Living for the City

It’s late August and Dr. Leana Wen is standing underneath the soaring dome of City Hall, a bank of cameras pointed at her as she leads a news conference to mark National Overdose Awareness Day.

As Baltimore’s health commissioner, substance abuse and addiction are among her top priorities, not to mention issues of national importance. Last year, more Baltimoreans died from overdoses (393) than from homicides (344). So she’s here—flanked by Senator Ben Cardin, Congressman John Sarbanes, Police Commissioner Kevin Davis, Fire Chief Niles Ford, and others—to sound the alarm about the nation’s opioid overdose epidemic and tout the city’s innovative response to the crisis.

There’s much to tout. In October 2015, Wen became the first health commissioner in Maryland to issue a blanket prescription allowing all Baltimoreans to obtain naloxone, a medication that can reverse an in-progress opioid overdose. The bold move attracted national attention and helped earn her a spot on a panel with President Barack Obama at the National Rx Drug Abuse and Heroin Summit in March.

The city Health Department is working now to train people to administer the remedy, and Wen makes sure to highlight the initiative’s progress in her remarks.

“We all trained over 14,000 people as of last month. Fourteen thousand people on how to save a life from overdose,” she reiterates, her voice echoing off the marble floors and columns of the chamber.

“Even more exciting than that,” she continues, “we have saved . . . 400 residents and citizens from overdose. Four hundred individuals who, otherwise, would have died.”

After her remarks, Sen. Cardin speaks, then Rep. Sarbanes, Commissioner Davis, and Chief Ford, each one singling out Wen’s leadership for special praise. Finally, as the last speaker—Kathy Westcoat of Behavioral Health System Baltimore—is coming to the microphone, two of Wen’s staffers—public information officer Sean Naron and communications director Michelle Mendes—catch their boss’s eye. She gives them a quizzical look and hurries over to them. After some hushed discussion, Wen and her staff slip away down a hallway, a camera crew trailing behind.

It all looks rather curious. Has she just been warned of a bioterrorism attack? A suspected case of Ebola or Zika? Maybe there has been an emergency and she has to go door-to-door, checking that residents have sufficient supplies of their vital medications, like she did last year after the riots? Wen’s purview as health commissioner is so vast that any of these scenarios are possible.

But it is nothing so dire—in fact, it’s good news. Turns out, the Food and Drug Administration has agreed to put black box warnings on benzodiazepines, a class of drugs commonly used to treat anxiety, and opioid painkillers, warning of the potentially fatal effects of mixing them. Earlier this year, Wen led a coalition of public health officials asking the FDA to add its sternest warning label to the drugs. Now that FDA Commissioner Robert Califf has agreed, he wants Wen to sit in on the conference call to reporters. And the camera crew is catching it all for a documentary about millennials making a difference.

Such is life for the 33-year-old Wen, Baltimore’s youngest-ever health commissioner and perhaps the nation’s brightest light in the field of public health.

“She’s a whippersnapper,” jokes Peter Beilenson, the city’s health commissioner from 1992 to 2005. “She’s very much a go-getter and a dynamo, and the city desperately needs that.”

Even before she was appointed in January 2015 to lead the city’s 1,000-employee-strong Health Department, Wen was something of a media darling. She gave frequent TED Talks. She wrote a critically acclaimed book (When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests) partly inspired by her time as a caregiver during her mother’s eight-year battle with breast cancer. And she was a regular commentator on medical issues for print, online, radio, and TV outlets.

But after the unrest following the death of Freddie Gray exposed the racial and socio-economic disparities in the city, Wen became—both locally and nationally—an even more influential figure, someone who could explain to believers and skeptics alike why the fissures in our society exist, how they got so big, and what we could do about them.

“After the unrest, we saw [an] opportunity to address these longstanding issues,” Wen says, sitting in her tidy office at the Health Department’s Jonestown headquarters one late summer morning. “It happened because of systemic racism, because of structural inequities, because of our policies of mass incarceration and discrimination—and all of those issues we believe are tied to health.”

This is a central tenant of public health: everything is connected. As the self-described “chief marketer for health in the city,” Wen spends a lot of her time helping people make those connections.

“We can’t talk about health without speaking about education and at the same time we can’t talk about education without speaking about glasses for our children and healthy babies and lead poisoning,” she says, now on a roll. “And then we can’t talk about violence without talking about addiction and mental health. . . . Whatever issue people care about, we then bring it back to why this is a public health issue.”

“She’s very much a go-getter and a dynamo, and the city desperately needs that.”

Wen was born in Shanghai, China, in January 1983. Her parents were political dissidents. She was 8 years old when they were granted political asylum in the U.S., settling first in Utah, and then, later, in a series of low-income communities in Southern California. There, she witnessed firsthand how poverty contributes to poor health.

“I saw neighbors go for years without access to care for their diabetes and then end up dying from it,” she recalls. “I saw children die from asthma, from other preventable illnesses, because they didn’t have access to health care for any number of reasons, whether it was cost or fear or stigma.”

Wen resolved to become a doctor, so she could address these glaring inequities. There was only one problem.

“I just didn’t know that I could make it,” she says. “I mean it sounded totally nuts to want to be a doctor when you don’t even know a doctor!”

In many ways, the deck was stacked against her: She was an immigrant. Her family was poor. And she suffered a severe stutter that still occasionally interrupts her otherwise perfect diction.

But Wen is not one to take no for an answer. Behind her impeccable manners, self-deprecating sense of humor, and sweet, dimpled smile, there is a formidable steeliness.

“I come from a family of fighters,” she says. “My father was imprisoned in China for years for speaking out against the government. . . . My grandparents were also activists. I come from a family that has a tradition of saying we cannot sit back and watch things happen to us. . . . We believe in shaping the course of our own future and of fighting every step of the way—for the right things.”

This being the family’s tradition, Wen applied her considerable intellect and, working longer and harder than most would dare, achieved. In 1996, at age 13, she enrolled at California State University, Los Angeles, graduating five years later with a degree in biochemistry (summa cum laude, thank you very much). From there, she went to med school at Washington University in St. Louis.

Reading Bill Clinton’s autobiography, My Life, helped with her next step.

“I was in medical school and saw these other issues of social determinism—I didn’t even know the term public health at the time. I just knew that I wanted to do something that addressed the root causes of why people got sick,” Wen explains. “So I read Bill Clinton’s book, and I read about his experience as a Rhodes Scholar and how he went to England and met all these other people who got involved with policy and politics. And I was like, ‘Okay! That’s what I should do.’”

So, she did. In 2007, Wen left for a two-year stint as a Rhodes Scholar in Oxford, England. It was as life-changing as she had hoped.

As a discipline, public health bridges the gap between medical science and public policy. For instance, diagnosing and treating cardiovascular disease is the job of doctors, but public health professionals seek to understand why, for instance, African Americans are about 30 percent more likely to die from heart disease than non-Hispanic whites. What are the cultural, societal, and/or biological factors that cause this? And, just as importantly, how can they be addressed? By necessity, it is complex and very challenging. Wen loved it.

“I believe that public health is the best way for us to level the playing field . . . that it’s a powerful social justice tool that allows us to get at all these other issues,” she says.

Wen’s time in England was life-changing for personal reasons, too.

“I met a lot of my mentors through Rhodes,” she notes. These include former Mayor Kurt Schmoke and former NAACP President Ben Jealous. She also met her husband, South African national Sebastian Walker, who was then working in England.

“My life totally changed as a result of reading a book . . . which sounds totally crazy!” she says with a laugh.

Back in the U.S., Wen started a fellowship at Harvard Medical School during which she worked in the ERs at Brigham and Women’s Hospital and Massachusetts General Hospital. While at Mass General, she treated survivors of the Boston Marathon bombings, which left her with nightmares for weeks.

“I am glad I was able to help,” Wen told USA Today at the time. “I wish I could have helped more. But I wish I hadn’t seen it.”

After Boston, she went to Washington, D.C., where she continued as an emergency physician, this time at The George Washington University Hospital. She says she liked the immediacy of ER work, but yearned to address what she calls “the larger picture.”

“This is the job I’ve always wanted,” she says. “I never could have articulated that this is the job I’ve always wanted, but I love the city, I love the people, I love being hands on. I love seeing the outcome of our work in such a visceral way.”

The Baltimore City Health Department has the distinction of being the oldest continuously operating health department in the country and, since its founding in the 1790s, has accrued an almost laughably disparate slate of responsibilities. These include animal control, restaurant inspections, emergency preparedness and response, STD/HIV testing, mother and infant health, youth violence prevention, and, of course, disease management.

Another interesting feature of the department is its funding structure. In contrast to most municipal agencies, only approximately 20 percent of the Health Department’s budget is supplied by the city. The rest comes from state and federal grants, nonprofits, and support from businesses and individuals. This results in a department that Wen says “functions at the pace, and with the principles, of a startup.”

Despite—or maybe because of—these unusual characteristics, the department has a history of attracting dynamic leaders, many of whom have created influential programs that have become national models.

There’s B’more for Healthy Babies, a motherhood preparedness program that has lowered the city’s infant mortality rate by 38 percent since 2009, when it was the nation’s fourth worst. Then there is Safe Streets, which employs community members—some of them ex-offenders—to walk the streets in volatile neighborhoods and “interrupt” escalating confrontations before they can turn violent.

Wen wants to make her mark, too.

In her first 18 months, her priorities have been addiction/mental health, youth health and wellness, and providing care for the most vulnerable/reducing disparities—worthy initiatives certainly, but perhaps lacking a certain unifying vision.

Then, in late August, Wen announced Healthy Baltimore 2020, an ambitious goal to reduce health disparities in the city by 50 percent over the next 10 years. She calls it Baltimore’s “moon shot,” a reference to John F. Kennedy’s 1961 speech declaring his intention to put an American on the moon by the end of the decade.

Wen certainly has her work cut out for her. Despite improvements in recent years, health disparities in Baltimore remain some of the worst in the nation, often breaking down along racial and economic lines.

“One of my predecessors did say to me when taking this job that the only limit to what you can do is your own ability to stay awake,” she says, not really kidding. “It’s challenging when you know that there are so many issues that need to be addressed, and when you know that there’s so much that can be done immediately.”

Paradoxically, after almost two years, Wen now realizes she can probably accomplish more by driving herself—and her staff—just a little bit less.

“We all need to take care of ourselves first and take care of our families first because, otherwise, we’re not able to care for our city,” she says. “And if we’re trying to have Baltimore City be the model of well-being for the country, maybe it’s an important place to start with well-being for ourselves, too.”

To that end, Wen and her husband, who live in Fells Point, have taken up cooking. A former competitive ballroom dancer, she’s also looking to reincorporate dance into her routine.

“I’m trying to do more fun things, things that I really love,” she says, adding that she rejects the term work-life balance because it sets up what, for her, is a false dichotomy.

“I mean, I love my work, and I also live in the community that I serve,” she explains. “It’s such a fluid and dynamic process that it’s difficult to say, ‘This is where my work ends and my life begins.’ Everywhere I go, I see all the residents in Baltimore as my patients, and so, where do you stop?”

Given Wen’s youth and ambition, it is only natural to wonder what will happen if and when Washington calls.

Beilenson, who meets with Wen for breakfast or lunch every few months, vouches for her commitment—with one caveat.

“I also got asked [if I was going to stay] in the first couple years,” says Beilenson, who now runs Evergreen Health, a health insurance startup headquartered in Hampden. “I stayed because I really grew to care about Baltimore, and it’s a great place to be a health commissioner because, frankly, there are so many issues to work on.

“But you know, I also believe in serendipity,” he continues. “I think, certainly, it’s her intention to stay but, for example, if the Clinton administration came calling to have her be head of [Centers for Medicare and Medicaid Services] or [Centers for Disease Control and Prevention]—if I were her, I wouldn’t turn it down.”

Wen doesn’t seem all that interested in talking about hypothetical job offers though.

“I am all in on Baltimore,” she affirms. “My family and I have moved here. We are settling here. I think it would be disingenuous to ask other people to invest in the city if I don’t invest in the city. I want everyone else to be all in on Baltimore, so I’m all in on the city, too.”