Admiral Rachel L. Levine, MD, is a pediatrician and adolescent medicine specialist whose clinical work focuses on the intersection of mental and physical health. She brings a strong commitment to equity and inclusion to her role as the 17th Assistant Secretary for Health of the U.S. Department of Health and Human Services.
We had the privilege of speaking with her ahead of the 2024 election to discuss a wide range of public health issues affecting children, including vaccinations, health disparities, hunger, nutrition and whole-child health.
Guest:
Admiral Rachel L. Levine, MD, Assistant Secretary for Health and Head of the U.S. Public Health Service Commissioned Corps. U.S. Department of Health and Human Services
Host/Producer: Carol Vassar
Announcer:
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Carol Vassar, podcast host/producer:
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Admiral Rachel L. Levine is a pediatrician and adolescent medicine specialist whose clinical focus has been on the intersection between mental and physical health. She’s also a person with a strong sense of equity and inclusion, which she brings to her current role as the 17th Assistant Secretary of Health for the U.S. Department of Health and Human Services, HHS.
Before her appointment to this role in 2021, Admiral Levine was Physician General and Secretary of Health for the State of Pennsylvania, where she addressed COVID-19, the opioid crisis, behavioral health, and other public health challenges. We had the honor and privilege of speaking with her just before the 2024 election to talk about a wide variety of public health concerns that affect children, including vaccinations, health disparities, hunger and nutrition, and the concept of whole child health.
But we began our conversation with an overview of her role as Assistant Secretary of Health for HHS and what exactly that entails. Here’s Admiral Rachel Levine.
Admiral Rachel Levine, Assistant Secretary for Health, U.S. Department of Health & Human Services (HHS):
Well, thank you very much. There are three lines of effort for the Assistant Secretary for Health. One is the Public Health Service Commission Corps. So I have the honor of leading the Public Health Service Commission Corps, with the Surgeon General, and that includes 5,500 dedicated medical and public health officers that serve our nation. And so that is one of our big responsibilities.
The second is that we have approximately 10 offices that report to my office, and that includes, for example, our Office of Minority Health, Office on Women’s Health, Infectious Disease HIV Policy, Disease Prevention Health Promotion, Office of Population Affairs and more. So all of those offices are run through my office and with critical public health priorities.
And the third is a little bit more subjective. We are a staff division of the Secretary, of the Secretary’s office, and the Secretary has called us the connective tissue of the department. Now, personally, I was hoping for the beating heart, but we got connective tissue and that’s okay. So we serve as an expert consultant and a convener to pull together initiatives across the department and sometimes across the government. Some examples would include long COVID, syphilis, climate change and health, environmental justice, and more. So those are the three lines of effort of my office.
Carol Vassar, podcast host/producer:
And as you talk about those three lines, what are some of the key priorities that you have identified during your tenure as Assistant Secretary of Health?
Admiral Rachel Levine, Assistant Secretary for Health, U.S. Department of Health & Human Services (HHS):
The framework of our priorities could be described in two words, health equity. So under Secretary Becerra, health equity is fundamental to all of our work at the Department of Health and Human Services. And so a number of priorities within that greater effort would include our office about Climate Change and Health equity. And we have a new Office of Climate Change and Health Equity and it’s sister Office of Environmental Justice. Another would include food and nutrition security and food is medicine, with that health equity lens.
Dealing with those healthcare disparities is fundamental to all of our work at HHS and those healthcare disparities were made worse, exacerbated by the COVID-19 pandemic. The acute phase of the COVID-19 pandemic showed us the depth and breadth of the health disparities that exist. Our vision at OASH, the Office of the Assistant Secretary for Health, it is healthy people, healthy communities, and a healthy nation for all. The program of Healthy People 2030, which is in my portfolio, defines health equity as the attainment of the highest levels of health for all people. And I firmly believe that we have not made true progress unless we have all made progress.
Achieving health equity requires valuing everyone equally, but with focused attention to past and contemporary injustices and the social determinants of health to work to eliminate those health disparities in health and healthcare. And we have to pay particular attention to, for example, communities of color, the Black African-American community, the Hispanic Latino community, the American Indian Alaskan native community. And then finally LGBTQI plus health equity has been extremely important for us. And so we are working with that every day in our Office of Climate Change and Health Equity, our Office of Population Affairs, our Office of Long COVID, and its issues in terms of health equity, food and nutrition security and more.
Carol Vassar, podcast host/producer:
As a physician, I don’t think we’ve mentioned that you’re a physician, you have a pretty unique vantage point into some of the challenges of our healthcare system. From your perspective, the drivers of healthcare workforce shortages, what are they and particularly in pediatrics, and what can we do from a policy perspective to address them?
Admiral Rachel Levine, Assistant Secretary for Health, U.S. Department of Health & Human Services (HHS):
Well, there are healthcare shortages, particularly for primary care physicians, and that would include pediatrics but also family medicine and general internal medicine. We have significant healthcare shortages in terms of mental health workers, really from peer counselors to child and adolescent psychiatrists and more. And all of that has been exacerbated, made worse, by the acute phase of the COVID-19 pandemic. Other drivers, of course, include the reimbursement system. It is that primary care physicians, mental health workers tend not to sometimes have the income that other more specialized services in medicine could, such as surgical specialties and different specialties in internal medicine.
And so there’s a lot of work being done to help those healthcare work shortages, particularly through HRSA, the Health Resources Services Administration. And that includes recruitment, loan repayment, and more. Now, our Surgeon General has talked about the mental health challenges of healthcare workers, and there was a Surgeon General’s advisory addressing health worker burnout a number of years ago, which lays out recommendations for a whole-of-society approach to deal with those challenges.
Carol Vassar, podcast host/producer:
I want to turn to the idea of whole child health and some of the policy related to that. And by whole child health, I mean the factors that help contribute to children’s physical, mental, behavioral, social, developmental health, and outcomes. A great deal of healthcare providers do promote whole child health. At Nemours, we call it going well beyond medicine. When you think about that concept of whole child health, what does it mean to you?
Admiral Rachel Levine, Assistant Secretary for Health, U.S. Department of Health & Human Services (HHS):
Holistic thinking, I think, is very important in whole child health. Now remember, I’m a pediatrician and an adolescent medicine subspecialist, and I do think that we have to think of the whole child and the family and community because it all relates together.
Well, that brings us to the social determinants of health, those social factors that influence our health that go beyond traditional medicine. That includes housing, it includes transportation, it includes economic opportunity for families, it includes environmental justice and climate justice. It includes nutrition. All of those different factors, education and more, really all relate to health. And so we need to think of all of those factors as we think of children’s health.
We have a new program called People and Places Thriving. It used to be called Equitable Long-Term Recovery and Resilience or ELTRR. You have to have an acronym in the federal government, but we have renamed that People and Places Thriving. And that is to me, the evolution of the social determinants of health, looking at what we call the vital conditions of health well-being and justice. And it’s really quite visionary and it’s an operational roadmap to build connections and support people and families in their communities.
Carol Vassar, podcast host/producer:
What do you think are some of the best approaches or most promising approaches that healthcare providers can pursue to make certain that children reach their full potential?
Admiral Rachel Levine, Assistant Secretary for Health, U.S. Department of Health & Human Services (HHS):
Well, I think that we do need to think holistically as we’ve been discussing and to be thinking of those social determinants of health or with the new foundation, the vital conditions. So not only just their physical health, but also their mental health. My whole career has been focused on that intersection between physical and mental health. But also asking parents and families about housing, about transportation, about education, asking about nutrition, their local environment and all of those different factors, and then putting together a treatment plan that includes physical health and mental health, but then those other social factors. I think that that’s very important for pediatricians and pediatric programs to be thinking about.
Carol Vassar, podcast host/producer:
You have been and continue to be an advocate for vaccinations. Now, I thought it was very prescient that you tweeted in 2019 a New York Times article supporting an op-ed written by three of your peers that had to do with making certain that children were fully vaccinated. That was a year before COVID-19 hit our nation, hit our world, and it laid out the evidence-based case for vaccinations.COVID laid bare the divide between those who agree with the scientific evidence and those who don’t. Long way of asking, as a nation, have we made any headway in our vaccination efforts and how can we take some of the communications lessons learned from COVID to better protect our children, our youth, against diseases for which there are safe and effective vaccines?
Admiral Rachel Levine, Assistant Secretary for Health, U.S. Department of Health & Human Services (HHS):
Well, as a pediatrician, I know that vaccinations are really one of the public health victories of the 20th and 21st century. We have immunizations against so many childhood illnesses which had in the past been devastating. That includes, of course, polio, tetanus, diphtheria, whooping cough, although we’re still seeing some whooping cough. I’ll give you another illness that people don’t think about, Hib, or Haemophilus influenza type b, which is a bacteria that when I was in training back in the ’80s would cause children to have pneumonia, meningitis, osteomyelitis and sepsis and cause many deaths. We’d never see that now because of that vaccine.
But because of misinformation and overt disinformation, we are seeing challenges in terms of our vaccination rates and challenges in terms of vaccine preventable illnesses. And that includes, of course, the very safe and effective COVID-19 vaccines, as well as we started our annual influenza vaccine campaign. Now on October 17th, the CDC released data that from the 2019 and ’20 school year to the 2022-’23 school year, national kindergarten coverage about state required vaccinations actually declined somewhat. In the ’23-’24 school year, coverage has declined in a number of different vaccinations. And so we really need to communicate as pediatricians, as primary care physicians, and as public health experts about the safety and the effectiveness of our childhood vaccines, of the COVID-19 vaccine and influenza vaccine, to work on our communications, and to get our vaccinations back up. And we have to find new ways to dispel misinformation and to work against even overt disinformation. We are absolutely committed to that at the Department of Health and Human Services.
Carol Vassar, podcast host/producer:
I want to turn attention to the youth mental health crisis. It’s received a lot of attention over the past few years. Tell us what you see as areas of progress as well as work that we still need to do as a nation.
Admiral Rachel Levine, Assistant Secretary for Health, U.S. Department of Health & Human Services (HHS):
So again, you know that intersection between physical health and mental health for children and adolescents has been where I have worked for many years in my career, both in academic medicine and as a pediatrician and adolescent medicine specialist at the Penn State College of Medicine, and then as the Physician General and then Secretary of Health of Pennsylvania, and now in this role as the Assistant Secretary for Health. We have to continue to work past the stigma regarding mental health. We have to continue to address the shortage of mental health professionals, work towards equity in terms of insurance coverage, and really work across public health in federal, state, and local public health to address these mental health challenges and work with pediatricians and child and adolescent psychiatrists and more.
Our Surgeon General has highlighted the mental health crisis of youth and adolescents, which was another issue that was exacerbated by the acute phase of the COVID-19 pandemic. So we have been doing that across HHS. We have a behavioral health coordinating council, which I co-chair with the assistant secretary for SAMHSA. And we have a specific subcommittee looking at youth mental health, another subcommittee looking at that intersection of physical and mental health. And we have some programs such as the Children and Youth Resilience Challenge through my office, national guidelines for child and youth behavioral healthcare through SAMHSA. CMS, the Center for Medicare and Medicaid Services has released delivering services in school-based settings, a comprehensive guide for Medicaid. We’ve been working with the Department of Education and more. And so we are making progress, but we still have a lot of work to do.
Carol Vassar, podcast host/producer:
One more topic I want to talk about, and that is the fact that in September we marked the two-year anniversary of the White House Conference on Nutrition, Hunger, and Health. Now, Nemours Children’s Health recently announced the completion of its commitment to help address food insecurity and other social drivers of health. Looking across the many commitments made on that day two years ago, can you update us on some of the things that we’ve learned in these years and some of the bright spots emerging from the conference?
Admiral Rachel Levine, Assistant Secretary for Health, U.S. Department of Health & Human Services (HHS):
Absolutely. The White House Conference on Nutrition, Hunger, and Health was the first White House conference on nutrition in about 60 years. So it was long time coming, and our office was pleased to help organize that. And it really emphasized the challenges of food and nutrition security as well as the critical aspects of nutrition in terms of health. And really a concept of food is medicine.
And so we have had a Food Is Medicine Initiative through my office and our Office of Disease Prevention Health Promotion. We have actually just released in the last number of weeks a Food is Medicine and Nutrition Toolkit. You can visit health.gov/foodismedicine, all one word, health.gov/foodismedicine, to tap into this new resource. And we are working on the 2025 Nutrition Guidelines for America, the Physical Guidelines for America, and we work closely with the President’s Council on Sports Fitness and Nutrition. So I think we’ve learned a lot. We have great partnership with the USDA, U.S. Department of Agriculture, about both food and nutrition security, as well as the concept of food as medicine. And again, we’ve made progress and we have a lot of work to do.
Carol Vassar, podcast host/producer:
We have done a wide-ranging interview today, Admiral Levine. Thank you so much for sharing your insights. Any closing comments that you’d like to offer?
Admiral Rachel Levine, Assistant Secretary for Health, U.S. Department of Health & Human Services (HHS):
Well, I always remain a positive and optimistic person for the future, and I choose to be positive and optimistic, because if we give into pessimism and despair that it hinders our work. So I think that we all have to work together and we are stronger together in terms of all of these public health issues. All Americans deserve care and services that are timely, affordable, accessible, equitable, and high quality. Of course, these are our family members, our friends, our neighbors, our patients, our colleagues, our students, co-workers and more. And I firmly believe we can do better, we must do better, and if we all work together, we will do better.
Carol Vassar, podcast host/producer:
Admiral Rachel R. Levine is the 17th Assistant Secretary for Health for the U.S. Department of Health and Human Services.
We thank Admiral Levine for sharing her time and expertise with us on the Nemours Well Beyond Medicine Podcast. And we thank you for listening.
We’ll extend our conversation on the topics of whole child health and children’s health equity on our next episode as we listen in on a fireside chat between two national leaders in health equity, Dr. Dave Chokshi, the former Commissioner of the New York City Department of Health and Mental Hygiene, who served in that role during the emergence and height of the COVID-19 pandemic, and Nemours Dr. Kara Odom Walker, Executive Vice President and Chief Population Health Officer. Their discussion was presented at the 2024 Child Health Equity Symposium presented by the Ginsburg Institute at Nemours Children’s Health. Don’t miss it.
In fact, don’t ever miss an episode. Subscribe to the Nemours Well Beyond Medicine Podcast on your favorite podcast app, or visit NemoursWellBeyond.org to find all of our past episodes that you may have missed. That’s NemoursWellBeyond.org.
Our production team this week includes Susan Masucci, Cheryl Munn, Lauren Teta, Steve Savino, Daniella Gratale, and Hannah Wagner. Special thanks to Tara Broido and Commander Brooke Kerns from the Office of Admiral Rachel Levine. I’m Carol Vassar. Until next time, remember, we can change children’s health for good, well beyond medicine.
