On Nov. 4, retired Admiral Rachel Levine came to Smith College to speak as part of the Smith College Colloquia series. Prior to her discussion of the future of public health in the U.S., The Sophian, in collaboration with contributing writer Jiahuai Kang of The Amherst STEM Network, sat down with Dr. Levine to discuss her career and her hopes for the future of American public health.
Over the last 50 years, Levine has played a crucial role in guiding public health policy at the state and federal levels, including as the 17th assistant secretary for health at the U.S. Department of Health and Human Services under the Biden Administration. In October 2021, Levine became the first openly transgender four-star officer in any of the US uniformed services. Following her time in the federal government, Smith awarded Levine an honorary degree at the 2025 commencement ceremony.
The interview took place during the 2025 United States Federal Government shutdown, the longest shutdown in American history. This shutdown notably led to the suspension of Supplemental Nutrition Assistance Program (SNAP) benefits across the nation, which Levine reflects on.
Disclaimer: This interview has been lightly edited for brevity and clarity.
AB: I understand you began working in pediatrics and went on to a faculty position at Penn State. I was wondering whether public health or public service was always a part of your plan, or what led you into that?
RL: Yeah, it was not part of the plan. I did pediatrics and a subspecialty in adolescent medicine at Mount Sinai in New York City, and then at the Penn State College of Medicine. I was fully ensconced in academic medicine, and had gone through all the different promotions and things, so I was a professor of pediatrics and psychiatry, I was division chief of my field of adolescent medicine and vice chair of Clinical Affairs. If you’d asked me what would be my future, it would have been to continue in academic medicine. But then I had this amazing opportunity to go into public service and public health, and it really was serendipitous. I had been involved with LGBTQ advocacy with an organization called Equality Pennsylvania—I was on the board. Also on the board was someone who had been prominent in [Pennsylvania] Governor Tom Wolf’s election campaign in 2014. She [asked me], “Would [you] be the co-chair of the Transitions Committee for Health [after Governor Wolf’s election]? And then they said, “Would you be interested in a position in the administration?” They offered me the position of Physician General. I accepted, and left Penn State to do that. And then about two and a half years later, the Secretary [at the time] went back to the public sector, and I became Secretary of Health of Pennsylvania.
AB: Transitioning into your Assistant Health Secretary work now, what did it mean for you to serve as Assistant Health Secretary. What were your big focuses in your time in the federal government?
RL: It was an amazing honor to be chosen by President Biden to be the Assistant Secretary for Health at HHS. In January of 2021, I got a text, “Would you be interested in a position in the Biden administration?” Well, yes! That led to this position. I had to go through [Senate] confirmation, and then I was sworn in at the end of March of 2021.
There are three avenues of effort for the role. One is the Public Health Service Commission Corps. The Public Health Service Commission Corps is 5500 dedicated uniformed officers in public health. We have the only uniformed public health service in the world. It is really an unknown treasure of dedicated physicians, dentists, nurse practitioners, nurses, public health professionals, [and] medical engineers. All these people work for the common good in our country and even overseas. The Assistant Secretary for Health is the four star Admiral. We work closely with the three star [Vice-Admiral], the Surgeon General, to lead the Corps. That was an amazing opportunity. I was in uniform as a four star Admiral, and I was proud and honored to take the uniform for the Public Health Service. The second line of effort is to be a counselor and advisor to the Secretary of Health and Human Services about all things medical and public health. The Secretary called us the connective tissue of the department. The idea was that we would pull together different agencies on different topics. The third [line of effort] is we had 10 offices that we ran. That included new offices called the Office of Climate Change and Health Equity, the Office of Long Covid Research and Practice, but also traditional offices of infectious disease, HIV policy, disease prevention, health promotion, Office of Population Affairs, Office of Research Integrity, Office of Human Research. The job was as busy, interesting, difficult, rewarding and challenging as I thought it would be.
JK: Were there any new insights or perspectives you gained from your time in office?
RL: There are several things that I did not have experience with. I had never been in uniform before, so leading the uniform service of the Public Health Service Commission Corps was a whole new, rewarding aspect of it. The other thing for me, which was very interesting and rewarding, but I hadn’t had experience with, is working with American Indian and Alaska Native tribes. We did a lot of work with tribes, and I visited a lot of different Native American and Alaska Native villages and areas. The thing that I knew, but that is so fundamental to public health, is the importance of health equity.
JK: What single policy do you think would have the greatest long-term impact on reducing these health disparities?
RL: I think the impacts of climate change are an existential threat to human health. And when I say existential, people tend to think that it means 30-50 years from now, but it’s right now. When I went to Alaska, they had so many difficulties because of climate change. Their homes are sinking into the permafrost, and their native food sources are being impacted by water changes, temperature changes, and impacts on the ice flow as well. And so they have so many challenges to their native way of living because of the impacts of climate change. I also saw this in Vermont, where their rivers have overflowed and impacted clinics, hospitals, and homes. We saw it with the forest fires on the East Coast a couple of years ago. You can see it from the sea level rise. You can see it from vector-borne diseases, including Lyme disease, that have expanded because of climate change. The current administration doesn’t think that climate change exists. Climate change does exist, and it has and is going to have an enormous impact on health and health care delivery.
JK: What would you say about reducing health inequality? More specifically, for low-income individuals who are having difficulty affording medical expenses?
RL: Well, there are a number of different answers. Clearly, economic opportunity is a social determinant of health that affects health, healthcare and healthcare access. Poverty leads to worse health outcomes. Some of that is caused by a lack of insurance. Under the Affordable Care Act, the Obama administration expanded Medicaid and Medicare, while the Biden administration had the most people with health insurance ever in the United States. All that is threatened now with the Medicaid cuts. But then there are other impacts on poverty. One is access to where health care is, especially in rural areas with maternity deserts and nutrition deserts. That is exacerbated now because of the decrease in SNAP benefits from the government shutdown. The impacts of climate change affect poor communities more as well. Everything, COVID-19, risk of addiction and overdose from opioids and others, all of those are exacerbated by poverty and lack of economic opportunity.
JK: I’d like to touch on what you mentioned about the Trump administration dismantling public health programs. For example, defunding USAID, cutting SNAP benefits, restricting abortion access, attacking trans youth, and so much more from Republican politicians. Do you think it’s possible to find common ground or shared values with the people responsible for dismantling these social programs? And if so, how can we achieve that?
RL: If you are currently working as a state health official, you still have to work with the federal government. So how do you do that? When I was the Secretary of Health of Pennsylvania, I was the president of ASTHO: The Association of State and Territorial Health Officials. [The US] has one of the worst maternal morbidity rates in the world, and it isn’t for the general population. It’s for two specific populations: African American women and Native American/Alaska Native women. That’s a classic health equity issue. But you can’t go to their governor or their state legislature and say, I have a health equity issue, because they don’t believe in “health equity.” So we can say, “We know that Black women are dying in this state more than white women. We want to address that.” And they’ll say, “Okay, let’s address that.” You just have to talk about what the issue is. At the same time, this is not normal. It is not normal for dedicated civil servants who work at HHS and many other agencies to be ripped and DOGE’d and fired. We expect certain policy changes, but not the rampant firing of tens of thousands of public health civil servants. That’s not normal. That’s one of the things that threatened public health more than anything.
AB: Moving on to more of a student focus, in your unique position as a physician, a federal uniformed public health official and a professor, what do you see as the role students can play in combating growing distrust of vaccinations and medical officials?
RL: We live in very challenging times, and there’s a real challenge about misinformation and disinformation, about public health and about specific public health issues, one of which you named, is vaccines. Vaccines and immunizations are one of the victories of public health in the 20th and 21st Century with so many diseases most notably polio and smallpox, which we decreased and eradicated because of safe and effective vaccines which are being threatened because of this misinformation. So what can students do? I think that first of all, students need to learn. You need to to learn about this misinformation and disinformation, to learn about public health, to learn about the differences between correlation and causation, and to be able to be a discriminating reader of the media, to be able to see this misinformation when it’s being when it’s being promulgated. You all are the future. It’s going to take years to fix the public health system, which has been dismantled over the last nine months. It’s not going to be me who does it, it’s going to be you all who do it. It’s important to be advocates in a productive way. There are many different ways to do that. I think one of the best ways is to do it locally. Talking to people and advocating locally, trying to change hearts and minds locally, is one of the most effective things that college students can do.
AB: You’re the first openly trans person to ever be in a Senate-confirmed position, and as a historically women’s college with a significant number of out trans and other genderdiverse students, Smith is in a unique position to cultivate and inspire these students in the face of ongoing overt attacks on trans rights. Do you have any advice for the next generation of trans leaders?
RL: My advice is to be patient and be persistent. Right now we’re in a very difficult time. It’s going to stay difficult for a number of years, but I remain positive and optimistic things will change, and I think opportunities will come back. You’re going to have to be resilient in the face of challenges, and then look for opportunities when they come. For example, I saw this opportunity to become the Physician General of Pennsylvania, and that was a little bit outside the box, but I grabbed it. We have a strong and resilient LGBTQIA+ community. We have seen challenges before. We will overcome them with time. We have to be ready when those opportunities come. You all are the future, I’m here to support you. Remember, I’m a pediatrician and adolescent medicine specialist. Young people have always given me hope for the future.
