Beyond the Dome

Alexander Billioux, M.D., Assistant Secretary of Health, Louisiana Department of Health Office of Public Health

Published in Aequanimitas - Aequanimitas Fall 2020

(Above photo from left: Louisiana Lt. Gov. Billy Nungesser, Gov. John Bel Edwards, Alex Billioux and State Health Officer Jimmy Guidry speak at a COVID-19 Press Conference. Photo courtesy of  The Advocate | Travis Spradling.)

Last March, about two weeks after Mardi Gras, Louisiana became one of the nation’s top hot spots for COVID-19. It was hardly a surprise: According to a New York Times report, between mid-March and mid-July, 3,508 deaths in that state were directly attributed to COVID-19. Louisiana was deemed the world’s fastest-growing state for new COVID-19 cases — with numbers like those in Spain and Italy.

Reports such as these keep Alexander “Alex” Billioux (Osler, 2010; Thayer assistant chief of service, 2014) up at night. As assistant secretary of health for the Louisiana Department of Health Office of Public Health, he spent his days working to improve individual and community health through innovative public health strategies, such as expanding Medicaid for the underinsured and promotion of healthy lifestyles. The public health office also ensures readiness for hurricanes and other threats to Louisiana. (Please note: Billioux stepped down from his position on Oct. 2.)

Billioux earned a medical degree from The Johns Hopkins University and a Doctor of Philosophy in clinical medicine from the University of Oxford. He holds a bachelor’s degree in liberal arts from the Louisiana Scholars’ College at Northwestern State University of Louisiana. He has worked clinically and conducted research to address illnesses of poverty through improving health care systems, clinician education and studying responses to HIV/AIDS and tuberculosis in Guatemala, Haiti, India, South Africa and Uganda. In 2015, he served as a White House fellow, assisting the Department of Health and Human Services, under then Secretary Sylvia Mathews Burwell.

Before assuming his role at the Louisiana Office of Public Health in 2018, Billioux was a senior adviser to the front office at the Center for Medicare and Medicaid Innovation. There, he helped to develop national care delivery models that screen for health-related social needs, such as housing and access to healthy food. Billioux and his wife, Veena, a Johns Hopkins-trained epidemiologist, live in New Orleans with their two daughters, ages 5 and 2. Recently, we asked Billioux to chat with us about his experiences in public office during the height of the pandemic.

What made you decide to pursue a career in public health?

I was always interested in biology and genetics. As an undergrad, I took premed courses, thinking I’d do genetics research, and in graduate school, I studied genes related to blood vessel development in cancer. But, I found my real passion lay in expanding people’s opportunities in life through improved health, and I became interested in public health. I loved the idea of improving health care, and inequity was a big concern of mine. I wanted to do impactful work, so I focused on infectious diseases and diseases of poverty.

How did your Osler training influence your career path?

In so many ways. The biggest thing was learning to be a clinician and advocate directly for your patient’s health. Seeing the same conditions repeatedly on the wards led to discussions on how my fellow residents and I could improve the health care system in our community. We’d review published literature and figure out how we could apply that knowledge to help improve patients’ lives. Through residency, I was exposed to what diseases of poverty look like in East Baltimore and the U.S.: heart disease and hypertension. The work opened my eyes to policy and led to a fellowship during the Obama administration. That led me to Louisiana to partner with health care systems, such as Medicaid and other insurers, to help others. I felt the need to do more to promote health and keep people well.

Any standout memories from that time?

I often think about one of my first patients during my assistant chief of service (ACS) year. She came to the hospital’s ER frequently, with shortness of breath, heart failure, COPD and an anxiety disorder. She lived in a tiny apartment isolated from the world by a spiral staircase and was admitted to the hospital every other month. None of that was improving her life. We would have been better off putting her in another social context that provides healthier food and shelter. We saw many people in similar situations. I learned that the social story behind your patients is often more important than the underlying pathology. Access to housing, healthy food, safety and transportation is vital. It not only makes sense financially. It’s about realigning resources to help people live their best life.

How has the COVID-19 crisis affected your work?

It has completely changed my role. I was leading several public initiatives, such as eliminating hepatitis C and reducing maternal mortality. Then COVID-19 struck. My biggest concerns are how to stop the spread and avoid politicizing the disease. COVID-19 also affects social interactions, and racism toward African Americans remains a big problem. Many are denied access to Medicaid, and their living conditions make them vulnerable to developing COVID-19 and having worse outcomes.

What have you done to help mitigate COVID-19 in Louisiana?

After our rates skyrocketed, we had one of the most precipitous declines because people followed the governor’s mandate to stay home. That would have been a good story. But there was a lot of pressure to reopen businesses, so we saw another rise in cases. Then we had to close bars and require masks. The number of cases declined. Now schools are back in session. It’s a roller coaster, and it’s hard to keep up, but we’re doing our best to raise awareness about how to avoid contracting the virus without politicizing commonsense public health measures.

What are your greatest challenges?

The biggest challenge in public health is convincing people to maintain their health. We can give the person with a heart attack medicine, but even when that happens, less than half will take those medications — even when patients almost died as a result. Convincing someone to take actions to protect their health before they have fallen ill, that’s the hardest part.

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