Stacie Saunders has always loved puzzles.
She loved the puzzle presented by her clinical lab work, the way a single drop of blood could reveal so much about a person’s health.
And she loves the puzzle presented by public health, the way individual problems link together to form a complex web of risks. Instead of looking at the microlevel pieces, she sees the image on the front of the box.
Now, Saunders is tackling her largest puzzle yet: COVID-19. As Buncombe County’s new public health director, she joined the Department of Health and Human Services in August to head the county’s coronavirus response.
“This is an opportunity for me not only to grow in my leadership and grow professionally in my career, but also to provide an opportunity for my family to grow in a really dynamic and diverse city,” Saunders says. “I love the idea that my family will grow up appreciating the energy of not only a really active city, but the energy of rural and natural spaces.”
Back to her roots
Saunders might be new to Asheville, but the Blue Ridge Mountains run deep in her blood. She grew up in Parrott, Va., a town of about 400 nestled in southwest Virginia’s Pulaski County along the New River. “It was a very old-school mountain town,” she says with a smile. “I grew up with the river below me and the mountains above me.”
After earning a bachelor’s degree in medical technology, Saunders first worked in clinical lab sciences, studying blood diseases and reproductive hormones. In 2007, she received a master’s degree in public health from Johns Hopkins University with a concentration in family and population health.
Saunders then made her way to North Carolina’s Alamance County, where she worked a grant-funded position for the county health department’s family planning clinic — a job that allowed her to better understand how public health departments can expand access to primary care, she says. In 2014, she was promoted to public health director.
Western North Carolina was on her radar long before a job became available, Saunders explains. Early in her career, she was fascinated by the collaborative approach WNC counties were taking to monitor regional indicators, such as birth outcomes and disease mortality rates, to assess community health.
“That type of collaboration not only allows for the county-specific approaches to combating public health issues, but it really opens the door up for regional approaches to improving health in our whole geographic area,” she says. “It’s that type of collective impact work, both at a local and regional level, that really excites me.”
‘Patient, nimble, flexible’
COVID-19 is by far the longest and most intense infectious disease outbreak that anyone in public health will be a part of, Saunders says. But many of the core public health tenets for handling the pandemic remain the same as for recurring diseases like the flu.
“The whole piece of public health preparedness is that we practice and exercise these things well in advance so that we’re prepared when it happens,” Saunders adds. “We hope it never does, but we’re prepared when it does.”
When COVID-19 began spreading statewide, Saunders was at the helm of a health department supporting nearly 170,000 residents; she now leads work for a county of over 260,000. But no matter the size, Saunders notes, the county-level approach to fighting COVID-19 is essentially the same across North Carolina.
Many of Buncombe’s policies, including contact tracing and encouraging residents to wear face coverings, are similar to what she was doing in Alamance. So far, she says, her main challenge has been learning about the composition of the community and strengthening working partnerships.
COVID-19 has taught health officials to be patient, nimble and flexible during a constantly evolving situation, Saunders explains. With that comes transparency; she referred to Buncombe’s COVID-19 dashboard as a way health officials are working to keep open communication with the public.
“I think that public health has tried really hard over many years to be as transparent as we can, within the guardrails of federal laws that make sure that we don’t jeopardize someone’s privacy, to get the information out as quickly and as timely as we can,” she says. “It’s definitely an interesting time with so much public-facing information and getting that out as quickly as we can while still doing the work.”
Beyond the pandemic
COVID-19 has taken the spotlight, but other functions of the health department haven’t stopped. “We’re still doing restaurant inspections; we’re still having our family planning clinics. Those things continue, pandemic or no pandemic,” Saunders says.
To do that work effectively, Saunders says, Buncombe must work with other North Carolina counties to advocate for additional resources. State and federal public health spending in particular, she adds, “could use some work.”
According to reports found on the Buncombe County Health and Human Services website, the state provided just over $1 million in 2010 to help support public health. In 2017, the most recent report available, the state allocated $707,642 — despite more than 18,000 residents moving to the county in that timespan, per the U.S. Census Bureau.
“Our populations are growing,” Saunders explains. “Having the same type of state allocation as our state population grows is not likely to support the infrastructure of public health well.”
Less than two months into her new position, Saunders says it’s still too soon to have a clear vision for the direction of the department. Right now, she’s working to get to know county staff, partner agencies and community members, learn the institutional history and hear from local leaders to better understand their hopes for the county.
“Pandemics bring public health to the forefront, but I want folks to understand the importance of public health outside of that experience,” she says. “I want to have public health embrace its role as the health strategist for a community to help explore the intersection of health and wealth and education and how all those things are intertwined.”