Health Policy$ense

Transforming Baltimore: The Role of Public Health

Leana Wen and Joshua Sharfstein Describe Successes, Challenges

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Photos: Hoag Levins
Appearing together on an LDI Alumni-Faculty Exchange panel were former Baltimore City Health Commissioner Joshua Sharfstein, MD, Associate Dean for Public Health Practice and Training at the Johns Hopkins Bloomberg School of Public Health; current Baltimore City Health Commissioner Leana Wen, MD, MSc, FAAEM; and panel moderator Bradley Herring, PhD, Associate Chair for Academic Programs at the Johns Hopkins Bloomberg School of Public Health.

The past, present, and future of public health in Baltimore was on full display during LDI’s recent Alumni Faculty Exchange panel, which featured current Health Commissioner Leana Wen, MD, MSc, and former Health Commissioner, Joshua Sharfstein, MD. The panel, moderated by Bradley Herring, PhD, a Wharton alumnus now at Johns Hopkins, touched on topics ranging from the role of public health in the city to recent events revolving around issues of equity and justice.

Dr. Sharfstein reflected on Baltimore as a city of “enormous needs and incredible resources,” and how he worked as Commissioner to “align those resources against those needs.” He and Dr. Wen noted the considerable management challenges of the job and the importance of hiring the right people who could innovate within the department. Dr. Wen described an in-depth interview process, during which each new potential hire is required to spend a day shadowing her and then interviews with the entire fifteen-member leadership team.

Dr. Wen, a former Rhodes Scholar and Harvard-trained Emergency Medicine physician, called herself the “accidental choice” for Health Commissioner, noting that she had never considered this kind of position prior to her appointment by Mayor Stephanie Rawlings-Blake in January 2015. It has turned out to be a “dream job” for her, allowing her to address the upstream social determinants of health rather than just the symptoms, to dive into rewarding hands-on work, and strive to unite the city around health.

 “It was in the ER where I learned the limitations of the clinical services we can provide,” said Dr. Wen, elaborating on how issues like housing, food insecurity, and crime affect the health of individuals and the population as a whole. 

She cited the recent unrest in Baltimore after the death of Freddie Gray as an example of the positive role public health could play amidst a crisis that drew national attention.  Within the first few days of the unrest, Dr. Wen and her department recognized that the closing of several pharmacies created an immediate problem for many residents without the means to visit another pharmacy outside their community. Her department set up a medication access line and hand-delivered prescription medications to Baltimore residents most in need.

Dr. Wen sees herself as “the chief marketer for public health in Baltimore.” Through her previous background and experience in media, Dr. Wen has utilized both social and traditional forms of media to ensure that in Baltimore, “public health is at the table” for important policy discussions on upstream issues that affect health.  She has been recognized nationally for her work on reducing stigma around substance abuse, including expanding access to naloxone and harm reduction services, efforts that date back to Dr. Sharfstein’s tenure, when he started the Baltimore Buprenorphine Initiative.

Dr. Sharfstein, now Associate Dean for Public Health Practice and Training at Johns Hopkins Bloomberg School of Public Health, served as Baltimore’s Health Commissioner from 2005-2008 and held subsequent positions as the Deputy Director of the Food and Drug Administration and Secretary of Health for the State of Maryland. He discussed the need for academic institutions and their surrounding communities to work together toward shared goals. He noted how Hopkins has funded epidemiologic studies in the surrounding community in Baltimore and that the uniqueness of Baltimore has allowed the Health Commissioner and department to fulfill a leadership role when challenges have affected the city.

While acknowledging some of the historical tension between academic institutions and the community, both Drs. Wen and Sharfstein discussed the importance of researchers engaging community members from the beginning of any research initiative to build bridges and empower communities who have been historically marginalized or outright exploited by academic institutions. 

When asked how academic institutions could be most helpful to the health department, Dr. Wen’s response was clear: she needs data on the value of public health interventions. “Help me make the case for these programs,” she told the audience of many of LDI’s senior fellows, junior faculty, and students. Mission accepted, Dr. Wen!

See related Q & A with Leana Wen, on bridging the gap between researchers and policymakers