Putting ‘Health in All Policies’.
This year marks the 100th anniversary of the passing of the 19th Amendment, which granted women the constitutional right to vote in federal and state elections in the United States. Passed by Congress on June 4, 1919 and ratified on August 18, 1920, the landmark legislation was a pivotal victory for democracy.
Despite this milestone, voter suppression remains a serious challenge in the US, largely impacting women and other historically marginalized populations. Voter registration restrictions, strict photo ID requirements, and gerrymandering are just a few measures that have prevented eligible people of color, LGBTQ people, low-income people, and former felons from participating in the electoral process.
On Wednesday, February 12, the School of Public Health will host the Dean’s Symposium “Voting and the Health of Populations: Celebrating the 19th Amendment Centennial” to mark the historic amendment, as well as examine the current state of voter disenfranchisement in the US, including how barriers to voting impact health policy and the health of the public. Keynote speakers include Rachel Levine, Pennsylvania Secretary of Health; Dariely Rodriguez, director of the Economic Justice Project at the Lawyers’ Committee for Civil Rights Under Law; and Susannah Wellford, founder and CEO of Running Start. The symposium will also feature a panel discussion on voting and health, moderated by Nicole Huberfeld, professor of health law, ethics & human rights.
“We tend to think of public health in terms of the coronavirus, or rates of heart disease, diabetes, and smoking—but many things influence health,” says Levine, whose state recently passed a historic election reform bill that aims to make voting more convenient through changes that include extended deadlines for voter registration, and mail-in and absentee voting. “From that perspective, there is a concept of health in all policies.”
Levine is also a professor of pediatrics and psychiatry at Penn State College of Medicine and an expert on eating disorders, the opioid crisis, and adolescent and LGBTQ medicine. Prior to becoming Secretary of Health, she served as Physician General of the Commonwealth, becoming one of the highest-ranked out transgender officials working in state government in the US.
Ahead of the symposium, Levine spoke about the importance of voting and its impact on women’s health issues, as well as breaking barriers in government.
How do you think voting—and voting legislation, such as Gov. Wolf’s election reform bill—impact public health?
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And certainly, in the elections in the last number of years, we have seen how every vote counts. But we have to make sure that everybody has an opportunity to vote, and that’s what the governor’s bill is about: no excuse mail-in voting, 50-day mail-in voting period, permanent mail-in and absentee ballot list, 15 extra days to register to vote—we really want to get rid of any barriers to people exercising their civic duty.
What do you consider to be the greatest threats to women’s health, and how will the 2020 election affect women’s health issues?
There are lots of issues involving women’s health that will be impacted by the 2020 election. We have had significant challenges with the current federal administration, in terms of some of the policies from Health and Human Services, particularly with reproductive health. Although it’s currently on hold in the courts, there were changes to Title X gag rules that would be very challenging for women’s health. All the challenges to the Affordable Care Act would negatively impact women’s health. Setting policies that not only religious facilities or churches, but also private companies, could refuse to provide contraception as part of their health plan would negatively impact women’s health. There are significant challenges to health and human services for women, and this is all out of the Office of Civil Liberties—an office of religious freedom that impacts LGBTQ individuals negatively as well.
We are also very concerned about maternal mortality. The United States and Pennsylvania have increasing rates of maternal mortality within one year after delivery. There are many different factors that influence that, including medical issues or societal issues that relate to the social determinants of health, But the US is the only established country that has an increasing rate of maternal mortality, and there are specific health equity issues associated with that. In Pennsylvania, the maternal mortality rate for white women has remained pretty steady, but it has increased significantly for African American women. We need to take a closer look at that. The legislature passed a bipartisan act for a Maternal Mortality Review Committee, which reviews many trends, including obesity, hypertension, diabetes, the opioid crisis and deaths from overdose, suicide, domestic violence, and guns. There are many different factors that influence women’s health.
As one of the highest-ranking out transgender government officials, what impact do you think you’ve made in creating a more diverse and representative government?
It’s been absolutely fascinating. I had the fortune of transitioning at an academic medical center at a large university—I transitioned while I was at The Penn State College of Medicine, where I was vice chair of clinical affairs for the Department of Pediatrics, and division chief of adolescent medicine at Penn State Hershey Medical Center. I found it to be a very accepting and welcoming environment, but even there, I had to write a nondiscrimination policy that included gender identity, because at that time, the policy only included sexual orientation.
When I was named physician general, there was a lot of interest from the press, probably even more than I expected. It was interesting when the press would say I was the “transgender Physician General,” or now, the “transgender Secretary of Health.” So I would ask, “if I’m the transgender Physician General, who is the cisgender Physician General?” Finally, the press has stopped doing that—now I’m the just the “Secretary of Health” and they don’t have to add that moniker, which I appreciate. I’m just here for the advocacy of public health.
But as part of the administration, I have had the opportunity to advocate for and educate people about LGBTQ issues, particularly health disparities, and be a role model for LGBTQ individuals and transgender individuals in government and in public service. That term is a little hard for me, but I think that I’ve been able to contribute to the community as an advocate in that way, so that’s very gratifying. When I was nominated and confirmed as Physician General and Secretary, I had to meet all of the senators in our very conservative senate, and it was interesting for them to welcome me into their chambers, shake my hand, and talk about public health. And Gov. Wolf is the strongest ally you’d ever meet—we formed an LGBTQ policy work group with agencies to look at LGBTQ policy issues. That has now evolved into the governor’s Commission on LGBTQ Affairs.
Jenny Boylan, a professor at Barnard College and transgender woman, wrote that “it’s really hard to hate someone whose story you know.” To me, it all comes down to Yoda. Yoda said that “Fear is the path to the dark side. Fear leads to anger, anger leads to hate, and hate leads to suffering.” People fear what they don’t understand, so if you can educate people, hopefully you can prevent them from fearing and then hating. If you get to know people and work with them, it helps get past stigma, and that’s what I try to do.