Lifelines Dr Leana Wen BOOK COVER

A doctor's diagnosis of our broken public health system

Updated 12:12 PM ET, Mon July 26, 2021

(CNN)Before she was old enough to understand the US public health system, Leana Wen witnessed it fail. Growing up in the '90s in Los Angeles after her family immigrated from China, many members of her community didn't have the money or insurance to access health resources, and they ultimately succumbed to preventable diseases.

Could their lives have been saved by a system that valued every life equally?
As Wen details in her new book "Lifelines: A Doctor's Journey in the Fight for Public Health," it was this lingering question that inspired her career as both an emergency room physician with the power to treat patients regardless of their identity or ability to pay, and as a public health official with the power to reform policies that she had seen fail so many people.
Leana Wen
Her passion led her to medical school at Washington University when she was just 18 before going on to study health policy at the University of Oxford as a Rhodes Scholar. Now, at 38, she has already amassed the titles of physician, medical analyst for CNN, contributing columnist for the Washington Post, professor of public health at the George Washington University, fellow at the Brookings Institution and former health commissioner of Baltimore. And from these experiences, she knows first-hand that creating and maintaining a robust public health infrastructure is no simple task, in large part due to a fatal flaw of any strong public health system: it is inherently invisible.
We don't see the faces of the kids who never got lead poisoning because of remediations to their homes; the lives that were spared because of community crime prevention programs; the children who go to bed full each night because of the food assistance they received. So, how do we fight for public support or funding for a system, the successes of which are so hidden?
Compounding the issue, the Covid-19 pandemic has all but made public health synonymous with disease control in the public consciousness. But in times of crisis, as in times of normalcy, it is so much more than that. It's the air we breathe, the food we eat, the housing that shelters us and the education we have access to. As Wen defines it, public health is the ultimate example of "all boats rise" -- the idea that improving the health of a community benefits all.
Get our free weekly newsletter

Sign up for CNN Opinion's new newsletter.

Join us on Twitter and Facebook

The key to achieving a strong and functioning system, Wen says, is to reimagine public health as having two components. The first is made up of public health agencies, which need to be vocal about the aspects of their programs that are successful. The second is comprised of all the people who are served by the system. They need to see themselves as being on the front lines of the public health battle and support the efforts that keep the community safe and healthy.
When viewed this way, public health isn't just about the application of science and medicine, but rather an ongoing effort to win the hearts and minds of a community. And that starts with reminding the public, as Wen puts it, that "public health saved your life today -- you just don't know it."
This interview has been edited for length and clarity.
CNN: You witnessed in the '90s that not every life is valued the same, and that includes in our public health system. Do you still see that inequity in our public health system today?
Wen: Absolutely, and tragically. I write in "Lifelines" about a child that I saw die in front of me from an asthma attack. His grandmother didn't seek medical help because she was afraid of the immigration officials and of her family being deported. That just should not happen in a just America. There are also people who do not receive preventive health or primary care services because they can't afford health insurance. This is why public health is so important -- it is about providing core safety net services to the most vulnerable.
CNN: What do you see as the fundamental roadblocks that are currently inhibiting access to health care and public health for those people?
Wen: It's the policies we have in place. For example, I treated patients before and after the Affordable Care Act was implemented. The ACA definitely made a difference in many people's lives by promoting the correct health care incentives -- like free preventive care. It's not perfect and there's still a long way to go, but it encourages people not to wait until they're really ill to seek out care. Before the ACA, I had treated a patient whose kidneys were failing. She was glad when her kidney failure was bad enough that she had to be put on dialysis because it meant that she finally qualified for Medicaid. I mean, for somebody to be glad to be tethered to a machine three times a week and unable to work or care for her grandchildren because it means that she finally can afford her health insurance -- that's so tragic.
CNN: Doctors constantly challenge their own understanding of human health. But what really struck me when reading about your career journey is that you've done something rather unique: you've challenged the role of doctors and the system that you work within.