Linda Poon is an assistant editor at CityLab covering science and urban technology, including smart cities and climate change. She previously covered global health and development for NPR’s Goats and Soda blog.
Baltimore City’s health commissioner leaves her post Friday to become president of Planned Parenthood, and she’s bringing her relentless work ethic along with her.
The incoming president of Planned Parenthood sounds more like a boxer than a doctor. “I am so ready for this fight,” Dr. Leana Wen tells CityLab.
Wen, an emergency room physician who has spent the last four years as Baltimore City’s health commissioner, is poised to begin her new job in a month. She’ll be the first physician in nearly 50 years to lead Planned Parenthood, and she’s arriving at a challenging time not only for the organization, but for women’s health in general. In a statement released last month, Wen called the threat to women’s health “the single biggest public health catastrophe of our time.”
Wen doesn’t back away from challenges, however, as her record in Baltimore demonstrates. She rattles off a list of public health achievements, such as the standing order she issued in 2015 for a blanket prescription of the anti-overdose drug naloxone at all pharmacies—that’s saved 3,000 lives, she says. Wen also gushes about the B’more for Healthy Babies program, how in the last seven years, it’s cut the infant mortality rate by almost 40 percent, down to a record low. Then there’s the recent success of the Baltimore Billion Steps challenge, which encouraged residents to be more active.
“I'm really proud of all of this work, but there is much more work ahead of us,” she says. Baltimore still struggles not only with poverty and violent crime but with some of the nation’s most stark income and health disparities. Life expectancy varies up to 20 years between neighborhoods, according to a 2017 white paper on the state of the city’s health.
That’s partly why she describes her move to Planned Parenthood as “bittersweet.” But leading this organization will surely offer a fresh set of challenges. Anti-abortion activists and conservative lawmakers have long targeted Planned Parenthood, and the GOP’s current political dominance raises the very real and imminent threat of being defunded. Bearing the brunt of the consequences will be lower-income women, for whom getting access to things like family planning services, birth control, and cancer screening is already hard given the national shortage of women’s health clinics.
Yet Wen is no stranger to tangling with the highest levels of government. Earlier this year she helped lead a lawsuit against the federal government for abruptly cutting funding to two of the city’s teen pregnancy prevention programs. Spoiler alert: She won. And when the Trump administration proposed regulation changes to Title X, the federal grant program that funds Planned Parenthood’s contraceptive services, she was an outspoken critic, penning a fiery op-ed in the Baltimore Sun.
CityLab recently caught up with Wen as she was tidying up loose ends in preparation for her departure. She reflected on her time in Baltimore, and how it’s prepared her to be a voice for women’s health. And she assured us she will bring her famously relentless work ethic and passion for public health to this national arena. Our conversation has been edited for length and clarity.
Why do you see women’s health as the single biggest public health issue today?
Look at what’s happened in the last week as a result of the [nomination hearing for the] Supreme Court. Right now, there are 13 cases that are one step away from the Supreme Court that deal with women's health. We are facing the very real probability that Roe v. Wade can be overturned or further eroded in the next year. That means dozens of states could be affected. More than 25 million women of reproductive age could face no access to abortion at all in their state. That’s more than a third of women of reproductive age in this country.
The other cases involve exclusion from Medicaid reimbursement for services like cancer screening and birth control—basic health services. And this is what is at stake right now, it is literally about people's lives.
Baltimore’s public health challenges are so multifaceted. What’s one takeaway from your time as the city health commissioner?
In Baltimore, the areas that we provide services in are by no means equal when it comes to people’s access to anything, whether it’s health care, medication, food. We’ve specifically said improving health is not enough if we’re not also directly reducing disparity. That’s why in our Healthy Baltimore 2020 plan, for every health outcome, the metric of success is not only improving that [specific] health outcome but also cutting disparities.
There are huge areas in this country where women have to drive dozens, hundreds of miles, in order to access basic health care services. Our moral imperative in public health—whether in the local Baltimore City health department or in Planned Parenthood—is to be there for all those who need our care. So I will always be focused on expanding our impact [at Planned Parenthood], and our reach, because we know there are huge unmet needs out there.
Can you paint us a picture of what the health disparity among women looks like?
I’ve seen what happens when women don’t have access to basic health care services. I’ve treated a woman who waited more than a year before she got a lump in her breast examined, because she didn’t have access to health care. And by the time she ended up getting seen, she had [developed] metastatic cancer; she died not long after I saw her, leaving behind three children. That’s what happens when safety-net clinics close. This is what the Title X change would directly cause.
So several months ago, the Trump administration came out with proposed changes to Title X regulations, which would, first of all, stop funding to clinics that provide the full range of reproductive health services. It also has a gag rule, which would force doctors and nurses to censor what we say to our patients. This is the government telling us that we cannot provide evidence-based medical information for our patient. Imagine that happening for anything else. Imagine this was diabetes and now doctors can’t tell patients anything about insulin. It just wouldn’t happen.
And the crazy part of it—first of all, this whole thing is crazy because it directly compromises our ethic as doctors and health professionals—is that this applies only for those women who depend on safety-net clinics. If you’re wealthy, insured, and can pay, you can get evidence-based information. You can get the best quality health care. But if you depend on government assistance, if you are a person with low income, then you will be deprived of the comprehensive medical services that all of us are entitled to. To me, it’s a public health issue but it’s also profoundly a civil rights and social justice issue. That’s why there is so much right now that is on the line.
You’ll be pivoting from overseeing the health of a city to overseeing the health of women nationwide. What changes or stays the same?
I am a front-line provider. I’ve worked in the ER, which is the front line of health care and of our hospital. A core part of my identity will always be being a physician. I continued to practice medicine as the health commissioner of Baltimore, and I intend to continue doing so as the president of Planned Parenthood. It’s what informs my work and my advocacy. So that’s number one.
Number two: In Baltimore, I am out there every day—at community meetings, in churches, in neighborhood associations, in our clinics, doing home visits. This is why the job of public health is so rewarding, because I can see the impact on the people I serve every day. At Planned Parenthood, the care that we provide is national, but our health centers are like local health departments. There are over 600 health centers around the country with care provided by our 55 affiliates. In the next year and in coming years, I’ll be going out to visit all of our affiliates in every one of our 50 states.
Some of our health centers provide prenatal care and do home visits for pregnant women, as I do in Baltimore. There are others that have community outreach workers who do education in beauty salons and migrant farms. I mean, there’s really interesting and innovative work that’s being done around the country, and I am so excited to learn about them, and specifically to go in person to visit all of our health centers in support of our frontline staff.
Planned Parenthood’s ex-CEO Cecile Richards has essentially turned the organization into a political powerhouse—for better or worse. In the last four years, what have you learned about the politics of public health and how will it inform how you will take on this new role?
As the health commissioner, it is my job to provide services but it's also my job to fight and advocate to ensure that we have access to these services. That includes [dealing with] legislation. I’ve successfully gotten legislation passed, for example to ensure that kids’ meals have, as their default drink, a healthy drink instead of a soda. I've gotten legislation passed in the state around good-Samaritan laws, and funding for anti-opioid [initiatives] and for other programs, including our Safe Street anti-violence programs and our B’more for Healthy Babies.
What do you have planned for the coming month?
I will be getting up to speed on everything that Planned Parenthood is doing. I will also be spending time with my family, including my husband and our 13-month-old son.
Actually, being a mother has really clarified for me what it is that I should be fighting for, in particular who I should be fighting for. I think about my son and the world that I want him to have. It's a world where women and men have equal rights, including over their own bodies and their own futures, where our society trusts women, where health is understood to be a fundamental human right. And where women's health and reproductive health are seen as mainstream health care—because that's what it is.
People have been asking me about what lessons [I have] for my successor. I have learned that if I don't fight for public health, nobody else will. That's why I feel incredibly privileged to be selected for this role; I know it's a huge challenge ahead but I am so ready for this fight.