The Last Word: Dr. Leana Wen

May 18, 2017

Dr. Leana Wen has served as Baltimore, Maryland’s City Health Commissioner since January, 2015. Before taking the job she was an emergency room physician, public health professor and activist for domestic and international policy to provide better access to health care and life saving pharmaceuticals. Dr. Wen is dedicated to reducing healthcare disparities, creating better access to healthcare services and encouraging a model of health care centered on prevention to build healthy communities. She is the author of “When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Care” and founder of Who’s My Doctor, a project to encourage transparency in medicine. 1199 Magazine spoke with Dr. Wen in February, just ahead of the successful fightback against the Trump administration’s initial attempt to repeal the Affordable Care Act.

The term public health is often treated like a hot potato and used broadly, to many different ends. What does it mean to you in your role as Commissioner of Health and as a physician?

We say that health and public health is about everything. You can’t discuss someone’s health without talking about the air they breathe, the food that they have access to and the environment. It’s not just of physical health but also to the factors that contribute to mental health and well-being. The danger is that nobody takes responsibility for it, and from our standpoint in the health department we believe that everybody should take responsibility for health because it’s something that we all contribute to. To me as a physician, health is about the health care that you receive and much more; if somebody has heart disease we know we cannot just tell them to take medications without also addressing healthy foods that they have access to, or lack thereof. If a child is obese we cannot just talk about that without addressing their lack of safety and how they would feel walking outside or exercising outside. We also know that health ties into other aspects like education, like employment, like public safety. These are all issues we need to take a role in. There needs to be the health lens that we apply to the social problems of our time.

Do you think there has been an erosion of general concern for public health in society? Why?

There is a saying that public health saves your life today, you just don’t know it. Public health is what prevents people from getting ill in restaurants because we do restaurant inspections. Public health is what keeps our water supply safe. Public health is what we do to prevent or ensure health conditions so people do not get shot and killed. Unfortunately, because public health is about prevention, there is no face of someone who benefited from it. It’s the face of something that did not happen. That’s why we as health professionals have to keep making the case ourselves. We have to be the best vanguard, the best guardians for public health. Because if we don’t stand up and talk about it, nobody will.

We are in a time of major change in our healthcare system. Can you discuss the connection between the growth of corporate healthcare, healthcare megasystems and the challenges faced by healthcare workers and those working in public health?

Healthcare has become a commodity rather than a right. It has become a privilege to those who can pay for it rather than something we do because it’s the right thing to do because it makes all of us healthier at the end of the day. That is a problem. Feefor- service medicine is a problem because it commodifies healthcare. It focuses our attention on what to do when someone is very ill, rather than how can we prevent that illness in the first place. I’m an emergency physician. Of course I want to take excellent care of my patients when they come in and are extremely ill—if they are the victims of car accidents, if they have had a heart attack, or if they have been shot—but I would rather have our resources be devoted not to that type of acute care, but to preventing someone from getting into the car accident or from that bullet from entering the person’s body. That is what we should be doing: focusing our efforts on prevention. We should be achieving these outcomes as early as possible for our children.

“Virtually every study has shown that prevention saves lives and saves money; when it comes to prenatal care, for example, women who don’t get prenatal care are five times more likely to have infants who die than women who do have prenatal care.”

Why is it important for caregivers to have a voice in the changes in our healthcare system?

We as the providers—doctors, nurses , social workers and other professionals—we are on the front lines. We see what happens to our patients. They are not just policies to us. That’s why it’s so important for healthcare professionals to be leaders in our field. We should be consulted for every decision that is made. We are on the front lines treating people every single day. Whatever decisions are made will impact our practices and directly impact the lives and livelihoods of our patients.

How will the changes to the ACA and Medicaid affect your city of Baltimore?

I’m extremely concerned about the impact of this ACA “replacement” plan. It is detrimental to the shortand long-term health of our residents. We know that this so-called plan will decrease coverage to potentially tens of thousands of Baltimore residents. It will take away their coverage, so individuals who are stable and being treated for medical and other conditions will now have their health care taken away from them. We know that this plan will impact Medicaid which covers the most vulnerable in our communities–including women, children and the elderly. We know there will be huge impacts on women’s health care; it further takes away reproductive choice and reproductive options for women. This plan makes no sense. It decreases coverage while increasing costs. It is something that will have significant long-term effects on the health and well-being of our residents as well as of our country.

On a positive note, you have also had a lot of successes in the work you’ve been doing in Baltimore. Tell us about some of those.

Our work around opioids, for one. We have changed the dialogue around addiction, so that there is an understanding that addiction is a disease, that it kills and that there is a way to save lives. We have gotten legislation changes and done outreach so that we now have a standing order—which is a blanket prescription for naloxone (a drug designed to rapidly reverse the effects of opioid overdose)—as long as they get a basic training. We have trained over 20,000 residents and everyday people have saved the lives of over 800 Baltimore residents. That’s something we are very proud of even as we recognize there is a lot more work to be done. Second, we have formed partnerships across the city around the common goal of reducing infant mortality. Within seven years we have reduced our infant mortality to a record low: that’s about 50 babies that would have died in 2009 that are now alive in 2017. We’ve expanded this plan to be about youth health and wellness more broadly. We’ve launched a citywide strategy called Healthy Baltimore 2020; we have a goal of cutting health disparities in half because we recognize we cannot have good health while we have structural inequities and legacies of racism and discrimination.

“We see what happens to our patients. They are not just policies to us. That’s why it’s so important for healthcare professionals to be leaders in our field. We should be consulted for every decision that is made.”

What role can 1199 and other community partners play in expanding access to preventive care?

Virtually every study has shown that prevention saves lives and saves money; when it comes to prenatal care for example women who don’t get prenatal care are five times more likely to have infants who die than women who do have prenatal care. We know that prenatal care programs are a life-saving, cost-saving measure and they are something we can all take part in. Part of the problem is that this is not where our financial incentives are aligned. There is no money to encourage people to invest in prevention, which is why advocacy groups and community groups have to take the lead. I commend the work that 1199 does to rally healthcare professionals and patients together in our common goal of improving health.

How do we encourage healthcare workers who live and work in our communities to have these conversations?

These conversations are a big challenge; all of us have to tie these conversations to the things people care about. Whether it’s public health, education reform, public safety, jobs –we have to be the ones making the case that improving health ties in to all of these other factors.

1199 Magazine | March/April 2017