Editor's note: The following Question and Answer with Dr. Rachel Levine was originally published in the December 4, 2018 edition of The Caucus, a publication of LNP Media Group, Inc.
FAST FACTS: DR. RACHEL LEVINE
Known For: Pennsylvania’s secretary of the Department of Health, founding the Division of Adolescent Medicine and Eating Disorders at Penn State Children’s Hospital at Milton S. Hershey Medical Center.
Education: Belmont Hill School, an independent school for boys in grades 7-12; undergraduate degree from Harvard College; Tulane University School of Medicine; pediatrics training at the Mount Sinai Medical Center in New York City; fellowship in Adolescent Medicine at Mount Sinai.
Dr. Rachel Levine was running the eating disorder clinic at Penn State Health Milton S. Hershey Medical Center when she was appointed by Gov. Tom Wolf to be the state’s physician general in January 2015. Two and a half years later, Levine, the first transgender woman to serve in the Pennsylvania governor’s cabinet, took the helm as secretary of the Department of Health, which has a nearly $1 billion budget and 1,200 employees across the state.
Levine, a native of Boston, attended an all-male prep school before studying at Harvard and Tulane Medical School. She landed a fellowship at Mount Sinai, in New York, and became chief resident of the Children’s Hospital. In 1993, she made what she describes as her “biggest transition:” leaving New York for central Pennsylvania.
Levine, 61, sat down with The Caucus in her office in the headquarters of the Department of Health for a wide-ranging conversation that covered not only the public health crises facing the state — from the opioid epidemic to a maternal mortality spike — but also the many transitions she has experienced to get to this point: her move from Central Park to central Pennsylvania, leaving patient care to take over a major public health department and to being recognized in the media for her work not her gender.
THE CAUCUS: How did you end up working in adolescent and specifically eating disorder work in central Pennsylvania?
LEVINE: After my fellowship at Mount Sinai in New York City, I stayed for five years, and then I made the biggest transition I have had in my life — which is saying something. In 1993, I moved from 80th and 1st in Manhattan to central Pennsylvania to be at the Penn State College of Medicine.
And there I developed the Adolescent Medicine Program. I have always been interested in patients with eating disorders because it really is this medical-behavioral-health intersection. I started the eating disorder program, and that grew over 20 years.
THE CAUCUS: What have been the most challenging things for you in your role as secretary of the Department of Health?
LEVINE: The biggest health challenge that we face is the opioid crisis. I think that we have been very successful in working across agencies. That is something I did learn at Penn State Hershey: if you want to run an adolescent medicine and eating disorder program, it has to be multidisciplinary. So we broke down silos, and we had pediatrics and adolescent medicine there. We had psychiatry there, psychology there, nutrition there. I was the mentor at Penn State Hershey for anyone who wanted to start a multidisciplinary clinic in terms of breaking down silos. Here we are with the opioid crisis, and we had to work across agencies to do that. We have worked inter departmentally and collaboratively throughout the entire Wolf administration, especially in the last year, where he has had a disaster declaration for opioids and a command center structure, which runs out of the Pennsylvania Emergency Management Agency. We have 15 different agencies at the table all looking at this from different perspectives and then organizing our response into different pillars — prevention, rescue and treatment — and then coordinating that response in a multidisciplinary manner, making sure that everyone is working collaboratively.
THE CAUCUS: Do you feel that this emergency declaration has helped?
LEVINE: Absolutely. A disaster declaration lasts 90 days. The reason we didn’t declare a public health emergency is there is no mechanism in Pennsylvania to do that. That law does not exist. So We are going to try to push forward with that again (during the Legislature’s new session). We are in our fourth iteration of the disaster declaration, and there are some specific things we have done under the declaration: We made neonatal absence syndrome a reportable illness; we are doing Naloxone leave-behind — many different measures that were specific to the disaster declaration. But I think the most important thing was bringing us all together.
THE CAUCUS: You’ve talked a lot about collaborating with other agencies.
LEVINE: I lead by consensus and collaboration. So with other human service agencies — Department of Health, Human Services, Drug and Alcohol Program and Aging — we would like to say that we collaborate, we can cooperate, we coordinate and we communicate. We are on the same page. We have breakfast together once a month. We meet together all the time, and you will not find any space between us.
THE CAUCUS: We recently saw your news release about maternal mortality. Has there been a dramatic rise in Pennsylvania? And, if so, what accounts for it? And are you seeing racial or geographic disparity?
LEVINE: Sure. This is a national issue, and there has been a significant increase in maternal mortality and morbidity, but our new committee is the Maternal Mortality Committee (established this year by Act 24). In the United States in 1999, the death rate was 9.8 women per 100,000 live births; in 2014, it was 18. In Pennsylvania it also has been rising. In Pennsylvania, from 2012 to 2016, the rate was 11.4 maternal deaths per 100,000 live births. For Caucasian women, it was 8.7. For African-American women, it was 27.2. So (it’s been) below the national average, which is good, but still rising with a significant racial disparity. No one knows exactly why the maternal mortality rate has gone up in the United States. Our committee has only had one meeting, so I can’t tell you exactly why in Pennsylvania, but we hope to learn that. That is the purpose of the committee. We are going to review every death.
THE CAUCUS: And is this something you are saying other neighboring states have done already?
LEVINE: Absolutely. Yes, new committees are being formed all the time. For us, it required legislation to be able to do that, and that takes a little while, but we have been working on this for a number of years.
THE CAUCUS: What are your priorities for the next four years?
LEVINE: In the past year and a half, our priorities were the opioid crisis, medical marijuana and the rural health initiative — an initiative to save rural hospitals, which are under stress in our current fee-for-service environment. That was actually the brainchild of the previous secretary, Karen Murphy. Also, public health preparedness, in my mind, always has to be a priority. So whether it is what we see all the time, which is snow, rain, flooding and other weather-related issues, or whether it is horrific shootings, which unfortunately we have seen even here in Pennsylvania, or whether it is fires, like in California, or hurricanes or infectious disease outbreak, we have to be prepared. And the last priority is nursing homes. We have had a real challenge in Pennsylvania with nursing homes. There was an auditor general report and a nursing home task force, and we have worked to implement that and improve it, and I think we have more work to do. The new priorities are going to be opioids; the second is public health preparedness, because I think it always has to be; the third is nursing homes, because I think we have made progress but have more work to do; and the fourth is going to be a shift to maternal — child health, which includes things like the maternal mortality review committee.
But, also, the governor’s policy office has an initiative called Ready to Start, or a “0 to 3” or “birth to 3,” looking at health in families and getting prepared for education for infants and young children.
THE CAUCUS: So are you having fun?
LEVINE: Absolutely. I feel very privileged to have this position and to work under Governor Wolf’s leadership. He is a great governor, and I have the best job and the best boss. It was hard to decide to leave Hershey, because I had to give up patient care. But let’s look at my previous job: I was at Penn State Hershey, being a physician in academic medicine. All I did was help people or try to. I would see patients and try to help teens and young adults and their families. I would teach students and residents how to help people. I would do clinical research about how to help people better, and I would run programs to help people. What could be more rewarding than that, right? So when I left, the idea was that I still wanted to help people, but I would have to do it from a public health perspective. I mean, at the Department of Health, we are not trying to harm anybody. All we are trying to do is protect the health and well-being of everyone in Pennsylvania, no question.
We have our challenges and frustrations too, but that is why it is so fantastic.
THE CAUCUS: Do you have any favorite moments from your tenure so far?
LEVINE: I have a couple. Being unanimously confirmed as the physician general by the overwhelmingly conservative state Senate. It was very interesting to go to all of their offices and have them shake my hand and talk about public health. The Legislature was a new experience for me — and it was probably a new experience for them. As health secretary, it’s a bigger job setting priorities, working with the governor and his office, working with the Legislature — that transition was very cool. I was confirmed 49 to 1 as secretary of health.
As an openly transgender woman, it was amazing to be nominated to be physician general. After I was nominated, there was a fair amount of press, which was interesting and a little bit different for me. I was always out, but this was really out. It was rewarding when newspaper articles stopped saying “transgender physician general, Dr. Rachel Levine,” and just said “Dr. Rachel Levine, physician general.” If I am the transgender physician general, who is the cisgender physician general? That person didn’t come to work.