PHILADELPHIA — Physicians and other public health providers shouldn’t let other people tell them what’s “in their lane,” Leana Wen, MD, president of Planned Parenthood, said here Tuesday at a Population Health Colloquium sponsored by Thomas Jefferson University.
“There is no face of public health by definition, because we prevent something from happening,” said Wen, who arrived with a security detail. “Plenty of people have said to our predecessors, ‘Public health has no role in environmental justice, automobile safety, or smoking,’ but where would we be now if our predecessors had listened to them?”
“Nowadays there are plenty of people who say that we have no role to play in violence prevention,” continued Wen, who formerly served as health commissioner for the city of Baltimore. “I’m an ER [emergency room] doctor; I don’t want somebody else telling me that I don’t understand how to treat violence, or gun violence, as a public health issue; it’s something I deal with every day in my work.”
“We had a program in Baltimore called “Safe Streets,” where we hired people recently released from incarceration to walk the streets of the city and interrupt violence, and every year they prevented hundreds of shootings from happening,” she said. “I think about the lives saved and families whose lives are forever changed because of [that] public health intervention, because we refused to stay in our lane.”
Access to legal abortion is the same way, Wen said. She noted that one of her mentors worked in emergency departments in the 1960s and told her there had been an entire ward in every hospital called the “sepsis ward.” Although today people think of sepsis patients as older patients with many comorbidities, “at that time [the ward was] filled with young women who had gone to other countries or farms and garages to have illegal, unsafe abortion care. The reason why I came to my job at Planned Parenthood from public health is that I see this as a public health crisis.”
“We are facing a situation where in less than a year, Roe v. Wade could be overturned,” said Wen, referring to the 1973 Supreme Court decision that legalized abortion. “If that were to happen — and I’m not making a political statement here; I’m giving you my public health assessment of this — we know if Roe is overturned, one in three women of reproductive age — 25 million women — could be living in a state where abortion could be outlawed, banned, and criminalized.”
“And we know the consequence of that — if you’re white and wealthy and privileged, you will find a way to get medical care,” she said. “But if you’re a person of color, a woman with low income, a person who already experiences many disadvantages and barriers to care, you’ll resort to other methods that are unsafe, and we could have thousands of women dying again. How could this issue … be something that’s not in our lane?”
Health “is not just about healthcare we deliver in the hospital; it’s about so much more,” Wen said. “But when we say that and talk about social determinants of health, sometimes we can feel hopeless … Where do we begin? I want to challenge us to go beyond the problems and start thinking about solutions.”
For one thing, “public health is a powerful convener and can move the needle on health outcomes,” she said. For instance, “In 2009, we were facing a situation where Baltimore had one of the worst infant mortality rates in the country … on par with other countries in the middle of civil wars.”
“So we convened over 150 public and private partners — insurers, federally qualified health centers, nonprofits, and clergy — and got together a program that involved home visiting for pregnant women, teaching the ABCs of safe sleep, getting crib deliveries, and postpartum care,” Wen continued. As a result of the program, “we reduced infant mortality by 38% in 7 years.”
During her time as health commissioner, Wen also issued a blanket prescription for the opioid overdose reversal drug naloxone to every resident of the city. “It’s a little bit scary to write your [national provider identifier number] on 620,000 prescriptions … [but] as a result, within 3 years, everyday residents saved 2,800 other lives in our city.”
These examples illustrate why using public health is powerful, she said. “Public health by definition convenes multiple sectors … It has a goal of meeting people where they are, when it comes to home visiting, when it comes to overdose and addiction treatment, and core to public health is the concept of prevention and focusing upstream.”
That’s why public health needs to be the place that makes these connections. “There’s lot of talk right now about maternal mortality,” said Wen. “It’s unbelievable that the rate of women dying in childbirth is higher now than it was 30 years ago … Maternal morality should be a ‘never event.'”
“Pregnant women dying — we should see that as pregnant women as a canary in a coal mine,” she said. “It’s not that pregnant women are dying, it’s that women are not healthy to begin with; women’s health is something that has been stigmatized and siloed in a way that’s not appropriate, leading to poor care for our patients.”
“From a public health and policy lens, I do find it a problem that the same people who want to ban abortion are also cutting access to birth control as well,” she added. Wen said that a very successful teen pregnancy prevention program in Baltimore resulted in a 61% drop in teen pregnancies in 15 years, but funding for it was cut by the Trump administration. “That doesn’t make sense for something that was highly effective.”
“If we don’t make these connections… who else is going to?” she concluded. “We have to define our lane instead of letting others define it for us … We must lead with urgency, compassion and action because that’s what our patients and community request of us.”
Source: MedicalNewsToday.com
