Rachel Levine Is Saving Pennsylvania — and Becoming an Accidental Icon in the Process

Pennsylvania Health Secretary Rachel Levine.

Published as part of our annual Best of Philly tribute. See all the winners here.

It’s a big day to talk to Rachel Levine. It’s Saturday afternoon, one day after Pennsylvania began its stuttered slide through Governor Wolf’s reopening phases, red to yellow and, for some lucky counties, even green. For many Pennsylvanians, it’s the end of a months-long lockdown put in place (somewhat controversially) by Wolf and Levine, the state’s secretary of health. You can almost imagine everyone emerging from state-mandated hibernation on this first weekend of freedom, stretching and squinting in the sunshine, timidly gathering in tiny pockets across the state.

But of course, many people have been out already, not timidly and in great numbers, because this day marks 12 days since George Floyd was killed by police in Minneapolis, which ignited protests across the world, global pandemic be damned. Today is the eighth consecutive day of demonstrations in Philly, and thousands of people have turned out for citywide protests, transforming the Parkway into a churning sea of people. You can imagine how stressful this is for someone whose job is to protect us all from a deadly pandemic, one who has spent the past three months pleading for Pennsylvanians to stay at home and away — six feet, please — from one another. (It’s quite a bit harder to imagine that only a few weeks ago, people were protesting for the right to get a haircut.)

This day is also the sixth day of Pride Month, and while Philly’s annual PrideDay festival was canceled in light of COVID-19, the organizers — and LGBTQ+ activists across the country — are standing in solidarity with the Black community, shifting their focus to support the Black Lives Matter movement and advocating for Black trans men like Tony McDade, who was also killed by police. You can imagine that Levine would feel the pull of these social protests. She’s a child of the ’60s, when protests were inescapable. She’s also a transgender woman, so she knows a fair bit about discrimination, especially now that the pandemic has thrust her squarely into the public spotlight. She recognizes the critical importance of this moment. Maybe, you can imagine, she’d even want to be marching as well.

But she’s not, obviously. Today, Rachel Levine is working from her home in the Harrisburg area. While the country is a tumble of outrage, fear and uncertainty, she is laser-focused. She has to be, because right now, Levine is facing the greatest challenge of her professional career and living out her worst nightmare — a global pandemic — in front of the world. As the state’s secretary of health, she’s tasked with keeping 12.8 million people safe from COVID-19, which often means telling them what they don’t want to hear and listening to those who especially don’t want to hear it from her, a transgender woman. And it means looking at public health, and racism, through a larger lens.

“Economic opportunity is health. A living wage with an increase in the minimum wage is actually health. Improving educational opportunities, improving nutrition, improving the environment, improving transportation for people is health,” Levine says. “Getting rid of racism is health.”

You can imagine plenty of things about Rachel Levine: what makes her laugh, what her childhood was like, what she would do if she ever had downtime, which she doesn’t. You can ask her these questions; answering questions — albeit generally those related to life and death — is part of her job. But today, and on all the days since the COVID-19 crisis began and probably long after it’s ended, the best way to understand Levine isn’t to try to figure out who she is, but to focus on what she does and what she means.

“Nobody really knew they had a health department or what it did until they started getting phone calls: ‘You may want to get tested for COVID-19,’” says Michael Fraser, the CEO of the Association of State and Territorial Health Officials (ASTHO), a national organization that represents public health agencies across the country. Levine is ASTHO’s president. Fraser has a point: Despite working at the forefront of many high-profile public health issues — like Pennsylvania’s still-raging opioid crisis, rural health, and health equity for LGBTQ+ and other marginalized communities — Levine had flown mostly under the radar, at least for people who don’t voraciously follow public health policy work. (You don’t?)

“This has really transformed the profile of lots of state health officials as leaders, especially when you see them on the podium with their governors,” Fraser continues. “It’s really been fun to see them propelled into the spotlight for this very mundane work that we do day in and day out. We’ve seen them become beloved communicators-in-chief.”

It’s true. Public health officials are sort of having a moment. In Ohio, it’s Amy Acton, who led the state’s pandemic response before resigning as health director in June. (Distraught Amy super-fans consoled themselves with Amy Acton mugs, t-shirts, wineglasses and devotional prayer candles.) In Maine, it’s the state’s CDC director, Nirav Shah, who has also inspired memorabilia, all with the tagline “In Dr. Nirav Shah We Trust.” Nationally, it’s immunologist Anthony Fauci, whose calm, pragmatic approach has earned him fan clubs, his own spate of memorabilia — and more than 26,000 signatures on a petition to name him People’s Sexiest Man Alive.

Here, it’s Levine, who has been praised for her COVID-19 response — for many of us, a steady, composed, data-driven approach in a time when others have peddled panic (and false hope), placed blame and questioned science. There are Rachel Levine fan-club buttons. Someone started a Twitter hashtag, #Respect4Rachel, to push back on bigotry directed toward her. A Facebook fan page, “Dr. Rachel Levine-We Love You,” has 6,460 followers. The comments there are a steady stream of gratitude, describing her in words typically reserved for Jesus and maybe Oprah: “a lighthouse in this dark storm” and “a calming force of nature.” One woman waits for the secretary’s daily press briefing like it’s a soap opera: “I need my Dr. Levine fix!” Someone wants her to run for governor. A few want her to run for president. At least one wants her to have her own TV show.

This public spotlight could be overwhelming for someone not accustomed to it. But while Levine didn’t anticipate all of this rather sudden attention (who could?), she has embraced it.

“When I became physician general in 2015, I did know that there would be a certain amount of media scrutiny,” says Levine. “And maybe somewhat more when I became the secretary of health in 2017. But there’s obviously much more media scrutiny now, much more commentary. But I’ve always been good at compartmentalizing. I enjoy being in front of people and speaking. I mean, if I didn’t like public speaking, then I chose the wrong job.”

Levine has always enjoyed being in front of people. As a professor of pediatrics and psychiatry at Penn State College of Medicine, she has lectured to med students and resident physicians for years. She’s lectured to other groups of physicians, too — first regionally, then nationally and internationally — about issues that lie in the fuzzy intersection of medical, behavioral and mental health, like eating disorders. (She started Penn State Health Children’s Hospital’s adolescent medicine division and eating disorders program.)

She’s spoken at hospitals, given keynote addresses, and been the grand marshal of Philly’s Pride Parade. For about 10 years, before her trail through government really unspooled in 2015, she performed in community theater. She was in shows at Harvard, which she attended as an undergrad, and she was the president of the drama club at Belmont Hill School, an elite all-male prep school in Massachusetts from which she graduated in 1975. Many years later, she’d go back to address the community as an openly transgender woman.

“It was really interesting,” she says of her time as a student at Belmont. “And it was very interesting to go back there and actually speak to the community. I challenged them a little bit in terms of being an all-male prep school and LGBTQ issues. But I love Belmont Hill.” She played guard and linebacker for the football team and was goalie on the junior varsity hockey team, and she sang in the glee club. Back then, her voice was a resounding baritone. Thirty or so years later, she took voice lessons — a year and a half of them — to raise her pitch.

But before all that, Rachel Levine was a child growing up in Wakefield, Massachusetts, a sleepy suburban town just north of Boston. She loved music, singing, Star Trek. Her parents were attorneys; her mom, Lillian, now 95, was also an unapologetic trailblazer.

“My mother was the only graduating female law student at Boston University in 1946, when it was very unusual for women to become attorneys,” says Levine. So perhaps it wasn’t entirely surprising that Lillian was supportive — “tremendously accepting,” says Levine — when her child, then in his 50s with a wife (they married during Levine’s fourth year of medical school at Tulane and divorced in 2013) and two kids, told her that he was transitioning to a woman.

“I grew up in the ’60s and the ’70s, and there was very little language to be able to talk about my feelings in terms of gender identity at that time,” Levine, now 62, says. She started to see a therapist in her 40s, and somewhere around 2008, she began to grow out her hair, which now falls past her shoulders in waves. When Wolf tapped her for physician general in 2015, she’d only been living publicly as a woman for about five years. Her appointment made her the top-ranking transgender official in Pennsylvania, and one of the most prominent transgender public officials in the country.

“When she was nominated for physician general, I had several members [of the Pennsylvania Medical Society] call me and say, ‘How can you allow this to happen? How can the medical society allow a transgender physician to be the physician general for the Commonwealth of Pennsylvania?’” says Fraser, who was then the society’s executive vice president. But Levine met with nearly all the state senators in their chambers (“I think it was interesting for all of us,” she says), talked public health — and was unanimously confirmed.

“Switching to physician general was a whole new world,” Levine says. She’d been in academia and medical practice her entire career, first at Mount Sinai in New York, where she did a fellowship in adolescent medicine, and then as the director of ambulatory pediatrics and adolescent medicine at a Harrisburg hospital and an assistant professor at Penn State College of Medicine, where she stayed for more than two decades. But, Levine says, she adapts to change very well: “I guess that’s a theme.” And anyway, it wasn’t the biggest change she’d faced. That, she says, was moving from Manhattan to central Pennsylvania in 1993.

“We lived on the Upper East Side, in a small apartment, a box within a box. I didn’t own a car for many years. And then moving to a house and having a yard and you could see the sky and see weather — it was just all very different,” Levine says. “I used to walk about and, you know — Wow! A Walmart! That’s really cool! It’s the size of two city blocks!”

Levine’s professional hop from Hershey to Harrisburg meant she was refreshingly unencumbered by past government experience. “Dr. Levine spent 20 years outside of government,” says Sarah Boateng, Levine’s executive deputy secretary at Pennsylvania’s Department of Health. “I particularly remember that in the early times when she was in the physician general role, she wouldn’t apply a bureaucratic approach to getting something done. She’d just say, ‘Let’s go and get it done.’ Who would have thought that a physician general could write a prescription for all of Pennsylvania? But she did.”

Boateng is referring to Pennsylvania’s statewide standing order for the opiate overdose reversal drug naloxone, which allows anyone to get the drug at a pharmacy without an individual prescription. It’s one of many bold moves Levine has made since joining Wolf’s administration. Others include spearheading efforts to ensure Medicaid coverage for transgender health services and updating policies that allow for altering your birth certificate to reflect your gender identity. And, of course, moves like advocating for a statewide stay-at-home order.

“She’s brave, and she’s willing to take the big, bold steps needed to get the work done,” says Boateng. “But she does it with a really kind and thoughtful and empathetic approach.”

She’s willing to take big, bold steps,” says Levine’s executive deputy secretary. “Who would have thought you could write a prescription for all of Pennsylvania? But she did.”

Plenty of people have dismissed or condemned these big, bold steps, branding Wolf’s state shutdown as unconstitutional, tyrannical, ruinous for the state economy, excessive. (One sign at a shutdown protest in Harrisburg: MY RIGHTS DON’T END WHERE YOUR FEAR STARTS!) They’ve taken aim at Levine, too, mostly for how she handled COVID-19 outbreaks in nursing homes. As these facilities quickly became virus hot spots (nursing and long-term care homes account for two-thirds of COVID-19 deaths statewide), Levine enforced a policy that required nursing homes to readmit COVID-19 patients after they were discharged from hospitals. She was also criticized for her lack of transparency about which facilities were affected and how badly. When a report was finally released, it was punctuated with errors. The furor grew when it was revealed that in the midst of this, Levine had taken her mother out of her personal-care home. It made national news; people chanted “Lock her up!” at a protest in Harrisburg.

Some observers defended Levine’s decision as a personal matter; others likened it to “insider trading”; several lawmakers demanded she resign. But Lillian, Levine explained at a press conference, had asked to move: “My mother is 95 years old. She is very intelligent and more than competent to make her own decisions.” Still, personal decision or not, it was terribly bad optics.

“Yeah, they’re celebrities, and they’re also the most-wanted, depending on your perspective,” Michael Fraser says of public health officials.

I’ve grown to like this lady so much,” wrote someone on Levine’s Facebook fan page. “Once this is all over, I’ll miss seeing Dr. Levine giving updates daily.”

But for some of us, they’re neither. For some of us, they’re simply lighthouses, daily anchors when everything feels a bit unmoored. As one person wrote on Levine’s Facebook fan page: “I’ve grown to like this lady so much, once this is all over I’ll miss seeing Dr. Levine giving updates daily.”

The day I speak with Rachel Levine is also six days before the Trump administration will finalize a rule that allows health-care providers to discriminate against transgender patients. It’s another chip off the mantel of LGBTQ+ rights, one that follows the transgender military ban and the reversal of other regulations that protected LGBTQ+ people from discrimination. That this latest reversal falls in the middle of a pandemic is particularly troublesome, since it could potentially lead to providers denying tests or treatment to LGBTQ+ people. It also happens to be the middle of Pride Month, and a day after the four-year anniversary of the mass shooting at the LGBTQ+ nightclub Pulse, but Levine has compartmentalized this, as she does. She has work to do, and she’s laser-focused — on coronavirus, on public health, on health equity, on all of it.

“One of my goals, being a state health official — especially being the secretary of health during this very challenging time of a global pandemic — is that people will see me. They’ll see me doing my work and doing the very best I can to protect the public health of everyone in Pennsylvania,” she says. But it’s not about the limelight; it’s about letting people put a face to something they might not understand, so that they aren’t fearful, so that they don’t get angry, so that it doesn’t lead to hate.

“The reality that she is a trans woman in a very high leadership role in our state government, the first cabinet member in Pennsylvania history to be out as a trans person, for example, is not insignificant. It’s not why she does the work, but it’s not insignificant to the community,” says Adrian Shanker, the executive director of Allentown’s Bradbury-Sullivan LGBT Community Center. He served with Levine on the board of the statewide LGBTQ+ advocacy group Equality Pennsylvania during the marriage equality fight; he considers her a friend.

“She was not appointed physician general or secretary of health because she’s trans. But she happens to be a trans woman, and seeing members of the LGBT community in positions with high levels of visibility gives an opportunity for trans people to see her as a role model, and that’s really important,” he says. “At the same time, every single day during her press briefings, there’s a public display of bigotry in the comments and during the livestream. And trans people have to see that, too, unfortunately.”

They’ll see the comments, of course. They’ll learn that people have protested outside her house. They’ll hear people refer to her with the wrong pronouns, and they’ll read nasty tweets. But they’ll still see her, standing behind a podium as she has nearly every afternoon since March 6th, beside the governor of Pennsylvania, wearing kooky glasses and a chunky necklace, reminding people to wash their hands for 20 seconds.

They’ll also see her on June 17th, two days after the Supreme Court (surprisingly, finally) rules that it’s illegal to fire someone for being gay, bisexual or transgender. It’s another big day, and Rachel Levine is there in front of people, a steady (controversial, comforting) presence, working behind the scenes and in front of the world to move things forward, maybe even make them better. On that day, she’ll finish her briefing the same way she always does: “Stay calm. Stay alert. And stay safe.”

Published as “How Rachel Levine Saved Pennsylvania” in our Best of Philly tribute in the August 2020 issue of Philadelphia magazine.