Advancing rural public health in Nebraska with Dr. Sydney Stein

Our work is shaped by the voices of leaders like Dr. Sydney Stein, State Epidemiologist at Nebraska’s Department of Health and Human Services, whose work spans infectious disease, chronic disease, and emergency preparedness. Her role is far-reaching, from statewide disease surveillance to the day-to-day realities of delivering care in Nebraska's most rural corners. Our conversation below was edited for brevity.

You're the State Epidemiologist for Nebraska at the Department of Health and Human Services. Can you tell us about your main role and responsibilities?

As state epidemiologist, I'm a leader within the Division of Public Health, and I oversee both infectious and non-infectious disease trends across the state. That means working across the division on surveillance, outbreak investigations, and health promotion and prevention.

It helps to understand that Nebraska's public health system is decentralized, and all public health really starts at the local level. The state's role is to coordinate daily response and prevention activities, provide technical assistance, and distribute much of the federal funding out to the local and tribal partners who implement the work on the ground.

What’s your professional background, and how did you end up in this work?

It's a bit unconventional — I'm a veterinarian by training. Before vet school, I found public health almost by accident. I was at the University of Missouri, took a job in the university hospital's microbiology lab, and fell in love with infectious diseases. So I ended up in a dual-degree program, earning my Master of Public Health with a veterinary public health specialty alongside my veterinary degree.

After that, I spent five years at the National Institutes of Health in Maryland doing bench science on emerging infectious diseases, which prepared me for a two-year CDC Epidemic Intelligence Service fellowship. Nebraska was my host site, and I focused mostly on zoonotic diseases — pathogens that move between humans and animals — including a lot of rabies work. When the state epidemiologist role opened up as my fellowship was ending, I was thrilled it was still available. My husband and I loved it here and didn't want to leave.

Some of your work focuses on rural health initiatives. Can you share some of the biggest challenges of delivering public health in rural versus urban areas?

They're significant, and they really differ from state to state. In Nebraska, most of our population and resources are concentrated in the eastern part of the state. As you move central and west, you find far fewer providers, hospitals, and birthing centers. Dental care is a particular gap — very few rural providers accept Medicaid patients for dental care, so people either go without or end up in an emergency setting for dental pain, which is a costly bandaid that doesn't fix the root cause. Others have to travel clear across the state just to get care, and that comes with transportation and sometimes language barriers.

It's always harder to implement programming in a rural setting, and it can even be difficult for local health departments to attract the talent they need if it isn't already coming from within the community. But those communities are smaller but mighty — there's a lot of investment in them by local partners.

What approaches does DHHS take to address those rural health challenges?

There are loan repayment programs for providers who commit to working in a rural part of the state. On the dental side, we're setting up rotations so students from the dental schools in Lincoln and Omaha spend time in local health departments with dental clinics, getting them exposure to these communities and, we hope, enticing them to stay.

We're also funding cohorts of community health workers at local health departments and interested healthcare facilities. A legislative change last year made it easier to certify community health workers. You no longer need a master's in public health or a nursing license, and they serve as an important bridge between public health, healthcare, and the community, helping patients navigate barriers and coordinate the care they need.

Many of the efforts above are being elevated through the Rural Health Transformation Program, and this is by no means an exhaustive list of the work occurring in this space.

Can you share a project you're especially proud of?

The statewide obesity and chronic disease work. When I stepped into this role, there was no coordinated effort in that space — people were working on it, but there was no shared momentum. In my first 90 days I was charged with building a statewide obesity plan, and since chronic disease wasn't my area of expertise, my colleague Krithi and I started with an environmental landscape survey to understand who was working in nutrition and physical activity across the state.

That led to two stakeholder forums — one on nutrition, one on physical activity — bringing together public health, healthcare, academic institutions, managed care organizations, and community-based partners to align on barriers, resources, and a shared vision. That groundwork fed directly into our Rural Health Transformation Program application, which secured five years of stable funding from the Centers for Medicare & Medicaid Services. That matters because the state obesity grant that preceded it was the first funding many of our local health departments had received for this kind of work in roughly a decade.

How does Roundtable fit into your work?

I adopted Roundtable right after those forums. We were engaging a large, cross-sector group of stakeholders. I realized I couldn't effectively manage all of those relationships through email. We needed Roundtable for this. Luckily, our Division of Public Health procured Roundtable right as the Rural Health Transformation Program was ramping up. Now it's how we stay connected with the whole group and keep the work moving. Roundtable makes connection and coordination easier and more automatic.

Any final thoughts on your role as a state epidemiologist?

No two days are the same, but the through line in my role is making connections, from the local level to the state to the federal level. I get to meet experts across so many different areas, and often I'll hear about a need in one conversation and then, a week or a month later, meet exactly the person who can fill it. I think of myself as a connector, a hub. That's my favorite part of the job — bringing people together, because we have so much expertise in our state. It's about widening that network so we can collectively get to the vision we all share: a healthier Nebraska.

‍

Learn more about Nebraska's work with Roundtable here.