Biden’s New Assistant Secretary Of Health On Protecting Trans Youth

JOHN DANKOSKY: This is Science Friday. I’m John Dankosky, in for Ira Flatow. This next conversation comes from an interview that Ira recorded earlier this month with Dr. Rachel Levine, who was appointed by President Joe Biden to be Assistant Secretary of Health for the Department of Health and Human Services.

IRA FLATOW: The American health care system is facing one of the most challenging periods in its existence, combating COVID-19, the opioid crisis, and reckoning with the historical inequities that have earned mistrust from communities of color. As we’ve seen over the last year, COVID-19 has laid bare the challenges that the American health care system faces. Black and Latino communities were hit harder by the virus and have seen lower vaccination rates compared to white, Asian, and Native American communities.

The opioid crisis is still ongoing, and mental health has been severely impacted by the pandemic. And now a wave of anti-trans health care legislation, pushed by Republican lawmakers, is sweeping through multiple statehouses, making it harder to access lifesaving health care for LGBTQ youth and adults, who already face higher rates of suicide and mental health issues.

My next guest, Dr. Rachel Levine, is taking aim at these issues through the lens of health equity. She’s Assistant Secretary of Health for the Department of Health and Human Services. Previously served as Pennsylvania’s Physician General, mainly assisting with that state’s opioid crisis. She’s also the highest ranking, openly transgender person to have ever served in the federal government. Dr. Levine, welcome to Science Friday.

RACHEL LEVINE: Well, thank you very much for inviting me. I’m very pleased to be here.

IRA FLATOW: Nice to have you. You’ve said that health equity is one of your top priorities. I know we’re not in a perfect world. But if we were, what does health equity look like to you?

RACHEL LEVINE: Well, health equity, at its heart, means that everyone has access to health care. No matter where they are, no matter who they love, no matter their race, or their ethnicity, or their gender, or their age, is that health care is a right, and everybody has access to the same health care.

IRA FLATOW: And I mentioned the widening health inequities revealed by the pandemic in my introduction. How else has the pandemic made health inequities worse?

RACHEL LEVINE: You are entirely correct. If you think of health disparities as an iceberg, we see the entire iceberg now. Before, we just saw the tip. But COVID-19 has exposed the depth of health disparities and health inequities that we have in the United States. And our work is certainly cut out for us in terms of addressing that issue.

IRA FLATOW: When you say your work is cut out for us, especially you, who is in that position, give me a roadmap. What do you see as that work plan going forward?

RACHEL LEVINE: Sure. Well, there are a number of different programs that we have to address health equity. One is that there is a Health and Human Services Health Disparities Council that has just been reformed by the secretary of health. I’m very pleased to co-chair that council. And we’re going to be looking at policy changes across the agency, in terms of making sure that health equity crosscuts everything that we do at HHS.

In addition, I’m on the COVID-19 Health Equity Task Force, where we’re making sure that health equity is the linchpin of everything that we’re doing in terms of COVID-19. So we have a number of different programs, policies, and task force to address this issue.

IRA FLATOW: Do you consider health equity to be personal to you?

RACHEL LEVINE: Well, I think that health care is a right. And I think, as I was saying, that everybody deserves access to quality health care. But you are correct that one of the communities that has been significantly impacted by these health disparities is the LGBTQ community. So out of the Health Disparities Council work, we’re going to have a group looking at LGBTQ policy changes across the agency, as well.

IRA FLATOW: We did a segment on gender-affirming health care a couple of months ago, and we heard from one of our trans listeners about the difficulties of getting top surgery. Let me just reiterate what was said– to get approval for the surgery, insurance required a letter that they had to get from a mental health professional that basically diagnosed them with gender dysphoria. And that same letter isn’t required for cisgender women who want to get cosmetic breast augmentation surgery. What can your office do to help end practices like this, which treat trans patients differently than cisgender patients?

RACHEL LEVINE: Well, one of the important policy changes that has actually already occurred at the Department of Health and Human Services was in the Office of Civil Liberties. So they are– they already made an important change in terms of their interpretation of the Affordable Care Act that you cannot discriminate against anyone in terms of sex. That includes sexual orientation and gender identity. And so we’re going to be looking to apply that across the department in terms of the Affordable Care Act, and in terms of other health care policies as well.

Now, there are standards of care for the treatment of transgender individuals. Those standards of care are established by an international organization called WPATH. That’s the World Professional Association of Transgender Health. There is a US arm called USPATH. I am a member of WPATH and USPATH.

And they are looking to revise their standards of care, which were done almost 10 years ago, to revise them and advance them. And so we’ll see what the organization says about the standard of care about having psychological evaluation before having gender-affirming surgery.

IRA FLATOW: Yet so much anti-trans health care legislation is making its way through various statehouses, pushed by Republican lawmakers. What are the stakes for trans youth and adults if more of these bills pass?

RACHEL LEVINE: Well, I think these bills are extremely difficult, extremely challenging, and they target particularly vulnerable transgender youth. Transgender youth are already at risk of bullying. They’re at risk of discrimination and harassment. And these bills seek to limit their ability to do certain school activities and to participate in sports. And the most egregious of these bills are actually limiting the ability of trans youth to access gender-affirming care by specialists at children’s hospitals in their state.

So these are very, very difficult, and I want to work in my capacity as the assistant secretary for health, both from raising awareness point of view, from an advocacy point of view, as well as internally, within the Department of Health and Human Services, on policy changes to try to address these issues.

IRA FLATOW: Now, I know that you have your experience, a lot of experience, specializing in pediatrics. What do you personally say to these kids about working with them?

RACHEL LEVINE: You are correct. My field is pediatrics and, specifically, my specialty is adolescent medicine. And within adolescent medicine at the Penn State Hershey Medical Center and the Penn State College of Medicine, I saw many youth and young adults that were trans for evaluation and for gender-affirming medical treatment. Again, I think these youth need to be nurtured. They need to be supported. They need to be advocated for. We need to work with them and their parents, and in their families, in terms of helping them achieve the treatment and care that they deserve.

IRA FLATOW: Is there any way the federal government can fight back against these anti-trans health care legislations in these various states?

RACHEL LEVINE: Well, one way that the federal government can address that would be passage of the Equality Act. And so the president has been a strong supporter of the Equality Act in Congress, and that would be a direct way that the federal government could address these very disappointing, challenging, and, in some cases, egregious bills. In terms of my job, again, I’m going to be advocating publicly as I’m doing now and have done countless times, especially during Pride Month this month, but also working on policy changes within the Department of Health and Human Services.

IRA FLATOW: When you served as Pennsylvania’s physician general, you led an effort to allow pharmacies to dispense a lifesaving overdose drug called Naloxone in response to the state’s opioid crisis. You’ve said that the drug has saved nearly 1,000 lives in that state since. How do you want to scale up your work on combating the opioid crisis on a federal level?

RACHEL LEVINE: Yeah, so, as the physician general, and then the secretary of health in Pennsylvania, we did concentrate on the opioid crisis in regards to prevention, in regards to rescue with Naloxone, as you mentioned, and then with advancing treatment, particularly for those suffering from the disease of addiction to opioids, medication for opioid use disorder, and then leading to recovery. So I want to take that experience and bring it to my work in the federal government.

We have a new Behavioral Health Coordinating Council that the secretary has established. I’ll be co-chairing that with the assistant secretary for mental health and substance use disorders. And we want to look at all aspects of the mental health challenges that we face, as well as, particularly, substance use disorders, opioid use disorder, and the risk for overdoses.

IRA FLATOW: What will be the signs, the metrics, that you can use that your office is making a measurable impact in all these things that you’d like to do?

RACHEL LEVINE: Well, we do have to look at outcomes about everything that we’re doing. For opioid use disorder, we need to look at opioid overdoses, opioid deaths, the use of other substances, such as stimulants which have recently increased. And then access to evidence-based treatment for substance use disorders, as well as mental health. Health equity, as well. We have to have outcomes so that we can show that we are making progress.

IRA FLATOW: Is there a target number, a reduction level, that you can point to on any one of these issues?

RACHEL LEVINE: Well, I can tell you that the president has set a very ambitious number of 70% of adults having at least, in the United States, having at least one dose of the vaccine. We are currently at 63%, and the president has said July 4th, we should be 70%. So that’s the immediate target that we’re working on. We need to have a national action plan this month to accomplish that goal and to accomplish that metric.

IRA FLATOW: And what about for the opioid crisis? A reduction to what?

RACHEL LEVINE: Well, I don’t have a specific metric for you. What I can say is that, from September 2019 to September 2020, which is some of our latest data, we had over 90,000 overdose deaths in the United States. That’s the most ever. So we need to see progress with that number, and we will be setting metrics.

Actually, the Assistant Secretary for Mental Health and Substance Use Disorders has not been confirmed yet by the Senate, so she’s not even here yet. But when she is, we’ll be getting together with our Behavioral Health Coordinating Council, and we will set metrics.

IRA FLATOW: So how would you compare your job that you have now to the previous ones you had in Pennsylvania doing health care?

RACHEL LEVINE: Well, you know, I’ve always felt very gratified in my career that I was helping people. As an academic medicine physician at Penn State, basically I would see children and teenagers and young adults, and I would try to help them. I would teach students about how to help people. I would develop programs with clinical research and administration, again, to help people. In Pennsylvania, as physician general and secretary, I tried to help people with a broader brush from a public health perspective. And now, I’m doing that nationally.

IRA FLATOW: And so you’ve got a lot on your plate, and it sounds like you’re very enthusiastic about this, considering the challenges, the mountain of challenges, facing you.

RACHEL LEVINE: Well, I’m a positive and optimistic person. And I think that under President Biden’s leadership and his administration, that we are going to make progress on all of these fronts. Now at the same time, I’m certainly realistic to the challenges ahead of us, but I feel that we are up to those challenges.

IRA FLATOW: This is Science Friday from WNYC Studios. In case you’re just joining us, I’m talking with Dr. Rachel Levine, Assistant Secretary of Health for the Department of Health and Human Services. I know the president has said that he wants to expand the Affordable Care Act, and that’s how he’s looking at getting more health care to everyone. But wouldn’t it make more sense to make health care affordable to everyone with Medicare for all or a single-payer option?

RACHEL LEVINE: Well, lots of challenges there. But the president strongly feels that we need to build upon the amazing progress that was made with the Affordable Care Act, the expansion of Medicaid. In Pennsylvania when Governor Wolf, the governor of Pennsylvania that I served, expanded Medicaid in 2015, we added 750,000 people who now had quality health care. So I think through the president’s plans, and actions through Congress, that we can accomplish those goals.

IRA FLATOW: Does he listen to you, President Biden?

RACHEL LEVINE: Well, I’ve been here less than two months. I advise the Secretary of Health and the administration in terms of medical issues and public health issues, and I do very much look forward to meeting the president personally in my time here.

IRA FLATOW: Let’s talk about vaccine hesitancy and refusal, a big issue at the moment for COVID-19. The US just passed a milestone that over 50% of adults are fully vaccinated. I think that’s amazing. But there are still many who are hesitant to take the vaccine, whether they don’t believe in its effectiveness, or if they’re from communities of color that have been historically mistreated by the medical system. When will we take it up to that next level, do you think?

RACHEL LEVINE: Well, we are working this summer to take it up to the next level. As you know, teens, 12 through 18, are now eligible to receive one vaccine, the Pfizer vaccine. Hopefully in the next month or more, we’ll also be able to have the Moderna vaccine for youth as well. And then all three vaccines are available to adults.

So we’re working to up our game now, and to advance vaccination distribution and administration right now. But you’re right– we have to work on two fronts now. We have to work on vaccine hesitancy and then vaccine equity to make sure that everybody has the opportunity to get these safe and effective vaccinations.

IRA FLATOW: As you said, you’ve only been in your job about two months. How do you like it so far?

RACHEL LEVINE: Well, it is very exciting. I am so grateful to President Biden for nominating me. I am grateful to the Senate for confirming me with a bipartisan vote. And, you know, I am dedicated to the public health of the nation and will do everything I can to advance that.

IRA FLATOW: Well, you’re a very strong spokesperson and willing to go out into the public and come on our show. And, as you say, that’s what you think your job is– is to go around and be visible.

RACHEL LEVINE: That’s exactly correct. I mean, I have many different aspects of my job, but one is advocacy to the public through great shows like yours about all of these issues– about the safety and effectiveness of the vaccines, about the importance in terms of mental health and dealing with the opioid crisis, and in terms of health equity, climate change– many, many health issues to deal with.

IRA FLATOW: Yeah, climate change– we never even got into that as an issue. Although it is a big health issue, is it not?

RACHEL LEVINE: It is. And actually, under the president’s executive order, we will be starting a new office within my office of the assistant secretary of Health and the Health and Human Services on climate change–

IRA FLATOW: Is that right?

RACHEL LEVINE: –and health equity. Yup, we’re going to be starting that office now.

IRA FLATOW: Because you believe it is such a– it’s screaming for attention.

RACHEL LEVINE: That’s exactly correct. This is a priority for President Biden, the Secretary Beccera, and myself.

IRA FLATOW: Well, we’ll keep track of that. And thank you for taking time to be with us today.

RACHEL LEVINE: My pleasure. It was great to be here.

IRA FLATOW: Dr. Rachel Levine, Assistant Secretary of Health for the Department of Health and Human Services.

JOHN DANKOSKY: That was Ira Flatow in an interview recorded earlier this month. After the break, what can our history of partnering with animals tell us about how we might partner with robots? Author and roboticist Kate Darling is next. This is Science Friday from WNYC Studios.

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