Lifelines: A Doctor's Journey in the fight for public health

What compelled you to write Lifelines and what is it about?

Dr. Leana Wen: For years, I’ve wanted to write a book about what public health really does. For far too long, public health has been overlooked and undervalued. My goal was to demonstrate all the good that public health does specifically through the lens of our work in Baltimore to combat the opioid epidemic, improve maternal and child health, and address racism, poverty, and violence as public health crises.

This book is also a memoir that tells my story, which, in its own way, is a story of public health. I came to the U.S. just before I turned eight. Though my parents worked multiple jobs, we struggled to make ends meet. At different points in my childhood, we depended on Medicaid, food stamps, and housing assistance. Public health was our safety net, as it is for so many.

Finally, Lifelines lays out a vision for public health. As we emerge from the pandemic, there are many lessons learned, not only about preventing the next pandemic but the crucial role that public health must have in American and around the world.

How did you go from ER to running Baltimore’s health department?

Becoming a doctor has been my dream for as long as I can remember. I chose emergency medicine because I never wanted to turn patients away because of their insurance status or ability to pay. But it was also in the ER that I saw the failings of our healthcare system. In Lifelines, I tell the story of a father of two young kids who died from a seizure because he couldn’t afford his medications. A boy with asthma who frequented the ER because he and his mother were experiencing homelessness and were in and out of shelters where people around them smoked. It wasn’t just healthcare that my patients needed—it was public health. Becoming the health commissioner of Baltimore, the “Doctor for the city”, was my dream job, the opportunity to finally address these systemic problems.

What were some of the programs you were most proud of leading in Baltimore?

I was very proud of reducing overdose deaths and treating addiction as the disease that it is. These programs, which included issuing a blanket prescription for the entire city for the opioid antidote, naloxone, helped save over 3,000 lives in three years. Another public-private collaboration called B’More for Healthy Babies reduced the infant mortality in Baltimore by 38% in seven years. I also led initiatives to address violence and trauma, like Safe Streets, that hired community violence interrupters to stop gun violence. Another program I started was Vision for Baltimore, a program to get glasses to every child who needed them, in every grade, K-8, right in their school and free of charge.

Lifelines contains some very personal and very painful stories. How did you choose which stories to share?

Some stories I chose because I thought it could help people with a specific need in their lives. I wrote about my mother’s fight with breast cancer for this reason; there are hard lessons we learned in the course of her illness that might assist others with advocating for better care. I chose some other stories because, at one point, they were the cause of great pain and shame. For example, I shared my struggles with infertility, miscarriage, and postpartum depression. I talked about growing up with a severe speech impediment. My hope is to help break down the stigma, shame, and fear that people have about challenging parts of their lived experiences.

You’re the mother of two young children, and you had an intense relationship with your own mother. What are your thoughts on motherhood?

Like many people, I had a tense relationship with my mother growing up. Becoming a mother myself changed everything in my life, including how I approach clinical care, public policy, and being a leader. Work-life balance is an issue that every working parent confronts. I’ve greatly benefited from listening to other women talk about not just what decisions they came to but how they made them, and in Lifelines, I wanted to share my decision-making process, both personal and professional, to help others at inflection points in their lives. 

How has the pandemic you and your family personally?

The most direct impact was that I had a baby during COVID-19, so experienced medical care both as a patient and as a provider. I write in the book about the many ways that I experienced the pandemic: as a physician helping patients to navigate hard decisions about risk; as a health communicator writing for Washington Post and doing on-air commentary for CNN to battle disinformation; and, as so many Americans have, as a caregiver when members of my family became ill from coronavirus.

What have we learned from COVID and what’s your vision for public health?

COVID-19 is a stark daily reminder of the consequences of neglecting public health. It has unveiled underlying health disparities and the laid bare what happens after decades of chronically underfunding local and state public health agencies. 

America must fundamentally reimagine what public health does and its place in our society. This includes changing the perception of public health from the sleepy backwater no one thinks about to the crucial first line of defense that’s an essential part of everyone’s lives. Public health officials must lead a daily campaign to demonstrate the critical role of public health—not only in infection control but in caring for the most vulnerable and helping to level the playing field of inequality. Public health agencies must change how they interact with the public, and the public, in turn, must change how we engage with our renewed commitment to one another.

What’s your advice for people who want to help elevate the work of public health? 

First, tell stories of success. Data provide context; it’s stories that compel action. We must make the invisible hand of public health visible.

Second, meet people where they are. Make the case for public health by starting with what’s most important to that person. No matter if what they care about most is the economy, criminal justice, or education, there is a direct role for public health. We need to get others, including our elected leaders, to talk about, care about, and invest in this work, by making our case forcefully, frequently, and convincingly.

Third, start somewhere. Lifelines offers a vision and a practical guide that’s a call to action. We, all, can and must start somewhere and do whatever we can. Don’t wait, and don’t let perfect be the enemy of the good.