Dr. Leana Wen is an emergency physician and public health professor at George Washington University who previously served as the health commissioner in Baltimore, Maryland. Dr. Wen is a familiar face on CNN, where she serves as a medical analyst, writes a weekly column in The Washington Post and hosts the Post’s newsletter, The Checkup With Dr. Wen. She’s also the author of the new book, “Lifelines: A Doctor’s Journey in the Fight for Public Health.” The busy mother of two recently took time to speak with HealthyWomen's editor-in-chief Jaimie Seaton.
This interview has been lightly edited for clarity and length.
HealthyWomen: You write very movingly at the beginning of your book about watching a young boy die when you were a child and how that influenced your decision to go into medicine. Can you talk a little bit about that?
Dr. Leana Wen: When I was about 10 years old, there was a boy who lived in the same apartment building as me. He was a couple of years younger, and we used to walk to school together. One day, I heard his grandmother scream for help. I ran in and could see that he was having difficulty breathing because he had asthma. And I understood that feeling very well because I also had asthma and knew that sensation of taking breaths in and not being able to fully exhale. I remember grabbing my inhaler and trying to help him breathe. But then at some point I knew that he needed a hospital. I also had severe asthma and had been in and out of hospitals and was asking his grandmother to call for an ambulance. She was too afraid to call because their family was undocumented. And she was afraid of immigration officials coming if she called for medical help. You talked about the end of the story, which is that I essentially watched this boy die in front of me. I understood from that moment that people's lives are not valued the same, that we live in a society where health care is not the basic human right that it should be.
HealthyWomen: There's another death later in the book, and both can be tied to public health. So I wondered if you could talk just a little bit about your views and the importance of public health?
Dr. Leana Wen: I give examples in the book about the problems with our healthcare system. The dying patients I've seen who were denied access to healthcare or did not have access — in a way that resulted in their lives being prematurely ended — they had preventable deaths because they did not have health insurance, because they did not have the ability to pay for healthcare, because of where they happened to be born or how much money they had. And it's unjust and very much fueled my desire to be in medicine.
It was also working in the ER that I saw how much health is not just about the health care that we receive. It's also about the air that we breathe, the food that we have access to, the housing resources that are available. All of that is what's involved in this concept of public health. Public health was not something that I went into medicine thinking that I wanted to do. I had no concept of what it meant. And public health is not just the opposite of private health, it's not as if some people who can't afford private health care are getting public health, but rather public health is about all these other conditions in our lives that enable us to have health, that is not just about the healthcare that we receive.
HealthyWomen: You actually just gave the perfect segue to my next question, which is, Why do you think so many Americans equate public health and access to health care as a negative, as if they're losing something rather than gaining something?
Dr. Leana Wen: It's an interesting question. There is this sense when we talk about health disparities that somehow health is a zero-sum game. Here in my city in Baltimore, there are neighborhoods just a few miles apart from another where a child born today can expect to live 65 years or 85 years, depending just on the ZIP code that they happen to be born into. When we talk about reducing disparities, we're not talking about taking an average and taking years of life and adding it to others. This is a concept of all boats rising, that when you help those who are the most vulnerable, you are assisting everyone. They're not taking resources. Health is not a finite resource that's only available in a certain quantity and you have to disperse it, rather having healthier conditions for all. Think about clean air. Or we've all been talking about Covid. Think about infection control. These are things that if you are helping someone, you're actually helping everyone. And so, I think this is something that we need to reframe the conversation around.
HealthyWomen: How do you think we can change that perception?
Dr. Leana Wen: Well, I talked about reframing the narrative. This is the time for us to be doing it. The initial title of my book was, “Public Health Saved Your Life Today, You Just Don't Know It.” And the idea of it is that public health doesn't have a face. Typically when you talk about public health, it's about prevention. We have prevented something from occurring. And so there is no space for something that didn't happen, but as a result people don't understand it, and it becomes neglected and underfunded and undervalued. And so, I think this is the time — in the time of Covid where people think about public health a lot more than they did before — for us to put a face on public health and get people to see why an investment of public health is so crucial.
HealthyWomen: Absolutely. I’m going to move on to the pandemic now. We've seen citizens not trusting public health officials and the catastrophic results. In your book, you wrote about credible messengers. Given the current political situation with respect to vaccines and masks, how can we do a better job and recruit better messengers, and who do you think those messengers could be?
Dr. Leana Wen: Public health very much depends on public trust. One of the four aphorisms in public health is that the messenger matters as much as or even more than the message. In terms of who the trusted messengers are, it really depends. And I would actually say that, all of us are the trusted messenger to somebody else. Somebody out there is looking up to us. It could be a former neighbor, it could be a colleague, it could be a cousin, it could be a nephew. There's somebody out there to whom we are a credible messenger. We should all embrace our roles as potential credible messengers to someone else.
HealthyWomen: Do you think that there are other public people or public types of people that could be credible messengers to help us when it comes to the pandemic, to get more people vaccinated or wearing masks?
Dr. Leana Wen: Well, certainly we've seen that throughout the pandemic, in the sense that we have seen religious leaders really step up, people in the community, barbers, the community health leaders, other individuals that people look up to. But I still think that people should not underestimate their own role with others in their own lives.
HealthyWomen: I read a tweet of yours that said, “Convinced (sic) the remaining unvaccinated to get vaccinated will be very hard. It's a much easier lift to get an additional dose to those who already decided to get two shots and are booster eligible. Doing so is our best hope to protect more Americans.” So my question is, will the pandemic end if we continue to have such a high percentage of people who are unvaccinated?
Dr. Leana Wen: Difficult to say. The possibility is that, as a result of how widespread omicron has been, the combination of people who've gotten infected with omicron and those who had prior immunity through vaccinations will be sufficient for us to prevent future surges. I hope that that's the case. I don't know that it will be, but it definitely remains true though, that vaccination is our fastest way out of the pandemic, and it's extremely unfortunate that there has been this level of misinformation and active disinformation that is preventing people from making the decision to protect themselves and their families.
HealthyWomen: Related to that, if we don't get to full herd immunity, or even if we do, do you think the virus is just going to continue to mutate? Is it something that we're always going to be living with, or do you see an end in sight?
Dr. Leana Wen: None of us have a crystal ball. I think one of three scenarios is possible. One is the best case, which is that we reach a high enough level of immunity through prior infection as well as vaccination that future variants don't have much impact. Maybe we'll have some seasonal effect and Covid becomes something more akin to the flu. The second possibility is that we have the exact opposite, that we have a new variant or multiple new variants that arrive that evade existing immunity and that spread more easily. It could even be more deadly, and we could see a whole new pandemic come through. That would be devastating. And then I think there's the third possibility, which is somewhere between these two. If there’s anything that we've seen through Covid thus far, it's that it's very difficult to prognosticate, that the virus continues to throw us curve balls, and that we need to be prepared for whatever comes our way.
HealthyWomen: Is there anything I haven't asked you that you would like to add? And I know that's a very open-ended question, but as it relates to what we've already talked about.
Dr. Leana Wen: Public health is under threat in a way that it has not been in the past. My fear prior to Covid was that public health would be forgotten, that it's neglected and is something that we just don't talk about, and therefore don't fund and don't value. My concern now is that it's gotten politicized, and it's become placed in the midst of ideological and partisan culture wars. That has many dangerous consequences because, of course, public health is not about partisanship or political divide in any way. So, how to bridge that going forward is going to be our collective challenge.
