Since January, Dr. Leana Wen has served as Baltimore's health commissioner, heading an agency with a $130 million budget and 1,000 employees. Wen took over a few months before the city erupted into protests and violence following the death of Freddie Gray, a young black man who died in the back of a police van. She worked to make sure hospitals and their staffs were protected during the street violence. Wen argued that drug abuse, poverty, mental illness and high incarceration rates for blacks were the background for the protests, and that better programs for drug-addicted and mentally ill people would help. Wen previously served as director of patient-centered care at George Washington University's emergency medicine department and as a GWU professor of emergency medicine. She was founding director of “Who's My Doctor,” a campaign calling for radical transparency in medicine, and wrote the book When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests. Modern Healthcare reporter Andis Robeznieks recently spoke with Wen about the role of health disparities in the recent violence, her advocacy for wider access to the opioid overdose treatment drug naloxone, and the state's unique system of global healthcare budgeting. This is an edited transcript.
Modern Healthcare: In a JAMA editorial you co-wrote this year, you encouraged public health officials to embrace finding solutions to the nation's health disparities. How do you think those inequities led to the unrest and violence in Baltimore?
Dr. Leana Wen: These inequities and disparities are in every U.S. city. Here in Baltimore, there are neighborhoods just blocks apart where the life expectancy differs by 20 years. These disparities tie into every single part of the work we do. They don't only affect health, they also affect employment, education and opportunity. What happened in April is a reflection of decades of problems of poverty, racial inequality and structural racism. But it also offers a call to action for us to start addressing these deep-rooted health disparities. We have renewed our emphasis on priorities that we established when I came into this office in January, focusing on youth health and wellness, substance abuse, mental health and care for the most vulnerable.
MH: How has childhood exposure to lead contributed to some of these problems?
Wen: Lead poisoning is a symptom and an effect of other deep-rooted disparities. The effects go beyond health. An individual who is lead-poisoned as a child has a higher chance of lack of cognitive function and lack of educational outcomes later on.
Similarly, individuals who are lead-poisoned or lead-exposed also tend to come from areas of decreased economic opportunity.
One of the great successes we've had in Baltimore is on lead. In the last 12 years, we have reduced the percentage of children in our city who are lead-poisoned by 86%.
MH: Why do you advocate wider access to the drug naloxone, which is used to treat opioid overdose cases?
Wen: Heroin and opioid abuse is a huge problem. Even though we know we need other treatments including psychosocial support and long-term medications, we have to get naloxone into the hands of everyone who needs it, including individuals who use substances themselves, their friends and family members, paramedics and police officers. We are expanding our efforts to reach every one of our 620,000 residents to teach them how to use this life-saving medication.
We have launched a citywide Overdose Prevention and Response Plan, where we have taught this year over 5,000 people how to use naloxone. We have trained our police officers, and already in the last month our officers have saved two lives. We advocated for legislative change so that as of October 2015, I can give a standing order to every city resident, which means that people don't have to go to their physician to get a prescription for this medication as long as they go through brief training.
