Dr Maxine Dexter: Physician Voices Are Crucial to Public Health

During the CHEST 2024 annual meeting in Boston, Maxine Dexter, MD, pulmonary and critical care physician at Kaiser Permanente, detailed her presentation, "Prescribing Change: Redefining the Physician Role in Public Health Advocacy" in an interview with The American Journal of Managed Care^®.

Driven by a belief that physicians are vital in shaping public policy, Dexter is a Democratic candidate for Oregon's Third Congressional District. She served as Oregon State Representative from 2020 until her recent resignation in August 2024. She resigned because she is on track to take a seat in Congress, replacing a retiring congressman. During her office, Dexter leveraged her medical expertise to champion legislative efforts grounded in science and public health, addressing pressing issues like the opioid crisis and air pollution.

Notably, her work on a 2023 harm reduction omnibus package and air quality initiatives highlighted the intersection of health, politics, and environmental impacts. As a former Northwest Permanente board chair of a 1600-physician group, Dexter's experience in a multispecialty, capitated care system further shaped her policy perspectives, merging clinical insight with a vision for healthier communities through proactive legislation.

This transcript has been lightly edited for clarity.

Transcript

Can you describe the topic of your session "Prescribing Change: Redefining the Physician Role in Public Health Advocacy"?

It's born of an acknowledgment that physicians have a powerful role to play in public policy making, and that we actually should see ourselves more in that role. So, talking about why I ran for office and how I've been able to take my practice as a physician to the state legislature where I've served from 2020 to 2024—I just resigned at the end of August, and I talked about a couple case studies, including the opioid crisis and a harm reduction omnibus package that I passed in 2023.

We also talked about air pollution and climate impacts on health, and the different bills that we've been passing really focused on the health impacts. It takes a controversial, sometimes politicized issue and really just bases it on the science. And we know the impacts of air pollution. We don't know all of them, but we know the significant impacts of air pollution on health, and we should be mitigating those for not just the wellness of people but the economic and downstream impacts of prevention.

Would you shed light on how public health and policy intersects with the state of health care?

I didn't talk about the whole spectrum of that. The focus of my talk was on how I'll be the first pulmonary and critical care physician to serve in Congress. So, I think that, at a pulmonary and critical care conference, was what a lot of folks were interested in, and why I wanted to go into office, and how I see my role as a physician impacting that—which I think is really important.

And I'll just go down that road really quickly because physicians see patients of every economic level, of every cultural background, language background. We take social histories; we need to understand whether people have housing, whether they have children, whether they smoke or use drugs. We take a very comprehensive history when we're talking to people. So, not only do we see people from every walk of life, but we understand their social issues. And when you do that all day every day, you also understand the impacts of social policies.

The lack of housing is something that I see in the ICU [intensive care unit] all the time. Now we're seeing people who are coming in with exposure to heat and to cold and to wet, and the impacts of that are escalating because there are more people who we're now taking care of and then discharging back to the street, knowing that all of that investment in trying to help them live a healthier life is not able to realize the benefits that a person would normally because they just are going back out to insecure situations. So, physicians can bring perspectives. I have a story for every issue, and it's stories that help pass policy.

As much as I'd like to say, at a medical conference, that it's data and science that we base our state and federal policies on, it's not; it's on stories and best guesses. We don't go back and fix our work when it doesn't work. As a scientist, that's challenging, but we need to continue to try to use data-driven principles to pass public policy that really thinks about public health.

Back to the question about public health, the most impact that we can make on the health of our communities is public health interventions, whether it's, decreasing smoking or making sure that people have clean air and clean water. You know, it used to be sewage systems and garbage collection. There are things that we have done as a nation that protects the public's health, and now we're backing away from things like vaccination, and you know, it's really a challenge for me. Gun violence prevention—that should be a public health issue, and we don't treat it as such.

We politicize these things, reproductive rights—this is absolutely something [where we need] physician voices. I was just talking to someone else who asked me about abortion care, and abortion is health care in my mind. That is a spectrum of the best practices in medicine. You know, there are situations where that is a best practice, and as a physician, I want the standards of care to be available to me when someone needs those standards. So, I think that that is something that I can say. This is not a political issue. This is a health care issue in a way that most people who aren't practicing physicians just can't.