Admiral Rachel Levine's Unplanned Path to Public Health Leadership

Dr. Levine was asked to co-chair the health transition committee for newly elected Pennsylvania Governor Tom Wolf. Soon afterward, she was offered the position of Pennsylvania's Physician General, an opportunity that would take her from the examination rooms and classrooms of Penn State College of Medicine to shaping health policy for an entire Commonwealth.

"Everyone advised me not to take it because I'd be giving up my academic medicine career," Dr. Levine recalled. "But I just felt inspired, and I said yes."

What followed was a decade of unexpected opportunities, historic firsts, and some of the most consequential public health challenges in recent history.

Dr. Levine would go on to guide Pennsylvania through some of its most difficult health crises before serving as the nation's 17th Assistant Secretary for Health and making history as the first transgender person to be confirmed by the U.S. Senate, and the first transgender person to serve as a four-star admiral in the U.S.

Yet the experiences that shaped her approach to public health began long before she entered government.

A Physician First

Raised in a Jewish family in Massachusetts, Dr. Levine grew up in a household where education and professional achievement were modeled. Both of her parents were attorneys, and her mother, Lillian, was the only woman to graduate from Boston University Law School in 1946.

Her interest in medicine began at Belmont Hill High School outside of Boston, where a love of biology and an inspiring teacher sparked her curiosity about the field.

During high school and college, she spent summers working in a surgical research laboratory at Boston University Medical Center, gaining firsthand exposure to medicine through research and opportunities to shadow physicians.

After graduating from Harvard College, where she majored in biology, Dr. Levine attended Tulane University School of Medicine. There, she discovered a passion for pediatrics as she began interacting with patients and participating in clinical rotations.

She was particularly drawn to adolescent medicine, then an emerging specialty focused on the unique physical, psychological, and behavioral needs of teenagers. A physician at Tulane who was exploring the field helped inspire her interest.

That interest led her to Mount Sinai Medical Center in New York City, where she completed her pediatric residency and fellowship in adolescent medicine. She remained in New York for several years before joining the faculty at Penn State College of Medicine in 1993.

At Penn State Hershey Medical Center, Dr. Levine established the Division of Adolescent Medicine and the Penn State Hershey Eating Disorders Program, bringing together medical and behavioral health care to support young people with complex needs.

Her clinical experience with complex medical and behavioral health conditions would later prove especially valuable as Pennsylvania confronted the opioid epidemic.

For Dr. Levine, the rewards of clinical medicine remain deeply personal. Even today, she occasionally encounters former patients or their families while shopping near her home in Hershey.

"When patients come up to me or family members come up to me and tell me about how I helped their child, their young person, or themselves, that just means so much that I was able to help them," she said.

Those encounters remain among the accomplishments she values most, even after a career marked by national recognition.

An Unexpected Call to Public Service

When Dr. Levine joined the Wolf administration in January 2015, she brought decades of clinical experience to an entirely new arena.

"I felt that it would be amazing to be able to help people from a broader public health perspective, with that broader brush," she explained.

In clinical medicine, she said, the focus is primarily on the patient and family directly in front of the physician. Public health requires a wider perspective, considering the needs of entire communities, whether a city, county, state, or nation.

As Pennsylvania's Physician General, Dr. Levine became a leading voice in the Commonwealth's response to the opioid epidemic. Among her proudest accomplishments was issuing the nation's first statewide standing order expanding access to naloxone, the medication used to reverse opioid overdoses.

The initiative represented a new approach to making a lifesaving intervention available to individuals, families, and first responders.

Reflecting on the decision, Dr. Levine recalled that her lack of familiarity with the limits of her new position may have worked to her advantage.

"In some ways, I didn't know what I didn't know. I didn't know what I couldn't do," she said.

The order eventually made its way through a lengthy policy and legal review process before becoming a reality.

Dr. Levine also worked to improve immunization rates, expand access to healthcare, and address disparities affecting underserved communities.

In 2018, she was confirmed as Pennsylvania's Secretary of Health, a position that would place her at the forefront of the state's response to the COVID-19 pandemic.

As the virus spread, Dr. Levine became one of Pennsylvania's most recognizable public officials, responsible for communicating evolving scientific guidance and helping navigate decisions affecting millions of residents.

The experience also tested skills she had developed decades earlier as a physician.

Finding Strength Under Pressure

Dr. Levine's growing visibility, particularly during the COVID-19 pandemic and her years in federal leadership, brought increasingly intense public scrutiny.

She recalled that her initial appointments in Pennsylvania were met largely with curiosity and acceptance. She was unanimously confirmed by the state Senate as Physician General and later was confirmed twice almost unanimously Secretary of Health.

But as her national visibility increased, so did the criticism.

"I went from famous to infamous to notorious," she joked, referring to herself as "the notorious RLL," a playful reference to the late Supreme Court Justice Ruth Bader Ginsburg, known as the Notorious RBG.

Dr. Levine credits her medical training with helping her navigate those pressures.

In an emergency department, she explained, physicians must remain composed even when treating a critically ill child. They learn to set aside their immediate emotions, focus on the task at hand, and process the experience afterward.

She has applied that same discipline to public leadership, relying on her ability to compartmentalize criticism and remain focused on her responsibilities.

She has also worked to turn opposition into motivation.

"The more you pressure me, the more you criticize me, the more you might scrutinize me, the more I come back," she said. "It really fuels my desire to come back and advocate more and to work harder."

Underlying that resilience is a principle she has carried throughout her career: "When in doubt, do the right thing."

Determining the right course of action is not always straightforward, she acknowledged. Whether caring for a patient or developing public policy, it requires careful consideration, collaboration, and a willingness to stand by difficult decisions.

Making History on a National Stage

In March 2021, Dr. Levine was confirmed by the U.S. Senate as Assistant Secretary for Health, becoming the first openly transgender person to hold a Senate-confirmed federal position.

Seven months later, she was commissioned as a four-star admiral in the U.S. Public Health Service Commissioned Corps, becoming its first female four-star admiral and the first openly transgender four-star officer in any of the nation's uniformed services.

The appointments placed Dr. Levine among the nation's most senior public health leaders while making her a highly visible figure for transgender Americans.

Her own experiences had already informed her commitment to creating more inclusive healthcare environments. While working at Penn State Hershey Medical Center, she helped strengthen institutional nondiscrimination protections to include gender identity and expression and supported efforts to make the medical center more welcoming to LGBTQIA+ patients, students, and professionals.

At HHS, Dr. Levine helped lead national initiatives spanning adolescent health, HIV prevention, reproductive healthcare, sexually transmitted infections, climate change, and health equity. Her work reflected an understanding of health shaped by years of caring for patients whose well-being depended on far more than medical treatment alone.

During her career she has received numerous awards and honors, including being named USA Today's Women of the Year in 2022, named one of Time Magazine's 100 Most Influential Climate Leaders, receiving an honorary Doctor of Science from Rutgers University, and receiving the Outstanding Public Service Award from the Milton S. Hershey Medical Center for her work as an advocate for the health of teens, children, and the LGBT community.

Choosing Optimism

After more than four decades in medicine and public health, Dr. Levine is looking toward the future at a time when the nation's public health systems face significant uncertainty.

She has expressed concern about declining trust in public health institutions, misinformation about vaccines, reductions in the public health workforce, and changes to healthcare access and funding.

Her optimism, she explained, is both a part of her nature and a conscious decision.

"I get up in the morning, and I decide I'm going to be positive and optimistic because that gives me the energy and the enthusiasm to do the work that is necessary to create change," she said.

That outlook is rooted in her earliest experiences as a physician.

During her medical training, Dr. Levine recalled working exhausting 36-hour shifts while caring for seriously ill children. Even on the most difficult days, she found motivation in knowing that her patients needed her.

"You have to have hope for the future that a recovery is possible," she said. "How do you get up the next morning? Because you're going to go help kids."

Today, she sees that same sense of purpose as essential for the next generation of health advocates, who will be called upon to rebuild trust, strengthen public health infrastructure, and address complex challenges facing their communities.

"Young people give me hope because they are the future, and I think the future is going to be bright," she said.

When asked how she hopes to be remembered, her answer was simple.

"That I worked for the common good, that I consistently worked to help people," she said. "That's what I want my legacy to be."