Patrick Allen takes over the New Mexico Department of Health as its latest cabinet secretary at a turning point for the agency. He previously served for five years as director of the Oregon Health Authority—experience that should come in handy if a bill creating a New Mexico health authority makes it to Gov. Michelle Lujan Grisham’s desk before the legislative session ends. He also comes to DOH as the state winds down its COVID-19 public health emergency order, which expires at the end of the month. Allen began running DOH at the start of January and was confirmed in February, succeeding Dr. David Scrase, who had run both the health department and the Human Services Department since the summer of 2021, and retired from the latter last month. The following interview has been edited for concision and clarity.
Is it true you’d only been to New Mexico once before accepting this job?
Yeah, that’s correct. Our daughter [Allen and his wife Joan have three adult children] was in school in Midland [Texas]. And she needed us to bring a car down to her, so we drove a car down through Utah and New Mexico and that was the first time we’ve ever been here.
Are you getting the lay of the land?
Yeah, a little bit. My wife is still back in Oregon cleaning 20 years of crap out of our house. I’m still doing a little bit of a two-household kind of thing going back and forth. But, yeah, right now I’m learning the politics and the players and how government works and those kinds of things and getting a little bit of chance to get out and about.
Our last two health secretaries have been medical doctors. Where does your interest lie in public health?
My academic background is in economics [Allen has a bachelor’s degree of science in economics from Oregon State University]. If you think about health care in the United States for very long, if you’re not going to be in medicine, economics is probably the next best thing. More relevantly, health agencies tend to be big, complex organizations with lots of things going on…and the most important skill set is: Do you know how to run a big organization successfully? I think any number of backgrounds can be really helpful for that—a health background for sure—but lots of other backgrounds can be really relevant.
The governor is backing legislation that would make the Human Services Department the Health Care Authority Department and take some portions of the health department and roll it into that new agency. Did you suggest this idea?
No, it was more like this was something she was interested in and it was a prominent part of her discussions with me about my coming to New Mexico, in terms of my experience running an agency like that and being familiar with the policy tools and advantages you get with the creation of a health authority.
Is the best way to understand the benefit is it will provide the state with more purchasing power?
It’s not just purchasing power. It can be regulatory power and policymaking power and using leverage to get better outcomes. An example I’ve used a lot in Oregon is around screening kids by age 2 for developmental delay. Ten years ago in Oregon, we were doing a terrible job—maybe 17% of kids on Medicaid were getting successfully screened. By using purchasing power…Oregon got that number up to about 85% of kids who were successfully screened, but the best part is the practitioner doesn’t know who’s paying for the kid they’re treating. And so they changed the practice for all kids to get screened. Now in Oregon, only about half of kids are on Medicaid, unlike 85% here in New Mexico, so the analogy breaks down a little bit. But that use of purchasing power and incentives made the system of care better for all kids in the state, whether they’re on Medicaid or not.
In addition to that Medicaid figure, are you seeing other key differences between Oregon and New Mexico?
Oh, sure. Oregon is, I think 73% or 72% non-Hispanic white. And so, when you think about health equity work in Oregon, you’re really talking about a non-Hispanic white-dominated culture and the systems that have been developed that really center whiteness in the delivery of everything. There are equally challenging health disparities and inequities in New Mexico, but their shape is completely different. I’m just beginning to understand what those are, and I’ve got a long way to go to figure out what that looks like in terms of how to inform health equity policy. Related to the percentage of people on Medicaid is the overall impact of poverty in New Mexico. Oregon is not a wealthy state, particularly in comparison to Washington and California, but it has significantly higher incomes than New Mexico.
Some other key areas are really quite similar. The rural/urban issues in New Mexico look very much like rural/urban issues in Oregon. Tribal relations—although they’re much more significant here—Oregon is still one of the top 10 states in the country for...Native American population. It’s really a big part of the attraction of coming here was the opportunity to do some things I think I’ve been successful at in one setting and see how I need to change and grow to be successful in a new setting.
Our sister paper in Portland, Oregon, Willamette Week, interviewed all of Oregon’s gubernatorial candidates last year, who agreed the Oregon Health Authority was a big problem and you needed to go. They were particularly critical about behavioral health, which also is an issue here. Would you respond to those criticisms?
The criticisms were maybe, in a couple of instances, a little more personal than I would have expected, but not surprising. I was one of the main faces of the pandemic response in the state and, while I’m really proud of the work that we did…as time went on in the pandemic, that got more and more controversial. I think any new governor, given where we were in the pandemic, wants to make a clean start and have COVID be less a part of their administration. I think we kind of bore a little bit of the brunt of that.
And, in the five years I was at the agency, I did not fix the state’s behavioral health problems. I think reasonable people might agree there were reasons for that and the pandemic was probably one of the big ones. But it’s a pretty straightforward thing for me: You want politicians to be responsive to the problems people [raise], like open drug use in Portland and people living on the streets and family members that couldn’t get services. So saying you’re going to clean house at OHA and make a change in leadership is straightforward. And the person they replaced me with is gone already. I take that as a little bit of validation that it’s a hard job with some really tough problems.
In terms of New Mexico…we’ve got some huge advantages in trying to tackle some of these problems. The constellation of facilities the state operates in areas like alcohol and drug and mental health facilities…really helps fill niches that were often left unfilled in Oregon. I think the Behavioral Health Collaborative is an incredibly strong way of taking…a scattered system of care and trying to bring some cohesion to it. What I’m able to bring, if nothing else, is an acute awareness of: If you don’t preserve those building blocks in the system, they’re real hard to get back.
Do you support New Mexico’s Public Health Emergency Order ending this month?
I recommended it, actually.
What do you say to people who remain anxious about ongoing cases, hospitalizations and long COVID?
I absolutely empathize with that. Is COVID a serious disease that we need to maintain a public health response to? Absolutely yes. Does it continue to be an emergency, and will it be an emergency forever? If you think about individual humans in a fight-or-flight mode and the corrosive impact of that constant stress…I think the same thing applies to societies and organizations. What we need to do now with COVID is figure out how we’re going to continue to take it seriously…but in a more integrated way that looks more like the rest of health.
What initiatives do you want the health department to tackle?
There are probably three at the top of my list. Like health departments all across the country, the agency really is kind of traumatized by the pandemic. So: helping the agency repair and heal a little bit, and get back…to a non-emergency way of doing business. Number two, and this is a huge priority of the governor, is really expanding access to health. And I say health rather than health care because it’s not just health care…it’s access to clean water and nutritious food and all the things that make up…the overall public health fabric. And that really ties in to the third, which is health equity.
A year from now, what do you hope the public will think about when it comes to the health department?
Perversely, I kind of hope the public thinks a little bit less about the Department of Health as an agency and more about the outcomes that they see as a result of our work. I hope they’re able to see an expanded set of access points…and receive the support they need to be healthy without having to think about a state agency as a piece of that.