23:02):
I mean, we put out kindof chronic pain guidelines as a department that
we use. It's kind of aguideline for our providers. Our Board of
Medical Examiners, which is an independentboard, but that we provide obviously support
for through the Department of Health.They are they take that very seriously and
so we have a lot of folksthat are watching that carefully. Our numbers
(23:23):
as a state compared to other statesis still very poor. I think we're
fifth worst right now in terms ofthe amount of opiates that are consumed and
used as a state per capita.So we've got to we're trying to train
our provide our providers right now.Our universities are doing the job of trying
to train them and how to howto manage pain without having to use oxycodone
(23:45):
or hydro codone and narcotics. Thatshould be the last choice. It's probably
not the best choice for chronic painmanagement, just because it'll provide your relief
for a while, but then asyour body gets accustomed, you need more
to which you have the same painrelief and so we have other means,
and I think the medical community hasresponded realizing kind of what the country has
(24:07):
gone through in the past, andwe're trying to find ways to change our
new doctors that kind of have adifferent approach on that. So it's it's
you know, it still is outthere, but it's markedly reduced from where
it was before. In closing,I'll ask you, what are the few
things into the Tennessee Department of Healththat people don't maybe not know about,
that people don't know about, yousay, they don't get enough about to
(24:29):
tell about this or that. Whatare some of those things? Yeah,
no, and I appreciate that question. Is I think a lot of times
everybody thinks that, you know,after COVID, that they just say,
oh, that's where you go toget COVID or if you have a yeah,
you know, an STD or something, you go there for treatment.
And we do. We still dothose things obviously, but we do a
lot of stuff. I mean,there's something as simple as you know,
(24:52):
again we mentioned in providing healthcare services, so we do a lot of primary
care in our health departments. Notall of them, but you know,
most of the them provide primary careservices, dental services. We birthen death
certificates of voter registration forms. Imean those are done through your health departments.
I mentioned the kind of loan repaymentprograms for a lot of medical professionals
(25:14):
and kind of address to healthcare shortages. I talked about the Narcan and fentanyl
test strips that we offer, butwe also do family planning. We do
those through telehealth services also, sowe do a lot of telemedicine things,
but live we do a lot ofanybody seeking contraception care. We do a
lot of those services from the Departmentof Health. We have a breastfeeding hotline
for moms that's available twenty four toseven. It's staffed by lactation consultants.
(25:41):
I think the number for that isa five five four two three sixty six
sixty seven. I think that's correct. But that's like a lactation services we
provide twenty So if a mom's havingdifficulty with then you born at home,
you can call and they can provideyou some help. And with breastfeeding WICK,
which is a program women infinite children. Less than half of the eligible
(26:03):
Tennessee population is enrolled, so there'sprobably double the people that could that could
use it, and it provides foodsecurity, nutrition, lactation, counseling,
emergency preparedness resources, that kind ofstuff. And you would encourage people right
now when inflation is high and foodprices are high and people might be having
a difficult time making ends meet onthat that there's no reason why you can't
(26:27):
find help with in the health department. So contact and with can often get
you tied into some of that.And then we have breast and cervical cancer
screens for Tennessee women who are uninsuredor underinsured. We do a lot of
that for women there as well.And again dental services. Those are some
of the things that we kind ofcommonly do that people I think don't even
(26:47):
know about that. We have alot broader reach really to help a lot
of folks out. But the Departmentof Health is I tell everybody, we
touch everyone in the state, whetherthey know it or not. You go
to a restaurant and you have foodthat's safe to eat, someone has already
tested that for you. That's beenthe Department of Health. That we go
out into the community and double checkto make sure things are being done properly,
(27:10):
and we do all the licensing andregulation of health providers is done through
the Department of Health, So weoversee doctors and dentists and therapists and anybody
and acapuncturists and you name it.We're overseeing a lot of them to make
sure that things are being done safely, so broad reaching, we touch more
people than they realize, and we'rehere to help, I mean the other
(27:33):
things. We're just trying to promotegood health. And I've told our department
we're not going to wag our fingerat people and tell them what they should
do, I think, but wehave to try to encourage folks to educate
them. And we rank forty fourthoverall in public health as a state in
the country, and we're very proudof our rankings in Tennessee both when it
comes to football and basketball and fiscalresponsibility and monetary stuff, but we're bottom
(27:57):
ten when it comes to public healthoutcome. So I'm trying to reignite the
desire from the state and appeal toour pride a little bit to try to
get us into a top ten rankingwhen it comes to public health. And
it's it's going to take a lotof effort in so many ways, but
those are all the things that wedo. We do so much more that
I haven't mentioned people on for probablyhalf an hour, but a lot of
(28:18):
stuff that we do in the DepartmentHealth. You have a very busy department,
that's for sure. Yes you do. We do, and a lot
of very committed people. Yes,yes, it takes people a lot of
people to help you. What websitesshould people go through to find out general
information about the Tennessee Department of Health, Yeah, they just if it is
Google, I mean it just Google. TDH dot org usually built to find
(28:41):
that you can always go to anykind of the MITN apps also will have
information on there. People can signup for Wick for example for that food
issue was talking about with Free Young'sFamilies. There's even an app for a
food shopper type of app that wehave. It's a wik app that people
can go on and find out whenthey go shopping, need help with that,
what's eligible and some of the nutritionalcontents. But the Tennessee Department of
(29:04):
Health, you just google it.It's a huge website tdh dot org and
there's lots of subareas be up belowthat that you can find information regarding the
Department but it's being enourage pople tovisit the site. It's got a lot
of information that you can find thingsabout. Again, Tennessee Department of Health,
(29:25):
Doctor Alvarado, I appreciate your timetoday and I certainly appreciate talking to
you, and it's nice to meetyou. Likewise, I appreciate so much.
Thank you. That's doctor Ralph Alvarado, the Commissioner of the Tennessee Department
of Health. If you have questionsor comments about today's program, you can
email me, John Clark at iHeartMediadot com. Thanks for listening. I'll
talk to you next week right hereon your local radio station on Tennessee Matters.
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