Jinlene Chan, M.D., M.P.H., has been with the Anne Arundel County Department of Health since January 2006. She began working with the department as a physician, providing medical and technical guidance for infant health initiatives, chronic disease prevention programs and emergency preparedness planning.
In 2008, Chan was promoted to acting deputy health officer for public health, then in 2010 she was named the deputy health officer for the Healthy Families Administration. In those roles, she was responsible for the medical oversight of the department’s programs and services. Chan has also chaired the county’s Fetal and Infant Mortality Review Team, which works to address issues that impact poor perinatal outcomes in the county.
In 2012, she was designated as acting health officer, and subsequently, in 2014, was appointed health officer for Anne Arundel County by County Executive Steve Schuh.
A graduate of the University of Georgia, Chan has bachelors degrees in biochemistry and Spanish literature; she completed her medical training at the Medical University of South Carolina in Charleston. Chan is board-certified in general pediatrics and general preventive medicine, and also has a Masters of Public Health degree from The Johns Hopkins University Bloomberg School of Public Health.
After completing her training, Chan worked overseas with the Immunization Unit of the Pan American Health Organization, a regional office of the World Health Organization, to provide technical assistance in disease surveillance to the Ministries of Health of Guatemala and El Salvador.
What was the genesis of the heroin epidemic in Anne Arundel County?
Here and nationwide, we think it has come about due to efforts at the local, state and national levels to restrict access to opioid prescription narcotics. Those efforts include education about prescribing habits, prescription drug monitoring programs (called PDMP in Maryland) and changing formulations of drugs, like Oxycontin, so users cannot snort it or inject it easily.
Nationally, deaths related to heroin have quadrupled to 2.7 deaths per 100,000 people since 2000, with much of the increase since 2010. The cost of prescription opioids has gone up, and they are not as easily misused. Heroin is cheaper. Its going for $10–$15 on the street, while an Oxycontin pill could cost about $80.
Do you feel that the epidemic is any more pronounced in the county than anywhere else in the region?
Not necessarily. In 2013 the number of heroin deaths in our county, 41, was greater than the totals of Prince George’s and Montgomery counties, but less than Baltimore City and Baltimore County. So, I don’t think Anne Arundel stands out in the region. However, the number of deaths is too high, and we still have much work to do.
What are your thoughts about solving the local/regional heroin epidemic?
[County Executive] Steve Schuh has created a heroin task force with an action plan that involves efforts among county and City of Annapolis agencies. We’re now trying to expand this plan to include ideas from the community and identify other approaches we should take. We had a symposium in April to share information and hold a strategic planning session involving providers and community organizations. This is a problem that impacts our entire community, and it will take the community to address it.
At its root, substance use is a health issue, and it should be approached as such. With addiction, you must have prompt and ample access to treatment and recovery services. We need diverse options, including residential, medication-assisted and outpatient forms of treatment, as well as sufficient recovery support services like housing, jobs and education.
What’s the best thing you learned from your international work?
After working internationally with limited resources, I better appreciated the close community relationships and creative solutions needed to improve health. When I got back to the U.S., I wanted to be where the rubber meets the road. So, I got into local public health.
Here, we work with so many different people and organizations for the public good, and I can see, while our resources are also somewhat limited, that we can accomplish amazing things when there’s a will — regardless of money.
What have been the biggest challenges in your career so far? How did you approach them?
The most recent economic downturn, around 2008–09, affected our department as it affected many other organizations and people. It was at a time when we were also faced with the H1N1 (swine flu) pandemic. Much was unknown about the disease at the time, and we worked in preparation to reduce the potential impact of a new flu strain on our residents. The vaccine was not plentiful initially, and there was some sense of panic in the community.
At one point, we were getting thousands of calls an hour. It took many of our resources, as well as county partners, to address community inquiries and needs amid budget constraints. There were many lessons learned, which will make us better prepared the next time something happens.
What makes you feel the most optimistic when you think about the future of health care in the county?
There have been many changes in the health system in recent years. The needs of the population continually change, so I might tell you that it’s constantly reforming. Health isn’t all about curing illness; it’s also about a holistic approach.
Even in recent months, we are seeing partnerships come together, like those between county and city agencies, and hospitals that are all working toward a comprehensive system that helps treat the county’s sickest people and those at-risk for severe chronic illnesses. Ultimately, linking support networks helps to keep people out of hospitals and emergency rooms, and in their own homes and businesses.
What is your budget, and how is that money designated within your department?
It’s roughly $55 million. About half of it comes from the county; about 8% is generated revenue from our various clinics (for example dental, mental health and substance abuse) and from permit and license fees. The remaining money comes from state grants, including federal dollars passed through the state to us.
What’s your take on the implementation of the Affordable Care Act in Maryland thus far?
Many people have gained access to health insurance that couldn’t have it before, which is confirmed when I talk to health providers who say that the number of uninsured patients has dropped dramatically. That’s basically what the Affordable Care Act is about: gaining access to providers and getting preventive services, like screenings and early intervention, as well as care that patients may have put off. By providing these services earlier, we’ll save money over time.
However, there is a gap in affordable dental care for adults. There is still work to be done there.
What are your views on the importance of the Electronic Health Records (EHR)?
There is much to be said for a paper chart in some ways, but there are also many limitations. I think EHRs will be adopted more and more when providers see what can be gained, especially as prices go down and functions improve.
This is really about connectivity and coordination of information from somewhat disparate areas and providers. Over time, EHRs will be widely adopted. CRISP (Chesapeake Regional Information System for our Patients) is a great statewide program. It doesn’t provide full medical records, but it does provide much of the “need to know” information to providers.
What else is the county doing to assist with the health needs of the poor and the unemployed?
A big part of a health department’s work is ensuring access to health care for our residents. We do this in different ways, including providing direct services, partnering with private providers or offering funding. As the private sector has grown more robust, we have moved away from providing direct services, but we still provide behavioral health services, dental services, immunizations, HIV testing and tuberculosis treatment.
How many clinics is the county operating now? Are there plans to add more?
We have various clinics of different sizes, with three in Glen Burnie and two in Annapolis. I’m also excited about having four Federally Qualified Health Centers in the county: Chase Brexton Health Care, Family Health Centers of Baltimore, Owensville Primary Care and Total Health Care. They are health care organizations that apply for, and receive, significant federal grant dollars to cater to the uninsured, low-income citizens.
What do you think will be different about the health department in five years?
There is much work that I’m interested in doing to take our department to another level. Currently, we’re working on our department accreditation. We are also partnering with academic institutions to lead more evidence-based initiatives and improve overall program performance that can be measured quantitatively and qualitatively. These program outcome assessments will help us to make better decisions concerning resource allocations for community health improvement.
What do you consider the highlight of your career to date?
Being health officer, I feel the weight of the responsibility of this job to oversee our county’s health. It’s amazing to be in this position and to work with incredible people, including the department’s 700 dedicated and caring employees. I’m honored and humbled to be here.