Women in Health Care (w/ Admiral Rachel Levine)

This week, Chelsea is sitting down with Admiral Rachel Levine, Assistant Secretary for Health for the U.S. Department of Health and Human Services and head of the U.S. Public Health Service Commissioned Corps. They discuss recent challenges in public health, particularly for children and teens, what it means to be a trailblazer in the field, and the progress that still needs to be made.

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Episode Transcript

Speaker 1 (00:00):
Hi, I'm Chelsea Clinton, and this season on in Fact,
we're celebrating Women's History Month. I'll be talking with trailblazing
women at the top of their fields about their personal journeys,
the progress we've made, and how far we still have
to go. Today we're talking about health, individual patient and

(00:24):
public health with Admiral Rachel Levine, the Assistant Secretary for
Health at the U. S Department of Health and Human
Services and the head of the U. S Public Health
Service Commissioned Corps. There's a long history of women accomplishing
amazing and important things in medicine and public health. Some
are well known, many less so. Florence Nightingale is considered

(00:46):
the founder of modern nursing, helped improve hygiene in hospitals,
and was a data visualization pioneer. Clara Barton founded the
American Chapter of the Red Cross. Virginia Alexander for in
E and the Child of Enslaved People studied racism in
the healthcare system. Virginia Apgar developed the Apgard test, which

(01:06):
is still used today to assess the health of newborns.
Matilda Krem was one of the first scientists to recognize
that AIDS was a new disease with potentially catastrophic consequences.
Monahana Atsia proved that lad was in fact in Flint's
water and that elected officials had known, covered it up
and lied about the cover up. And those are just

(01:28):
a few. There are so so many more, including my guest,
Admiral Rachel Levine. Admiral Levine trained in pediatrics and adolescent
medicine at Mountain Sinai in New York City and then
moved to central Pennsylvania, where she became a professor of
pediatrics and psychiatry at the Pinn State College of Medicine.
There she started both the Adolescent Medicine division and the

(01:50):
eating disorders program at the Pinn State Hershey Medical Center.
In she became Pennsylvania's Physician General, and in eighteen she
was in Pennsylvania Secretary of Health. In both state level roles,
she directed significant attention and resources to combating the opioid epidemic,
and when she became the U S Assistant Secretary for Health,

(02:12):
she became the first openly transgender federal official confirmed by
the U. S. Senate. Add We'll being thank you so
much for being part of this podcast. I'm incredibly grateful
for your time today, and I thought we could start
with talking about the pandemic. I know that in your service,

(02:34):
first in Pennsylvania and now on behalf of the United States,
the pandemic has been not the only focus of your work,
but certainly a main focus of your work, and so
I think we have to start with just asking you
to reflect on where you think we are and what
are your current priorities. Well, thank you very much for

(02:55):
that question. Clearly, the COVID nineteen pandemic has been the
biggest public health challenge that we have faced in our
nation and globally in over a hundred years, and everyone
has felt the impact, all families, adults, children, businesses, hospitals,
medical providers, public health providers. I think that we are

(03:19):
doing much better in regards to the pandemic now. We
have seen a number of different very challenging variants, but
the omicron variant, which was very contagious. The numbers are
going down. The number of new cases is going down
in the United States and in most areas globally. The
number of hospitalizations is going down, and slowly the number

(03:41):
of deaths are going down. And so with the extremely
effective and safe and important vaccinations and the tremendous work
of all of our heroes on the front line, their
medical professionals. We are making significant progress, but we can't
let our guard down, and we have to remain very

(04:02):
vigilant about increases in the future, and especially increases that
could be due to perhaps another variant in the future.
So we're going to make sure that we're prepared. Admiral Levin,
I am lucky enough to be able to see you,
but for people who can't, you're wearing this beautiful uniform
of an adible and you are the commander of the

(04:24):
United States Public Health Service Commissioned Corps. And I got
a lot of people listening to us, and a lot
of just Americans broadly may not know what the Public
Health Service Commission Corps is or does, or what your
responsibilities leading it are. Could you talk a little bit
about the core and what you do with it and

(04:44):
as its leader. Well, thank you so much. I am
really so honored to be the leader of the Public
Health Service Commission Corps. It is housed within the United
States Department of Health and Human Services, and it is
led by the Assistant Secretary for Health, which is my position,
and the United States Surgeon General. The United States Public

(05:04):
Health Service Commission CORP is one of the eight uniformed services.
So there are six military services armed services, but then
there's also NOAH, and there's US, and we are, of
course the only one that is dedicated solely to protecting, promoting,
and advancing America's public health. It provides an opportunity for

(05:25):
really very dedicated healthcare and public health professionals to work
in diverse assignments, to work in underserved and vulnerable communities.
So that is one of the things that we do.
We have core officers that work for the Indian Health Service,
and we have core officers that work in the Federal
Bureau of Prisons. We also have core officers really in

(05:45):
many of the different divisions of our department and across
the government. So we have core officers that are detailed
to the c d C, the f d A, and
and i AGE doing research, et cetera. They might be
detailed to state or local public health departments. And also
we also respond to public health emergencies in the United

(06:06):
States and the globally, and we have been detailed and
deployed like never before during the COVID nineteen pandemic with
thousands of missions that our core officers have done, as
well as serving to help with accompanied miners at the
United States Border on Operation Allies Welcome with Afghanistan refugees,

(06:27):
and then to serve if there's a hurricane or a
flood throughout the United States. So it is just truly
an honor to be in this role and to lead
such dedicated expert public health and medical professionals. What was
your journey into medicine and into pediatrics when you were
a little kid. Did you always want to be a

(06:47):
doctor where you one of those kids like ran around
with the stethoscope around your neck, And once you decided
you wanted to be a doctor, did you know you
wanted to be a pediatrician. Well, I really really loved
biology in high school and then wanted to study medicine,
and in medical school, I fell in love with pediatrics.
I really found that my compassion, my love of medicine

(07:08):
was serving children and teenagers and their families, and so
I did my training in pediatrics and then an adolescent
medicine at Mount Sinai in New York City. I bet
a lot of people don't realize that increasingly there really
is a focus on adolescent medicine as a subspecialty and
all of the various challenges that adolescents that teenagers really confront.

(07:33):
I wonder if you could just share kind of what
youth health issues, youth mental health issues you are you
most concerned about, and what now are you doing in
your current position to help address those you are correct. So,
adolescent medicine in the eighties, when I was graduating from
medical school and doing my training, was a rather new field.

(07:54):
What particularly drew me to that field was the opportunity
to work with that inter section of physical health and
mental health because many of the challenges that teenagers have
really lived at that intersection. So I had the opportunity
at Penn State in the Penn State Hershey Medical Center
to start the adolescent medicine program, and I started a
program for children, teens, and young adults with eating disorders.

(08:18):
So we're talking about those within orexia nevosa, the Levia
nevosa and also binge cheating disorder. In my time as
the Physician General and then the Secretary of Health of Pennsylvania,
I brought that interest in that intersection to dealing with
substance abuse and the overdose and opioid crisis and worked

(08:39):
intensively on that in Pennsylvania and still work on that. Now.
We are really seeing a crisis in terms of mental
health issues for children and teenagers now, which has been
exacerbated by the COVID nineteen pandemic. We are seeing so
many teens with issues such as depression, anxiety, but also

(09:02):
an increase in young people even from when I was
in practice, with eating disorders. And I think that is
really one of the challenges that as we worked through
the COVID nineteen pandemic, we have to concentrate on and
President Biden said that in his State of the Union address,
and Secretary of Sarah of HHS has emphasized that, and

(09:22):
we are working on that across the divisions at Health
and Human Services now, and we want to make sure
that we work on workforce development for behavioral health, that
we continue that integration of physical health and behavioral health,
and we expand the treatments available for children at lessons
in their families. What advice would you have to any

(09:44):
parents who's listening to this and who's really worried about
their little kids or their teenagers who think that maybe
their children are confronting dealing with anxiety, depression, or other
mental health challenges, and as parents, they may feel like
they don't know how best to help their kids. What
advice would you give to parents, Well, I would take

(10:05):
it very seriously, so I would certainly take the opportunity
to speak with their child or teenager and explore what
the issues are that might be influencing their mood or
their anxiety, whether it is the changes due to the
COVID nineteen pandemic or other social or personal issues that
they might have. I think that their pediatrician or family

(10:27):
physician would be a good place to start about their concerns,
and then there might be a referral made for an
evaluation and perhaps some counseling. The school guidance counselor might
also be a good place to start if they feel
comfortable doing that. But I think that parents have a
really good gut feeling about their children and their teenagers,
and if they feel something's wrong, they should listen to

(10:49):
those instincts and explore it and make sure that their
child or teenager gets the help that they need. And
there's no shame in asking for help. That is something
that we are trying to emphasize over and over again,
is that we want to get past that stigma associated
with mental health issues and associated with seeking help either
for oneself for one's family. Your mind and your body

(11:12):
are connected, and there are so many issues that are
mind and body related, and so there is no shame,
there is no stigma, and that is one of our
priorities at HHS is to work past that stigma and
to make sure that people can get the help that
they need for themselves and their families. We'll be right back,

(11:36):
stay with us. I want to now move to different
challenge that certainly has troubled me im mentally, which is
the ongoing effort to restrict abortion care access for women,

(11:58):
to sometimes remove abortion care access for women and for
pregnant people around the country, and the commensurate assault on
women's rights fundamentally, what do you make of this trend?
From your physition in government, but also just your position
as a physician well, the buying Harris administration and our

(12:20):
Secretary of Sarah and myself in our office, we are
certainly fully supportive of all reproductive rights for women and
the current state laws and the depending Supreme Court case
we'll see what the result of that is. But certainly
there are threats to reproductive freedom and rights for women
in the United States and globally. The role that I

(12:42):
can play, particularly in my office, is to make sure
that we expand all options within our Title ten program.
And could you explain what that is for people who
don't know what Title ten is. So, our Title ten
program has been around for decades now, and that supports
contraceptive and reproductive rights care for men and women, for

(13:05):
teenagers and indigent individuals. And so there are Title ten
funded clinics throughout the country that fund valuations, testing and
treatment for sexually transmitted infections, screening for reproductive cancers, as
well as the prescription of appropriate contraception to men and

(13:26):
women throughout the nation. One of the public health victories
of the last thirty five years and war is the
significant and continuous decreasing rate of unintended pregnancies in the
United States and the decreasing rate of adolescent pregnancies in
the United States. That is due to comprehensive sex education

(13:49):
and comprehensive access to these reproductive options and contraceptive options
through Title ten and other programs. So the teenage pregnancy
prevention program is in my portfolio as well as that
Title ten program. Now, I've known about Title ten since
my training was I worked in a Title ten clinic
in the eighties at Non Sinai in New York City,

(14:10):
and then in six I actually started a Title ten
clinic at Penn State College of Medicine. So the opportunity
to leave that program is just a privilege. That program
was significantly impacted by the previous administration, which limited its
size and scope, and so we are literally building it
back better, as the President says, where we are expanding

(14:32):
again the Title ten program. We're increasing it, and this
is going to be an integral program as we face
these reproductive rights challenges. I was a public school kid
in Arkansas in the eighties and nineties and I had
age appropriate sex education, and I remember my junior high
school admiral there were I mean, you had to go

(14:53):
to the school nurse, but there were like free contraceptives
available for kids. And it is challenge ing for me
to recognize that we've lost ground that if I were
a kid in those same schools today, I may not
have the same high quality age appropriate but science informed

(15:13):
sexual and reproductive health education. And the same access to protection.
What do you make of the reaction against and the
reversal of sexual and reproductive health education for kids in
so many parts of the country. Well, you're correct in
many parts of the country, we have lost ground. In
other parts of the country, we continue to make progress,

(15:36):
but I think it's an enormous challenge. From a public
health perspective, this should not be a political issue. This
is a public health and medical issue. And teenagers and
young adults they need access to the correct information about
their reproduction, and they need access to contraception and sexually
transmitted affection preventions such as condoms. And from a public

(15:58):
health perspective, we had made progress. We want to continue
to make progress on all of these fronts. This is
just basic public health and good medical care for teens
and young adults. Something else that is basic, good public
health and good medical care for teens and young adults
is enabling pediatricians and adolescent medicine doctors to provide healthcare

(16:19):
to trans youth. And it also has been deeply disturbing
to see, notably in Texas, but not only in Texas,
efforts from the state government to intervene in the ability
of pediatricians and adolescent care providers and child services to
be able to support trans youth and their families. What

(16:41):
can you or the federal government do to try to
help protect the safety and the health and the well
being of trans kids. Transgender youth are at risk, They
are vulnerable, they are at risk of bullying and harassment
and discrimination, and to limit their access to evidence based

(17:02):
standard of care medical treatment, gender affirmation treatment is unconscionable,
and it's being done for political purposes. And again, these
should not be political issues. There should be medical issues,
public health issues. There should be issues that young people
talked to with their parents and their doctors, and that
is how their care is decided. Many places around the country,

(17:24):
that care is provided by our expert children's hospitals. So
I'm going to think about Pennsylvania, where I have been
for many years, and so the Children's Hospital of Philadelphia,
associated with the University of Pennsylvania, has a great gender
clinic for transgender and gender diverse youth. The penn State
Children's Hospital where I was, has a clinic. The University

(17:44):
of Pittsburgh Medical Center Children's Hospital has a great medical clinic.
In Pennsylvania. The Children's National Medical Center has a clinic
Boston Children's Hospital. You say LA Children's Hospital. I mean
these are not fly by night places. These are ex
at children's hospitals with outstanding medical and behavior at health professionals,
and they are following very established standards of care, international

(18:08):
and national standards of care for the evaluation and treatment
of trans youth and gender diverse youth. And the idea
that this is being impacted for political purposes is terrible.
So this is something that we are going to continue
to work on across the Department of Health and Human
Services under the presidents and the secretaries leadership. So I
am going to advocate to protect these vulnerable trans youth.

(18:31):
We're going to work on policies that protect these vulnerable
trans youth and their families. The Office of Civil Rights
has interpreted Section fifteen fifty seven of the Affordable Care
Act that you cannot discriminate on the basis of sex,
and that includes sexual orientation and gender identities. So that
includes having access to gender affirmation treatment. And so we

(18:55):
do encourage children and teens and families and medical professionals
who feel that they are being discriminated against to contact
the Office of Civil rights at HHS. In addition, the
Department of Justice is looking at these to see what
they can do, the Department of Education as well, So
we will do everything we possibly can at the federal
level to try to protect trans youth and their families.

(19:18):
As a parent, it just makes me so angry. It
makes me so angry, Admiral, that the Texas state government
apparatus is so willing to play politics with kids lives,
just it makes me really angry. That's exactly right. I mean,
what is happening in Texas is that the governor and
the Attorney General have instructed the Child Protective Services in

(19:42):
Texas to start investigating parents who are having their children
receive gender affirmation treatment by qualified medical and behavioral health specialists.
So there's a lot of tremendous important work the Child
Protective Services have to do to investigate and protect children
from wild abuse and to direct them towards these vulnerable

(20:03):
children and families. Again is wrong, and it's segregious, and
it's traumatizing to kids and to parents, and certainly again,
it is so heartening to hear all that the Biden
administration is doing across not only your department, a JHS
but also the Department of Education and the Justice Department.
It is simultaneously infuriating that federal government resources now have

(20:28):
to be purposed to help protect children because of the
kind of political malfisians of the governor and the Attorney General.
I guess another question though, to Admiral is for parents
or for kids who want to know what you are doing,
So not only what your job description is, but what

(20:49):
you are doing on issues relating to trans youth or
protecting l g B, t QI plus youth or any issue.
Where do they go? Do they go to your website?
Like how do people find out what you're doing to
help protect their health or help protect public health? So
they would go to the website at the Apartment of

(21:09):
Health and Human Services, which outlines my position as the
Assistant Secretary for Health and an admiral in the United
States Public Health Service Commission CORPS. And we also are
active on social media, particularly on Twitter. So if you
follow our Twitter handle, then you know we are commenting
daily on these public health issues of the day. That

(21:29):
includes COVID, that includes mental health and overdose prevention, that
includes health equity, that includes a new office under my
portfolio for climate change in health equity because climate change
is happening right now. We are seeing the health impacts
of climate change now, It's not some distant time in
the future. So we're working very intensively on that that

(21:51):
would be available in our twenty feed and many other
different public health issues. We're taking a quick break. Stay
at this adderal, you have broken a number of ceilings,

(22:13):
and since we're talking during Women's History Month, I do
want to ask you about what it has been like
to be such a ceiling breaker multiple ceilings. You're the
first woman to be the head of the U s
Public Health Services Commission's core, the first ever female four
star admiral to lead the organization. I find that so
fun to say. I admit. We're also the first openly

(22:34):
transgender four star officer in the history of the nation's
eight uniform services, and one of the few openly transgender
government officials at the federal level in the United States,
and the first to hold an office that required a
Senate confirmation. Are you aware of being so many firsts?
How does that feel? Or are the achievements that you

(22:54):
kind of unlocked and then you just gone on about
your job. All of the above, So I certainly do
recognize the importance of being able to achieve these positions,
and it is truly an honor and a privilege, you know.
I have always felt very good about my career in
medicine and public health because it allows me to help people.

(23:15):
So in academic medicine at Mount Sinai and penn State,
to help children and teenagers and their families, to teach
students how to do that, to do clinical research, to
run programs about how to help people. And then in
public health. This has allowed me in Pennsylvania and now
in the United States from a national perspective, to do
this with this public health brush, to do it from

(23:35):
a public health perspective, And I am just so honored
for the impact that I can make. But also and
I understand the historic nature of what it symbolizes for
the l g B t q I plus community and
particularly for youth. Now I stand on the shoulders of
many l g B t q I plus individuals, trans
individuals who came before me, some of whom are known,

(23:56):
some of whom are not known, and had to sort
of live and work in the parkness. So what I
want to do is hope that my appointment into these
positions is the first of many to come as we
create a more diverse future, a more inclusive future. Diversity
always makes us stronger. The diversity and all of its

(24:16):
mirrored and wonderful aspects in the United States really makes
us all stronger. And so it is just an honor
to take the uniform for the United States Public Health
Service Commission Core and to serve at the same time.
I'm just really busy on public health. So whether it
is COVID nineteen, whether it is mental health and overdoses,

(24:38):
whether it is health equity, climate change, the Title ten program,
We talked about ending the HIV epidemic, nutrition programs, the
blood supply. There are so many different priorities that we
have for this office and a HHS that keeps me
very busy, and that's just great because I get to
help more people. We spoke about you being the first,

(25:00):
clearly your hope that you won't be the only. What
do you think we need to do to ensure that
there are second thirds and then we lose track in
the best sense. Well, that's the goal, is that? And
Vice President Harris said that she's the first, but she
won't be the last. And I am firmly convinced that
I will not be the last, and hopefully eventually I
won't have to be known as the transgender United States

(25:23):
Assistant Secretary for Health, that it doesn't have to define
who I am. I think that's going to take time
as we continue to work on diversity, equity, and inclusion.
And I think those three signposts, those three guardrails need
to be continually emphasized and continually protected. And I feel

(25:45):
very confident that that is what the Biden Harris administration
is going to continue to work on in public health
and hh S, and it really across the administration. So,
since we are talking during Women's History Month, as a
woman in medicine and public health, do you think we
are in terms of representation for women in public health
and medicine? And what more do you think we need

(26:06):
to do to ensure there's full equity and inclusion for
women across public health and medicine. Well, we have made
so much progress in the last fifty sixty years. Fifty
sixty years ago, it had been rather unusual for a
woman to be in a college of medicine. When I
was in medical school. I don't know precisely, but probably
maybe a quarter of the class was female. And now

(26:27):
in any medical school across the country, any law school,
any graduate school, at least fifty percent of the class
is female. I think that we have made a lot
of progress in that regard. There are, still, however, challenges
for women in some fields of academic medicine and in
some fields of medicine, so there's still more work to do.

(26:47):
We need more women in surgical specialties. We need more
women in academic medicine, more women chairs of departments, more
women deeds, more women in charge of public health agencies.
So we have made aggress but we have more work
to do. And just a final question that we're asking
everyone this season again, since we're here during Women's History Month,

(27:08):
is there and you may have just answered this one
statistic or fact about women in public health that either
particularly inspires you or maybe enrages you, but then that
rage gives you inspiration. Well, I'm going to switch gears
a bit for the statistic and talk about teens with
eating disorders, because again that was my field from decades. So,

(27:30):
as we had said, we have seen a significant increase
in the amount of young people with eating disorders and
across all genders and across all genders. It's not just
young women. We see young men with eating disorders, We
see children with eating disorders. We see eating disorders an
l g B t q I plus youth. In fact,
we see a lot in l g B t q
I plus youth. We see eating disorders an all ethnic

(27:50):
groups and all socio economic groups. So you cannot assume
that young person who starts to have symptoms that couldn't
be an eating disorder because of any of those characteristics.
We see even dis sort as an adults as well,
which can be very serious. So the risk of eating
disorders is really in all age groups and all genders.
And so that is why it is so important to

(28:10):
have access to quality, evidence based standard of care. So
the statistics to statistics one is a seventy increase in
the number of calls to eating disorder hotlines. But the
promising statistic that people don't realize is that around of
teenagers with in erection devosa a believing of also will

(28:31):
completely recover. So people tend to have said that even
disorders are chronic illness and you never recover from that,
and that is simply not true. And so the vast
majority of teenagers with serious eating disorders like interirecting, and
believe me, I can completely recover. That does take time,
and it takes multidisciplinary treatment with medical and psychological and

(28:55):
psychiatric professionals and nutritional professionals, but actually the comes through
very very good with expert care. Admiral Levine, thank you
so much for working so hard to ensure that every
child and every adolescent across our country does have access
to the highest quality standard of care rooted in public

(29:16):
health and evidence and in science and not in politics.
I am very proud that you are our first woman
head of the U S Public Health Service Commission to
core and very grateful for your time today. Thank you
so much. It's really pleasure to be here. To learn
more about any of the health initiatives mentioned by Admiral Levine,

(29:39):
you can follow her on Twitter at h h S
Underscore a s H or go to HHS dot gov.
And if you're looking for resources to support transgender and
non binary youth and how you can help the Trevor Project,
the A C l U and LAMB illegal are a
few great places to start. In Fact is brought to
you by I Radio. We are produced by a mighty

(30:02):
group of women and one amazing man, Erica Goodmudson, Mart Harror,
Sarah Horowitz, Jessmine Molly, and Justin Wright, with help from
Lindsay Hoffman, Barry Laurie, Joyce Kuban, Julie Supran, Mike Taylor,
and Emily Young. Original music is by Justin Wright. If
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(30:22):
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