Member Spotlight: John J. Dreyzehner

September 28, 2017 | ASTHO Staff

John Dreyzehner, MD, is commissioner of the Tennessee Department of Health. A physician with more than 25 years of service in clinical and public health leadership at the federal, state, and local levels, Dreyzehner also practiced in the field of addiction medicine for several years while working to bring attention to the public health aspects of the now well-recognized epidemic. As commissioner of the Tennessee Department of Health, Dreyzehner leads an agency with more than 3,500 full-time employees and more than 120 physical locations in all 95 counties in Tennessee.

What was the experience or motivating factor that compelled you to become a state health official?

I felt called to be a local health official, a physician for a whole population, but I had not imagined I would do it for a decade. No two days were alike. The people were wonderful, the variety and challenge endless, and I experienced a lot of personal and professional growth. But I never imagined I would get a call asking me to consider being a commissioner of health, let alone in Tennessee, and as a cabinet official. It was a humbling honor. I met Gov. Bill Haslam for the first time at the interview. I was honored to be offered the role. It has been a great privilege to work for his administration and I have been fortunate to have a wonderful public health team around me. What a tremendous honor to be the physician for the population of Tennessee. This is incredibly compelling work we are privileged to do, each of us in these roles, for the time we are given to do it.

Was there someone who influenced you to lead a health department?

The simple answer is I truly felt led to the role and the mission to be a physician for the whole population, and I was encouraged to do so by my wife, Jana. But that story started as a physician for a much smaller regional population in southwest Virginia. The story is, I was practicing as an occupational health physician in central Appalachia, and I was considering a number of future options. One day, I was sitting at a conference table, having lunch with a group of people who were involved in recruiting me to be an associate corporate medical director at a very large company. The question came up about where I lived and what I most liked doing. I described some things I was excited about in a region that I loved, and a junior person blurted out, “That sounds really great, why would you want to leave?!” That was the nudge. I didn’t want a corporate job. I wanted a mission. I was getting more engaged in the community and public health, but wanted to do more. Several people I respected in my rotary club had been encouraging me to apply to a multi-county health director position that had been vacant for some time. This was just after September 11. That made it even more compelling. I thought it was a little crazy, but my wife Jana really encouraged me and I began to feel led to it. I recall I was one of several people interviewed by a large panel, and I was offered the role. My boss later told me the panel could see that I really wanted the job. They were right.

What is your morning ritual?

It’s only quasi-ritualistic. If I am home, it is quiet reflection, then up to the gym, where I usually bike and do a weight circuit. Then I have coffee, check the news, email, and occasionally make a phone call. For breakfast, I am on my 10th year of Greek yogurt (and I’m brand loyal) with berries and nuts, unless I am fasting. I’m lucky to usually be able to walk to work.

What do you do to stay healthy?

My regular morning workout is key, five or six times a week. If I don’t do it first thing, forget it. I also try to get as much incidental activity as I can in the city and on the farm: walking, stairs, midday pushups. Weekends are active. I try to think of food as medicine. I do indulge (never come across an ice cream I didn’t like) but I try to stay balanced. My kids have me fasting more. My wife helps me keep up with relationships, which is very important. Now if I could just get myself to stretch!

Where is your favorite vacation spot?

You may as well ask my favorite food—"yes” is the answer. I love to travel! The great outdoors, different cultures, lifeways, foodways, and history—all of this fascinate me. A wilderness, an unexplored road, an ancient site, a rural or urban landscape full of possibilities stirs me. There is magic everywhere so I can’t pick a favorite. Late in life, one thing has surprised me. For years I never wanted to go to the same place twice. But recently I have been surprised by nostalgia and have returned to a few places where I have lived or visited frequently. It is like the joy of getting caught up with an old friend.

What are your favorite hobbies?

I call it macro-gardening. I like to work the land. Odd for a kid who grew up mowing a small suburban Chicago lawn. Even walking around it to relax, my wife catches me with pruning shears (I am not compulsive). I find joy, as well as calming, productive distraction while out on the tractor or tending a path of field, smelling the earth and the plants, feeling the wind. If I actually produced something to sell, it would be called farming. Then there is travel with family and friends, and a few things I enjoy collecting. I also love to read—newspapers, magazines, books, especially stuff I don’t have to read—and I have my guilty pleasures when it comes to select movies and TV shows. My wife and I got hooked on Nashville. We live and play in some of the areas where it is set.

What is your state doing to address the opioid epidemic, and how are you supporting the 2017 ASTHO President’s Challenge?

Since 2004, I have been deeply engaged in a public health approach to this epidemic—the only approach, I believe, that will ultimately resolve this still unfolding epidemic. I became one of the early alarm sounders when the gravity of the epidemic—really a syndemic—figuratively slapped me across the face in the form of a thoughtful medical examiner colleague calling me in early 2004 to tell me 13 people died in just one of my small county emergency rooms due to accidental drug overdoses. I was aghast. I knew there had been a few, but 13—or, a rate of 48/10K! I later learned about 217 in 2003 in a rural 23-county area. I didn’t know about that at the time. And yet I would have known about one case of meningitis, tuberculosis, or pediatric flu death. I was a local public health official in Appalachia, and it was obvious to me that our world was changing. I just didn’t know how much.

My instincts were to organize local public health colleagues to better characterize what we were seeing and spread the word, form a coalition to raise awareness, as well as ask friends in Tennessee and the Appalachian Regional Commission to help. All that happened, but none of it was enough. I created a market triangle model—i.e., “buyers” to be “treated,” “sellers” to be “controlled,” and “potential buyers” to be prevented from entering the market—to help guide me in understanding how to constrain the epidemic. The thing I got right was the need to do all three. The thing I got wrong was thinking they were equally important. They are not. If I have any key message, it is: we are going to have to prevent our way out of this epidemic because we can’t arrest or treat our way out of it.

It has been a long journey to the present moment and we have many miles yet to go, but I am more hopeful than I have ever been. The population and the body politic has been roused. There are too many activities in our state to encapsulate here. As part of the public health approach, we have created a strategic map for our department and partners so we can see, track, and execute our plan. We still have much more to do. We are currently co-chairing the governor’s opioid workgroup with our Department of Mental Health and Substance Abuse Services. I am proud of the fact that Tennessee was the first state to pass and implement “shall check” provisions with the support of our medical community. Housed in public health, this is a prevention, treatment, and control triple play. MMEs have declined 22 percent, provider shopping 63 percent, and the law was reauthorized and strengthened in 2016. That is just one example. Other examples include: developing opioid prescribing guidelines and passing and substantially strengthening state laws regulating pain clinics, better understanding and addressing Neonatal Abstinence Syndrome, increased naloxone availability without a prescription, and recent legislation allowing safe syringe exchanges. In their 2016 report, the National Safety Council described Tennessee as one of four states “making progress” in the fight against prescription drug abuse, but we still have much to do. For the first time, though, I feel that we have reached the beginning of the end.

How did your career in public health begin?

It began when I discovered how much I enjoyed the body of work as an Air Force flight surgeon. I eventually trained in occupational medicine and then practiced in it for five years before the need to have a larger mission pulled me back in to a local health director role in central Appalachia. I have never looked back.

What do you love most about the public health work you do?

I have been doing it for more than 20 years, including my years in the Air Force, where I first learned about it. I find it incredibly challenging and satisfying. No two days have ever felt the same and I get to work with some of the greatest people in the world who are all committed to doing all they can to make a positive difference. I love that.

What do you find most challenging about public health?

Sometimes when we are most successful, nothing happens. It is hard to measure and get sustaining resources for things that you are preventing until you fail to prevent enough of them. Even then, until there is sufficient understanding of the issue, the vulnerabilities, what is behind those vulnerabilities, as well as what can be done about them (rarely a simple or a single answer), it is very difficult to get attention or buy-in for prevention-oriented solutions. They don’t have a constituency.

What are your primary public health priorities?

Fostering and creating opportunities for health equity and optimal health for all as we move upstream toward primary prevention, innovating (and reporting, or following) the evidence trail, as well as a focus on changing our systems and our culture to address the big four—that is, increasing and sustaining tobacco and nicotine abstinence, increasing physical activity, increasing healthy eating, and preventing development of substance use disorders.

What is your vision for the future of public health?

We need to be part of the solution and not just stating the problem. The solution is system change. It is very hard, but with a public health approach—finding the index cases, helping them, identifying at-risk people, and helping and increasing resistance and alternatives to the negative sides of the big four—we can do it. Our forebears did this and made huge progress with infectious disease before we had antibiotics. In terms of the current opioid crisis, we already know we can’t arrest our way out and we can’t treat our way out. We have to prevent our way out. Yes, control of legal and illegal supply is important and treatment is needed and people recover, but our role is to push the public health approach because that is the only long-term solution. It is also the hardest and least obvious.

What are three things public health leaders can do to educate and engage the communities they serve?  

At the Tennessee Department of Health, we like the Kiazen approach:

1. Go and see
2. Ask questions
3. Show respect.

What are the most important lessons you’ve learned during your career in public health?

The health of the population comes first, above all. Being a physician for the population is very different from being the physician for an individual. This is not well understood. As a clinician first, it took me some time to understand this.