Member Spotlight: Nate Smith
Nate Smith, MD, MPH, is director and state health officer for the Arkansas Department of Health. The department protects and improves the health and well-being of all Arkansans by responding to outbreaks and other public health emergencies, implementing programs to educate and improve health outcomes, licensing and certifying professionals and facilities, and providing evidence-based preventive health services in communities throughout the state. The Arkansas Department of Health has over 2000 personnel, a budget of over 250 million dollars, and delivers services throughout the state in over 94 different locations. The department is a centralized health department with no independent local or tribal health departments in the state. The Arkansas Department of Health is proud to have received accreditation from the Public Health Accreditation Board in 2016.
How long have you been an ASTHO member?
I was appointed director in 2013 by Gov. Mike Beebe and then reappointed by Gov. Asa Hutchinson in 2015. I have been a SHO (and ASTHO member) since 2013, but served as senior deputy and a member of the ASTHO Infectious Disease Policy Committee since 2010.
What was the experience or motivating factor that compelled you to become a state health official?
Becoming a state health official was the furthest thing from my mind when I first joined the Arkansas Department of Health in 2004. This is true even when I accepted the position of senior deputy in 2010. Over time, though, I must have warmed up to the idea, because in 2013, when then-Governor Mike Beebe asked me, “Are you ready for this?” I said, “Yes, sir.”
Was there someone who influenced you to lead a health department?
Former Arkansas SHO (and former ASTHO President) Paul Halverson was a wonderful mentor to me. For the three years I served as his senior deputy, he gave me excellent hands-on training in public health leadership. It was really Paul’s mentorship, encouragement, and friendship that influenced me to take on the job when he left.
What other positions have you held at the department?
At the Arkansas Department of Health, I have served as medical director for the HIV/STD Program, branch chief for infectious diseases, associate director for science for the Center for Health Protection, center director for the Center for Public Health Practice, state epidemiologist, and deputy director for Public Health Programs.
What is your morning ritual?
I am not an early riser, although mornings are probably my most productive time of the day. I typically wake up around 6 a.m., get my four kids (ages 11 to 17) up and off to school, then spend some quiet time at home in devotional Bible reading, prayer, and sermon preparation (I am also an ordained minister in the Anglican Church). After a quick breakfast (usually a banana and a glass of orange juice), I head in to work, arriving between 7:30 and 8:30 a.m., depending on the day of the week. On Mondays, Tuesdays, and Fridays, I usually start the workday meeting with my three deputy directors; on Wednesday mornings, I have Infectious Disease Journal Club over at the medical school followed by my morning HIV clinic. On Thursday mornings, we have Public Health Grand Rounds, which have become a centerpiece for bringing together public health practice and academia in Arkansas.
What do you do to stay healthy?
My main form of physical activity is long distance running (usually marathon-distance or longer). On weekdays I do most of my training at night between 10 p.m. and midnight (after my kids have gone to bed), and I usually do my long training runs on Saturday mornings. During the summer, when it becomes uncomfortable to run long distances, I usually switch to bicycling and swimming. I also try to eat at least five servings of fruits or vegetables each day.
Where is your favorite vacation spot?
Pinnacle Mountain, Lake Sylvia, and Petit Jean State Park are among my favorite local spots in Arkansas. As a family, we like to explore places we have never been before (especially in Africa). In the past few years, we have been to Victoria Falls in Zambia; Jinja, Uganda, which is on the shores of Lake Victoria (at the source of the Nile River); and the Grand Canyon.
Why is health important to you?
Health is central to well-being. One of the best ways to show your love for others is to care for their health and well-being.
What are your favorite hobbies?
Running, biking, and swimming.
How did your career in public health begin?
I earned my MPH while doing my postdoctoral fellowship in AIDS clinical research, so maybe that is where the seed was planted. After my medical training, I headed to Kenya as a medical missionary, but was initially focused on clinical care. Seeing firsthand the overwhelming needs in these communities and knowing that so many of the illnesses were preventable, I became more interested in preventive care and population health. The HIV crisis in East Africa really pushed me into a community-based, public health model of care. I think that was when my public health career really began. In 2004, I joined the Arkansas Department of Health as medical director for HIV/STD and branch chief for infectious diseases, so I guess that’s when I became a bona fide public health professional.
What do you love most about the public health work you do?
I love our mission "to protect and improve the health and wellbeing of all Arkansans." I love knowing that each day we are making a difference in the lives of our neighbors, especially our most vulnerable ones, whether they know we are making a difference or not. I also love working with so many gifted, dedicated, and experienced public health professionals, both within my state and across our country.
What do you find most challenging about public health?
The pace of change. When it comes to life and death public health issues, such as infant mortality, I feel such a sense of urgency, but it seems to take so long to implement change on a population level and to change the minds and hearts of decisionmakers and the general public. Having the patience to take the long view is a real challenge for me.
What is something you’re most thankful to have been a part of during your career in public health?
I am thankful for so many things I’ve had the chance to be involved in during my public health career, but probably the one that stands out is my involvement with the President's Emergency Plan for AIDS Relief (PEPFAR) in Kenya from 2004-2009. When I first came to Kenya as a medical missionary in 1999, 50 percent of our inpatients and 12 percent of our antenatal mothers were infected with HIV. We had limited testing capacity, no access to effective treatment, and I was one of the only trained HIV care providers in the country. Ten years later, we had a community-based program for care and treatment based on a public health model of care that was reaching over 40,000 people living with HIV, including about 4000 children. In Kenya, PEPFAR was truly transformational on a population level, dropping the adult HIV prevalence from over 10 percent to less than 6 percent.
What are the most important lessons you’ve learned during your career in public health?
Be patient, play well with others, and never give up hope.