Civic Rx

Today, we peer into long-term care in America — those services, both medical and non-medical, that patients in old age or with chronic illness need to perform activities of daily living. More than half of older Americans will eventually require long-term care. And this number will only swell as we reach into the next decade when, for the first time in our nation's history, there will be more elderly than children. Of these Americans, the vast majority would prefer to age at home and in their communities. But our long-term care system, such as it is, is ill-equipped to accommodate them.  Nearly 1 million Americans nationally languish on waiting lists for home-based care, with an average wait time that exceeds 3 years. More than 50 million, meanwhile, serve as unpaid caregivers for their family. And 3 in 4 worry about not being able to afford a nursing home, which on average, costs $100,000 a year. By way of reference, the median household income among those 65 or older in 2018 was $44,000. Medicare, the federal insurance program for older Americans, does not cover long-term care. Nor do most private insurance programs — which themselves exact exorbitant costs. Wealthy Americans can pay out of pocket, and Medicaid covers the very poor and disabled. But the vast majority — or “forgotten middle” — of Americans, have no sustainable option for accessing care. Here to discuss this broken system — and why COVID-19 has exposed and exploited all those caught in its breach — is Dr. David Grabowski, Professor of Health Care Policy at Harvard Medical School and an acclaimed decades-long researcher of long-term and post-acute care. David has published dozens of articles on the economics of aging and is the perfect person with whom to explore both the challenges and the opportunities for long-term care in the United States. His reflections on this moment are not to be missed. For more on Civic Rx, visit civic-rx.org.

While COVID-19 continues to dominate news headlines, another crisis lurks unabated and largely unaddressed: climbing maternal deaths. Among industrialized nations across the globe, the United States stands out as the most dangerous for pregnant women. Over 700 women die each year, 60% of them from preventable causes, during pregnancy or delivery. And Black women are 3 times more likely to die than White women.   Perhaps surprisingly, it didn't used to be this way.   For much of the 20th century, the US enjoyed an almost unmitigated decline in its maternal mortality rate, driven by scientific advances and improvements in general living conditions. But in the late 1980s, that progress began to stall. The maternal mortality rate in 1987 was 7.2 deaths per 100,000 births; by 2017, that rate had more than doubled. Today, the US is the only country in the developed world to see its maternal mortality rate go up; American mothers are 50 percent more likely to die in childbirth than their own mothers were. And it has the highest maternal mortality rate of any wealthy nation in the world.   What's provoked such a dramatic rise in America's maternal mortality rates — just as the rest of the developed world has pushed its' down? Why are women of color disproportionately vulnerable? And what can we do, at the hospital level and the state and federal levels, to redress maternal health inequities?   Few are better poised to shed light on these questions than Dr. Elizabeth Howell, Chair of the Department of Obstetrics & Gynecology at the University of Pennsylvania's Perelman School of Medicine. Dr. Howell is a practicing ob/gyn and a nationally recognized leader in redressing maternal and child health disparities. And on today's episode, together, we begin to unpack America's maternal mortality crisis.   For more, check out the below: - to learn about the Black Maternal Health Momnibus Act - to watch Dr. Howell's TEDMED talk - to understand the Alliance for Innovation on Maternal Health's (AIM) safety bundles, and - to get a “primer” on maternal mortality in the U.S., from the Commonwealth Fund   And to learn more about Civic Rx, go to civic-rx.org.

Just last week, Dr. Rochelle Walensky became the first CDC director in more than 20 years to call for federal action against gun violence. Meanwhile, President Biden both on the campaign trail and since has vowed his commitment to advancing meaningful gun reform, publishing six executive orders on the issue this April. And the NRA — long the swaggering villain in this saga — has been steadily losing sway, as it's mired in bankruptcy and litigation.   Is this a tipping point in the fight for gun safety?   Today, we talk with Shannon Watts and DeAndra Dycus, two extraordinary mothers and founder and volunteer, respectively, of Moms Demand Action: America's largest grassroots movement to prevent gun violence. Together, we explore why this fight is so often marked by cycles of tragedy and neglect, what might be done to break the political stalemate, why we need gun owners at the table, and which policy solutions are most likely to be effective — as well as the stories of Shannon and DeAndra themselves.    It's a humbling conversation. No matter your stance on gun safety, I hope you'll join us and take a listen.   To learn more and join the gun violence prevention movement, visit momsdemandaction.org or text JOIN to 644-33.

We were just approaching the cusp of normalcy this summer when Delta, abetted by a silent revolt of the unvaccinated, pulled us back into a war against the coronavirus. Once again, now, COVID-19 cases are surging, hospitals are brimming, deaths are rising, and Americans across the country are being beseeched to don their masks. For even the most resilient among us, this relentless tug between progress and regress on the pandemic is exhausting. But for thousands of Americans, this stress has morphed into something even more pernicious: According to a survey by the US Census Bureau, more than 42% of people last December reported symptoms of anxiety and depression, a dramatic increase from just 11% in 2019. Among 5,000+ US adults surveyed by the CDC, 13% reported starting or escalating substance use to cope with pandemic-induced stress. Young people, people of color, essential workers, and those previously diagnosed with mental illness have been disproportionately afflicted. But the challenge of this growing mental health epidemic transcends any single community: as Americans, we are all at risk. And the time to act is now. Today, we talk with Dr. Ashwin Vasan, the President and Chief Executive Officer of Fountain House, a national organization delivering services to and aiding the recovery of the seriously mentally ill. Dr. Ashwin Vasan is an epidemiologist, a social entrepreneur, and a physician who has committed his career to the advancement of health equity. And today, he shares why it's necessary to treat the seriously mentally ill with respect and with dignity, how his organization has mobilized to meet their needs, and why the pandemic has only magnified the urgency and the value of building a movement to advance the civil rights of the mentally ill. For additional episodes and more about Civic Rx, check out civic-rx.org.

Climate change is “the greatest global health threat… in the 21st century.” Even and especially in the wake of pandemic, climate change accelerates transmission of infectious disease, disrupts our health care supply chain, overwhelms our public infrastructure, and exacerbates chronic illness — from lung cancer to chronic kidney disease.   Here to talk with us about what this means is Dr. Ari Bernstein, a pediatrician, assistant professor, and the interim director of The Center for Climate, Health, and the Global Environment (C-CHANGE) at the Harvard Chan School of Public Health. Dr. Bernstein leads Climate MD, a program that prepares a climate-ready healthcare workforce. And he developed the Health Effects of Climate Change course, which has been taken by more than 100,000 students virtually in over 100 countries.    In this episode, Dr. Bernstein and I delve into the varied and multiplying impacts of climate change on health: our bodily health, mental health, public health and health care delivery. We discuss the responsibility of the health system to advance climate resilience and environmental justice. And we explore the policies and the questions the Biden administration must grapple with to make a dent in this global crisis. 

We're back! Our first season featured the voices of everyone from Tony Fauci to former Australian Prime Minister Julia Gillard, each of them grappling with the pandemic and with the daily crises it created. But the stories we unspooled are only the beginning. There are still countless threats to our public health, from climate change to structural racism, that during COVID, have been either exacerbated or ignored. Enter Season 2. This summer, I invite you to join me in cutting into these next big issues — beyond COVID — and talking to the scientists, the policymakers, the activists and storytellers who are lighting the path forward. I can't wait to get started, and to share these discussions with you. We're back this July, at civic-rx.org, and wherever you get your podcasts. See you then.

The COVID-19 pandemic has unsparingly exposed the flaws of our fragmented and exorbitant healthcare system, but it has also highlighted opportunities to better deliver care. Chief among these are new models to bring care closer to patients, be it in the form of virtual medicine, mobile health clinics, community health workers, or home-based care. Indeed, now more than ever, brick-and-mortar hospitals are working hand in hand with community-based organizations, public health departments, and local and state governments to deliver services and reach people who otherwise might fall through the cracks. As a post-pandemic future draws nearer, I wanted to talk with someone who has lived that evolution, and could speak to what this new approach meant for the future. Which is why I’m excited to introduce Dr. Meena Seshamani, Vice President of Clinical Care Transformation at MedStar Health -- a large, Maryland-based health system -- where she is charged with leading value-based care initiatives across the system’s 10 hospitals and 300+ outpatient care sites. Today, Dr. Seshamani shares MedStar’s experience adapting its practice and operations to a once-in-a-century pandemic. She offers lessons, in innovation and in crisis management, for other health systems navigating this period. And she explores what changes need to be made more broadly to foster an equitable, better integrated, more wholesome approach to care delivery — leveraging the insights gleaned over the last 15 months. For more ideas on how to reform our ailing American health system, and how the pandemic might spur us forward, check out:  - "Ten Actions For Better Post-Pandemic Health Care In The United States," in Health Affairs - "After COVID-19: Thinking Differently About Running the Health Care System" in The Journal of the American Medical    Association - "9 ways COVID-19 may forever upend the U.S. health care industry" in STAT - "Covid-19 - Implications for the Health Care System" in The New England Journal of Medicine For more on Civic Rx, visit civic-rx.org.

Have you been vaccinated? And if so, can you prove it — should you need to?   These are the questions that countless Americans are asking themselves as the United States vaults past 200 million doses, or more than a quarter of its population now vaccinated, against COVID-19. These numbers will only continue to rise, and already, we’ve been thrust into a fierce debate over the utility, the equity, and the logistics of vaccine passports — proof for the holder of inoculation — that could afford a ticket to normalcy. Vaccine passports in various forms are even now being piloted in cities and countries across the globe, including in Israel, Denmark, and New York.   Not surprisingly, the issue has become the latest front of the culture wars. Several conservatives have argued that such passes violate personal liberties, and Texas and Florida’s governors have both showily signed orders prohibiting their use, citing privacy concerns. Liberals, meanwhile, are split, with some insisting on their value as a powerful public health tool and still others highlighting the risks of exacerbating health disparities, as access to the vaccine itself remains unequal.    This debate is not new. Vaccine passports date back to the late 19th century, during the third bubonic plague pandemic, when officials in British India first required certificates of immunization for domestic travel. Then as now, the issue was both contested and massively complex — encompassing legal, ethical, policy, logistical, and equity dimensions. Despite these debates, vaccine passports in some form seem near inevitable, as a growing number of states and businesses all say they will require documentation to open their doors.    Understanding what’s at stake therefore becomes deeply important. Enter Dr. Arthur Caplan, Mitty Professor of Bioethics and founding director of the Division of Medical Ethics at NYU School of Medicine in New York City. Dr. Caplan is the author or editor of over 725 peer-reviewed papers and 35 books, including most recently Vaccination Ethics and Policy. He is steeped in the ethics but also the politics and the practical challenges of vaccine passports. So he’s the perfect person to unravel this issue with us.   Together, we discuss what vaccine passports are and are not, where they are being deployed — and how effective they are in their intended aims —, who opposes them and why, what operationally might thwart their implementation, and their implications for equity and personal liberty.   For more information, check out the links above, and follow @ArthurCaplan on Twitter.

In order to get ahead of the COVID-19 pandemic, we need to understand where it’s going. And key to this is genomic surveillance, or the systematic collection and interpretation of viral genetic sequences to identify new variants and detect transmission patterns. Genomic surveillance is one of the most powerful tools officials can wield in crafting public health interventions, on everything from lockdowns to travel bans to vaccine policy.    Unfortunately, the United States is not doing enough of it. Of the more than 30 million COVID-19 cases we've counted this past year, only 0.6% have been sequenced — placing us 33rd in a global ranking. Like most other elements of our pandemic response, genomic surveillance in the United States has been halting, uncoordinated, and underfunded.    The Rockefeller Foundation (TRF) wants to change that. Three weeks ago, TRF released a blueprint — distilled from conversations with dozens of scientists, public health officials, and industry stakeholders — for building a national genomic surveillance system. And it’s committing $1 billion to the cause. Here to talk to us about why this is important, and what the building blocks of a national genomic surveillance system should look like, is Dr. Jonathan (“Jono”) Quick, the author of The End of Pandemics and TRF’s Managing Director of Pandemic Response, Preparedness, and Prevention.  I hope you enjoy the conversation.    For more information, check out: “Accelerating National Genomic Surveillance,” the TRF’s action plan for creating a national genomic surveillance system in the United States. “Implementation Framework: Toward a National Genomic Surveillance Network,” its companion document that identifies key barriers to realizing a robust national genomic surveillance system and outlines practical opportunities to reduce these barriers.  this piece in The Atlantic about the rapid rise of genomic surveillance, which has revolutionized pandemic response

After more than 2.5 million deaths and widespread economic devastation, finally, the world has a shot of hope: multiple, effective COVID-19 vaccines. But as wealthy countries race to inoculate their populations, the majority of poor countries have yet to administer a single dose.   Enter COVAX, the COVID-19 Vaccine Global Access initiative. COVAX is a coalition of organizations — from the World Health Organization, to Gavi, to the Coalition of Epidemic Preparedness and their key implementation partner UNICEF — that is working to ensure that vaccines are distributed equitably across all nations, rich and poor. It's secured almost 3.6 billion vaccine doses for distribution this year, and as of this morning, has shipped just under 30 million to 50 countries — the majority low- and middle-income countries.    As you can imagine, equitable global procurement, allocation, and delivery of vaccines is a tricky endeavor. Which is why I'm thrilled that today we have Gian Gandhi to translate for us the key questions and challenges. Gian is a health economist and the COVAX Coordinator for UNICEF, in which capacity he coordinates the COVID-19 vaccine supply response across 100 principally low- and middle-income countries.    Gian and I recorded this conversation two weeks ago, so some of the numbers we discuss have since grown. But the crux of our conversation — about the genesis of COVAX, the dangers of vaccine nationalism, the challenges in last-mile delivery, and the role of different stakeholders, from pharma companies to ordinary citizens, in pressing for equity — is more relevant than ever.      To learn more about COVAX, and check out its latest updates, visit Gavi's page on the partnership here.    For an interactive vaccine market dashboard, with up-to-date information on the procurement and delivery of vaccines to countries worldwide, visit this page here.    Show your support for fair and equal global access to COVID-19 vaccines, as part of the UN's #OnlyTogether campaign, on social media.    And learn more about Civic Rx at civic-rx.org. 

For much of the last year, the highest per capita rate of coronavirus infections belonged not to New York City, nor New Jersey, but to a 27,000-square-mile territory in the southwestern US called the Navajo Nation. Encompassing 3 states and 309,000 members, the Navajo Nation is the country’s largest Native American tribe.  It was also, in 2020, one of its worst hot spots. But the COVID-19 crisis, like so many others that have afflicted Indian Country, was decades in the making — borne of a long legacy of neglect and promises broken by the U.S. government.  Here to share the unique challenges his people have navigated, their successes, as well as their priorities with a more receptive US administration, is Jonathan Nez, the 9th President of the Navajo Nation, and the youngest in its history. I learned a lot from him and am excited for you to hear what he has to say.   To learn more about the Navajo Nation, check out: - this brief retelling of their history - the Navajo Department of Health’s page on COVID-19 - President Nez’s testimony to the U.S. House last July, about tribal needs amid the pandemic  - this CNN feature on their tremendously successful vaccination campaign    To listen to more Civic Rx, visit us at civic-rx.org. 

Nestled between India and China in the heart of the Himalayas, the Kingdom of Bhutan has long been known for its philosophy of Gross National Happiness, as a more holistic alternative to GDP. Over the last year, Bhutan has acquired yet another source of fascination and acclaim: its pandemic response. Even as countries the world over have struggled to contain the pandemic’s spread, Bhutan, somehow, has emerged relatively unscathed. Since March 2020, in the 12 months since the pandemic first struck, Bhutan has sustained just 1, a single, death from COVID-19.     Here to share this remarkable story is Bhutan’s Minister of Health, Her Excellency Dechen Wangmo, who since 2018 has served as the only woman in Bhutan’s cabinet. Minister Wangmo tells us today about her own journey, her vision and her hopes for the future of Bhutan. She also recounts how her country was able to mobilize so early, and effectively, against the threat of pandemic.  We discuss what public health measures the country instituted and also how they were able to enlist the unmitigated trust and commitment of the public to these goals.  It’s an interesting conversation, and I hope you enjoy it. To learn more about what’s discussed: Read more about Bhutan at the World Bank and World Health Organization websites   Follow Minister Wangmo on Twitter Check out this feature in The Atlantic about Bhutan’s pandemic response    To learn more about Civic Rx, visit civic-rx.org.    — Quick dictionary: ILI and ARI surveillance = influenza-like illness (ILI) and acute respiratory infection (ARI) surveillance, performed by many health facilities around the world to monitor virus activity and identify novel viruses, as part of the global influenza sentinel surveillance system   Abbot = in Buddhism, the administrator of a monastery or large Buddhist temple

One year ago this month, America lost its first life to the coronavirus. Since then, nearly 500,000 Americans have succumbed to the pandemic, and many more have lost their family, their classrooms, and their livelihoods.   No person has been more widely reviled for dooming our response than former President Donald Trump. But a new report published in the British medical journal The Lancet finds that as damaging as were Trump’s actions and his antagonism toward science, they represented merely the extension of a long tradition of harmful policies stretching back decades, which collectively left the United States acutely vulnerable to the pandemic: and resulting in the deaths of 461,000 Americans, in 2018 alone.   This report, published by the Lancet Commission on Public Policy and Health in the Trump Era, offers an unsparing assessment of the many and overlapping failures of the US health care system, as well as of the social mores and policy choices that fueled and have perpetuated those failures over four decades.   Here to discuss their findings, and what they mean for a nation still struggling to move forward, is Dr. Steffie Woolhandler, co-chair of the Lancet Commission and distinguished professor in the CUNY School of Public Health at Hunter College. Dr. Woolhandler is a practicing primary care physician as well as a co-founder and board member of Physicians for a National Health Program, the only national physician organization dedicated to implementing a single-payer health program in the United States — now encompassing more than 20,000 members. She has authored over 150 journal articles, chapters, and books on health policy and continues to guide the national debate as a staunch champion of Medicare for All.   For more about the Lancet Commission, check out: - its landing page, with links to the full text as well as graphics and associated editorials - the report itself, at 49 pages an excellent weekend read   Follow Steffie on her Twitter page.   And learn more about Civic Rx at our website, civic-rx.org. 

Yesterday, we inaugurated a new president and vice president, and with them, a government invested in science, grounded in evidence, and committed to transparent and compassionate leadership.    Today, they face a global pandemic that has devastated the American economy, stolen 400,000 lives, and disproportionately harmed the poor and people of color. They also inherit a country deeply divided, suspicious of truth, and more vulnerable to disinformation than perhaps at any other time in our history.   To achieve any real progress in beating back the pandemic, they -- with us all -- must commit intently to combatting disinformation and restoring trust in scientific expertise. Honest, transparent, straightforward science communication is key to this mission. The past 10 months have demonstrated that the success of even basic public health measures like mask-wearing and social-distancing hinges on how well they are communicated, and who does the messaging.    To begin to plumb the complexity of communicating effectively, during this public health crisis, I wanted to talk to my dear friend, frequent media commentator, and brilliant epidemiologist, Dr. Celine Gounder.    Dr. Gounder is an infectious disease doctor and clinical assistant professor at New York University, the Founder and CEO of nonprofit multimedia organization Just Human Productions and, until just yesterday, a member of the Biden-Harris Transition’s COVID-19 Advisory Board.   She’s the perfect person to help us understand why effective science communication is so critical to curbing this pandemic, and what has made it in turn so elusive. And I couldn’t be more thrilled to welcome her to the show.    To learn more about Dr. Gounder, check out her website.   For more on Civic Rx, visit civic-rx.org.   

In countless ways, the COVID-19 pandemic has exposed, exploited, and exacerbated the racial inequities long endemic to our healthcare system. Today we talk with Dr. Kermit Jones, a primary care physician, lawyer, and former Navy flight surgeon about the interaction between COVID-19 and longstanding structural racism in medicine.     To learn more, check out: - the CDC's primer on the racial and ethnic disparities of COVID-19   - The Washington Post's analysis of 5.8 million COVID-19+ cases late last year - this perspective in the Journal of the American Medical Association's Health Forum on racism in the health care system  To listen to other episodes of Civic Rx, visit us at civic-rx.org.

Dr. LJ Punch (they/them/theirs) is a critical care surgeon, a former professor of trauma surgery at Washington University St. Louis, and a staunch advocate for gun violence prevention. For the past four years, they have been building the T, an anti-violence center in St Louis that supports the local community in recovering from trauma — be it from guns, opioid addiction, COVID-19, or homelessness. Most recently, they opened the Bullet Related Injury Clinic, or the BRIC, to provide both physical and mental health care to those whose lives have been upended by gun violence. Today, we talk to Dr. Punch about community, gun violence prevention, their journey to St. Louis, and the imperative of rebuilding trust. To learn about Dr. Punch’s work and see how you can contribute, visit their websites for the T and the BRIC. To listen to more episodes, visit civic-rx.org.

Today I’m thrilled to welcome two friends and brilliant policy leaders, Dr. Ben Miller and Dr. Kavita Patel, to explore what policies the Biden-Harris administration might undertake to redress the country’s rapidly worsening mental health and addiction crises.  America is on the brink of an unprecedented mental health pandemic. A full third of Americans have reported symptoms of clinical anxiety or depression — a 200% increase from pre-pandemic levels; rates of opioid-related deaths are increasing in more than 40 states; and mental health emergency department visits have surged, as more people struggle without the providers to support them.  In our last conversation, we learned about what it was like to treat the surge of mental health cases on the ground. Now, we discuss what an enlightened government might do to build a system capable of meeting soaring needs in the future. We consider what the administration’s foremost priorities should be, and how the bitter partisanship on Capitol Hill might thwart or inform this agenda. And we review the policy levers that leaders at the local and state levels are already pulling to break through the noise.  Ben and Kavita are the perfect people to walk us through these questions. Ben is the Chief Strategy Officer of Well Being Trust, a national foundation committed to advancing the mental, social, and spiritual health of the country. And Kavita is a primary care doctor and Vice President of Payor and Provider Integration at Johns Hopkins Medicine, as well as the former director of the White House Office of Intergovernmental Affairs and Public Engagement, under President Obama.  For more on Ben and Kavita, check out their websites, as well as this Atlantic piece they penned in May foreshadowing the national mental health crisis. And for more on Civic Rx, visit our website at civic-rx.org. 

For 10 months, we have borne witness to the unsparing ravages of a pandemic that has plundered over 250,000 lives, millions of jobs, countless life milestones and, normalcy. Throughout it all, the overwhelming feeling has been that of being unmoored. Which is why, as we enter what appears a resurgent phase of the COVID-19 pandemic, there’s another crisis on my mind: mental health. Yes, we are also in the throes of a mental health pandemic. Orders of magnitude more people, in the United States and around the world, are suffering depression, anxiety, PTSD than this same time last year. And this is due both to the direct mental health consequences of COVID-19 — which has effectively perpetrated a mass trauma on our psyche — and to the indirect consequences, ranging from joblessness to racial disparities to political rancor. As divided as this country may be over even the basic existence of COVID-19, what remains uncontested is that we’re not doing enough to shore up one another’s mental health. Enter Dr. Jessi Gold, an Assistant Professor of Psychiatry and the Director of Wellness, Engagement, & Outreach at the Washington University, St. Louis School of Medicine. Dr. Gold is a practicing psychiatrist and a prolific writer and observer of mental health as depicted in the media and popular culture. For years, she has shared candidly of her own experiences while speaking vigilantly against disinformation online. Today, Dr. Gold and I talk about her experiences discovering and practicing psychiatry, pre- and post-pandemic. We explore what it means when so much of the country is suffering from pandemic-induced anxiety and depression. And we reflect on the particular trauma befalling health workers, and how only recently that stigma has begun to lift. I hope you enjoy our conversation.    For more on Dr. Gold, including links to her writing, check out her website. For more on Civic Rx, visit civic-rx.org.     And as a reminder, if you or anyone you know is suffering, please don't wait to get help. Call the National Suicide Prevention Lifeline at 1-800-273-8255, or reach the Crisis Text Line by texting HOME to 741741. Stay safe.

When the dust settles on this year, this election, this pandemic, one of the many truths that will knell clear is that our healthcare system desperately demands reform. Never before has the interdependence of health, social privilege, and economic security been so grossly on display. We need a wholesale reimagination of how we define, deliver, and pay for care.  Fortuitously, we have a model for what this might look like. And it comes in the form of Cityblock Health, a growing public health startup that integrates primary care, behavioral care, and social services to deliver high-quality care to low-income communities.When the pandemic struck, it became clear that the racial and economic disparities long festering in our country would be splayed viciously open, and Cityblock’s patients would bear their disproportionate toll.  Today, we talk with Cityblock’s cofounder and Chief Health Officer, Dr. Toyin Ajayi, about how the company mobilized to meet this need, and why this moment only magnifies the urgency and value of its model. Cityblock spun out from Alphabet’s Sidewalk Labs in October 2017 with a mission to treat, at scale, the root causes of poor health in underserved urban populations. It has since expanded beyond New York to Connecticut, Massachusetts, North Carolina, and Washington, D.C.  For more information, check out: Cityblock’s blog Toyin’s TEDMED talk And listen to more Civic Rx episodes at civic-rx.org. 

We are at a time of unprecedented upheaval and none is more affected, around the world, than women and women of color.  On the 25th anniversary of the Beijing Platform of Action, in the very year that we were meant to honor and redouble our commitment to gender equity, even the limited gains of the last two decades hazard being swiftly and summarily rolled back.  Here to discuss why these inequalities are so critical to redress is (my and) a #shero of global proportions: the Honorable Julia Gillard, Australia’s 27th Prime Minister and Leader of the Labor Party, from 2010 to 2013. To this day, Julia is the first and only woman to have served as Australia’s Prime Minister. She is the Inaugural Chair of the Global Institute for Women’s Leadership at King’s College, London; Chair of Australia’s leading mental health awareness organization, Beyond Blue; Chair of the Global Partnership for Education; Patron of Camfed, the Campaign for Female Education; and, just announced, Chair-elect of the Wellcome Trust. Most recently, Julia published her second book, Women and Leadership: Real Lives, Real Lessons, with former Nigerian Finance Minister Dr. Ngozi Okonjo-Iweala — sharing the experience and advice of some of our most extraordinary women leaders, in their own words.  I am so honored, and grateful, that Julia joined us, and so thrilled to be able to share our conversation with all of you.  For more about Julia, check out her website. View her famed misogyny speech, which rocked the world for its “masterful, righteous take-down” of sexism.  Read "Essays on Equality," the Global Institute for Women's Leadership's report on the gendered impacts of COVID-19.   And learn more about and purchase Julia's new book, Women and Leadership.

More fundamentally than any other event of the past decade, the COVID-19 crisis has kindled a wholesale re-imagination of how we conceive, deliver, evaluate, and pay for health care. Foremost among these changes is the sudden ubiquity of telehealth, but the pandemic has also unleashed a wave of investment and regulatory innovation not seen perhaps since the launch of the Affordable Care Act.      Few are better poised to unpack these trends than Dr. Bob Kocher, an industry titan who for nearly two decades now has stood at the vanguard of efforts to make healthcare work better, faster, cheaper across this country. Today, Bob is a Partner at venture capital firm Venrock, where he leads healthcare IT and services investments and serves on the Boards of Virta Health, Aledade, Renew Health, Lyra Health as well as Devoted Health, both of which he cofounded. He’s an Adjunct Professor at Stanford’s School of Medicine and a Senior Fellow at USC’s Leonard D. Schaeffer Center for Health Policy & Economics. Before coming to Silicon Valley, Bob played a key role crafting the Affordable Care Act — serving as Special Assistant to President Obama for Healthcare and Economic Policy. Most recently, Bob was tapped by Governor Gavin Newsom to serve on California’s COVID-19 Testing Task Force, which quickly and substantially expanded the state’s testing capacity.    Bob is a brilliant physician, entrepreneur, policy wonk and scientist. His reflections on this moment are not to be missed.   More on Bob’s work, including his reflections and scholarship on health care writ large, can be found on his website.    For more on Civic Rx, visit civic-rx.org.  

We are now four weeks from November 3 and arguably the most consequential election of our lifetime. By that date, millions of Americans — hopefully, the vast majority of Americans — will have cast their ballot for our next president. Alongside that choice, as well, are myriad other offices at the state and local level that wield a profound impact on our day-to-day lives. These so-called down-ballot races are the site of the largest loss of Democratic power since the years of Eisenhower, as more than 1000 seats slipped from blue to red in the decade after Barack Obama’s historic victory.  Here to discuss why these races are so critical, how the Democratic Party has mobilized in the wake of 2016, and in what ways campaigning has adapted amid a global pandemic is Swati Mylavarapu. Swati is a Cofounder and Board Chair of Arena, a Founding Partner at Incite.org, and the former National Investment Chair of Pete for America, where she raised over $100M for Pete Buttigieg’s presidential campaign. Across every role, Swati has worked to catalyze the next generation of Democratic leadership. And in February, 2020, she and her husband pledged $200K more to help flip the U.S. Senate and protect hard-won Democratic majorities in the U.S. House.  For more: Register to vote.  Learn more about Arena, which is building the pipeline of progressive political leadership.  Learn more about Incite, which invests in rising leaders across the country. And listen to more episodes of Civic Rx.  

Mayor Michael Tubbs is Stockton’s first Black mayor and America’s youngest mayor ever to lead a city of greater than 100,000 residents. Since his election in 2016, Mayor Tubbs has pledged himself to revitalizing and reinventing the city of his birth, spearheading a bevy of new programs to fight violent crime, boost the college enrollment rate, and lower unemployment. In 2019, he launched the country’s first mayor-led guaranteed income pilot; this summer, he mobilized 24 other mayors to advocate the same.  Today, Mayor Tubbs discusses his childhood in Stockton -- how his own hard journey at once epitomizes and indicts our obsession with American exceptionalism. He talks about his struggle to cultivate trust with his constituents, and the lessons he’s learned leading an ideologically diverse city council. He shares the work Stockton has done to reform its police department, after municipal bankruptcy forced a critical rethinking of police funds. And he describes the history and impact of Stockton’s successful guaranteed income pilot.  For more, stream Stockton on My Mind, HBO’s new documentary on Mayor Tubbs, on HBO and HBO Max. Learn more about the array of initiatives he’s spearheaded through his nonprofit organization, the Reinvent Stockton Foundation, and check out his 2020 re-election platform, to learn what he's envisioning for his city next.  

A couple weeks ago we heard from Richard Barth, President of the KIPP public charter school network, about how K-12 schools across the country are navigating the capricious and unprecedented demands of COVID-19 this school year. Today we hear from a leader in higher education about how one major university is managing the same. Marc Tessier-Lavigne is a pioneering neuroscientist, biotechnology executive, and, since 2016, the president of Stanford University, where he has accelerated the university’s commitment to not only advancing knowledge but also leveraging those discoveries to solve real-world problems.    President Tessier-Lavigne’s own story — as the son of a Canadian military family, a first-generation college student and Rhodes Scholar who went on to perform groundbreaking neurological research and serve as both Genentech executive and now two-time university president — itself deserves a full conversation. But suffice it to say that, as a Stanford alum, I’m grateful that the university and my second home have President Tessier-Lavigne at the helm during this crisis.    Across the country, over 88,000 cases have already been reported on college campuses. Stanford made headlines last month when it announced that, in response to these numbers, it was closing its campus to most undergraduates this fall. Today, President Tessier-Lavigne and I explore how Stanford has reimagined its campus to prepare for COVID-19. We unpack why school leaders pivoted their reopening strategy amid the virus’s summer surge. We discuss college sports, and the Pac-12’s contentious decision to cancel football this season. We examine the financial consequences that this, and many other necessary changes, have exacted, both from students and from the university as an institution. And all of these issues we consider through the lens of equity.    For more details on the discussion, check out: Stanford’s reopening plans,  this profile of President Marc Tessier-Lavigne, and NYT’s college cases tracker, which only continues to grow.   And for more about Civic Rx, visit www.civic-rx.org. 

Since the earliest weeks of 2020, we’ve seen the federal government take a backseat to the states in directing America’s COVID-19 response. Though we could devote an entire episode to the frailties of this laissez-faire federalism, instead I want to help us dissect where we stand at the state level, by talking with one of the most robust state leaders during this crisis: North Carolina’s Secretary of Health & Human Services, Dr. Mandy Cohen. Secretary Cohen held several leadership roles in the Obama administration before moving to North Carolina in 2017. Since then, she and her team have been working hard to transform the state’s health system into one that integrates and pays for not only medical care, but also its underlying drivers: from housing to food security to transportation to domestic safety. This vision for whole-person health has propelled a cascade of new programs that establish North Carolina, as Politico mused last year, quite possibly as “the most innovative health care state in America.” And the COVID-19 pandemic, rather than distract from this mission, has only underlined its urgency. On today’s episode, Secretary Cohen and I discuss some of these new programs. We review her personal story and journey to North Carolina, and consider how her experience coordinating Affordable Care Act implementation has informed her approach to crisis management today. We talk about the void in federal leadership on COVID-19, and the avenues by which states are striving to learn from and collaborate with one another instead. And we explore what the next few months might look like, should the coronavirus continue to spread.     For more on North Carolina’s health and human services work, check out: the Department of Health & Human Services’s website this New York Times’s feature, “Inside North Carolina’s Big Effort to Transform Health Care” this Politico profile, “Why North Carolina might be the most innovative health care state in America”   And for more on the Civic Rx podcast, visit www.civic-rx.org.

As August slides into September, the absence of a national strategy on school reopening has left thousands of families to struggle alone with the decision about whether and how to send their kids back to school. In every state, school districts are fending for themselves to develop a plan that balances sometimes conflicting risks to public health, economic security, and emotional wellbeing.   Here to elucidate the challenges and considerations demanded of such a decision is Richard Barth, CEO of the KIPP Foundation, the largest network of public charter schools in the country. Founded in 1994, KIPP today serves over 100,000 predominantly underprivileged students across 255 schools, 88% of whom qualify for federal free or reduced-price lunch; 95%, from Black or Latinx families. When COVID-19 hit, the KIPP Foundation lept into action: reaching out to its 28,000 alumni, enrolling teachers in digital learning courses, launching a virtual mental health program, standing up local food banks, and providing vital human services in students' communities. Every community presented unique challenges, yet what distinguished KIPP's response was its commitment to engaging deeply with the families that it serves and to ensuring that both its messaging and its policies were community driven.    If you're interested in learning how a nationwide K-12 public school network has mobilized to respond to COVID-19; how it’s deciding which of its schools should and should not open; why it has prioritized investments in community resilience; and how racial and socioeconomic inequities have looked in practice for students and families, this episode is for you. And if you enjoy it, follow it up in two weeks, with our episode on colleges and universities.   Until then, learn more about KIPP here. See the state-by-state progress on school reopenings here.    And learn more about Civic Rx here.

For the past 7 years, Ilyse Hogue has served as the President of NARAL Pro-Choice America, the oldest organization dedicated to building political power around women's reproductive freedom and right to abortion. That time on the front lines has afforded her tremendous opportunity to reflect on the curious and complicated history of abortion rights advocacy — a history she's now distilled into a powerful new book, The Lie that Binds, which chronicles how the formerly non-partisan issue of abortion was reinvented as a political device, to advance a much broader agenda of social control. In this episode, Ilyse and I unpack the emergence and the evolution of the anti-choice movement, from its roots in school segregation to the administration of Donald Trump. We discuss the role that disinformation, then and now, has played in framing the debate. And we explore what those of us on the side of choice can do to re-engage and reclaim the narrative — at a time that reproductive rights seem perilously under threat.     To learn more about Ilyse's work and to purchase her book, The Lie that Binds, you can visit the book's website.   For more about Civic Rx, visit www.civic-rx.org. 

I interviewed the United States' 19th Surgeon General, Dr. Vivek Murthy, at a vibrant virtual town hall hosted last week with cultural heritage organization, Indiaspora. At a time of heightened physical isolation, sharing this space and this community to discuss one of the defining struggles of our age — loneliness, and social disconnection — was as cathartic as it was generative. In this episode, Dr. Murthy reflects on the Listening Tour he took as a new Surgeon General in 2014, when to his surprise, loneliness emerged again and again at the root of disparate communities' challenges. We also explore the biological mechanism of loneliness, its evolutionary origins and consequences for our physical and mental health. And finally, we draw a connection from this moment in history — our growing political polarization and the national reckoning with racial injustice — to loneliness as both cultural experience and public health crisis. Interwoven throughout are insights and stories from Dr. Murthy's new book, Together: The Healing Power of Human Connection in a Sometimes Lonely World. The conversation is as timely as it is urgent, reminding us gently of our power and responsibility to lead from a place of love.   To learn more about and purchase Dr. Murthy's book, check out the Together website.   For more about Civic Rx, check out www.civic-rx.org. 

I first met Dr. Abdul El-Sayed 7 years ago at a fellowship retreat. He was still in medical school, but even then it was clear, our healthcare system dismayed him: it was unaffordable, inefficient, and cruel to those who needed it most. The experience galvanized Abdul to pivot from practicing medicine to repairing public health, beginning with the city of Detroit, where he became the youngest health commissioner of a major American city when he was appointed to rebuild the Detroit Health Department, after it was gutted and privatized during municipal bankruptcy. In 2018, Abdul ran for Governor of Michigan on an unapologetically progressive platform of universal health care, clean water for all, debt-free higher education, and a pathway to 100% renewable energy; he didn't win, but earned the endorsements of several progressive leaders, including Senator Bernie Sanders and Congresswoman Alexandria Ocasio-Cortez. Most recently, he's written a book, Healing Politics, which diagnoses our country's epidemic of insecurity and the empathy politics we must embrace to treat it.    Abdul is brilliant, a political force, and a bright moral light at a moment when we need such leadership dearly. Over the years, I've been grateful to call him a friend, someone I trust to make sense of the times we live in. So for this episode, I asked Abdul if he would join me to talk about his journey, this unsettling moment in our country's history, and his blueprint for a more equitable and sustainable future, as charted in his book. What results is a thought-provoking conversation about personal agency, what it means to live a life of meaning, why so many people are hurting right now, and what we owe to each other as a society.    For more on Abdul and to order his book, Healing Politics, visit his site here.    And contact the show anytime at www.civic-rx.org. 

Dr. Leana Wen is an emergency medicine physician and a professor of health policy & public health at George Washington University. Previously, she was the Health Commissioner for the City of Baltimore, where she led the nation’s oldest continuously operating health department. She’s the author of critically acclaimed book, When Doctors Don’t Listen, and its ensuing TED talk, now viewed over 2 million times. In 2019, Dr. Wen was named one of TIME 100’s Most Influential People. For this episode, Dr. Wen and I delve into her time in Baltimore and, particularly, the lessons it holds for the moment we’re in now, as cities hasten to respond to dual crises of racism and infectious disease. We also explore the critical role that trust — institutional trust, social trust, patient-to-physician trust — plays in an effective pandemic response, and discuss what we can do to restore trust in public health and public officials. And through it all, Dr. Wen reflects on her personal journey, and how she came to discover and inhabit her own voice.   For more on Dr. Wen's work, check out: her TED talk: "What your doctor won't disclose" her weekly column in The Washington Post  her reflections on 4 years as Baltimore's Health Commissioner, in Health Affairs her feature in The Atlantic, for a representative day-in-the-life: "Working a million hours to heal a city" And for more on Civic Rx, visit www.civic-rx.org. 

Dr. Anthony Fauci is the Director of the National Institute of Allergy and Infectious Diseases, where since 1984, he’s overseen a vast portfolio of basic and applied research to prevent, diagnose, and treat infectious disease — everything from HIV/AIDS to malaria, Ebola, Zika, and now COVID-19. He was a chief architect of PEPFAR, the President’s Emergency Plan for AIDS Relief, and today serves as one of the seminal members of the White House Coronavirus Task Force, where he advises the federal government on its response to the pandemic. Our space here cannot adequately capture Dr. Fauci’s contributions, but suffice it to say that he is a giant in medicine and a profound personal hero, and it was a treasure to talk with him for this episode. We cover a lot of ground in limited time, from the state of our country’s coronavirus response, to his approach to navigating the political tensions intrinsic to his job. We also reflect on his personal journey, from his childhood to choosing medicine through his four decades in government. I deeply enjoyed this conversation, and hope you do, too. For more, check out: the CDC's guidelines on how to protect yourself, this tracker by the NYTimes of the status of all 50 states' reopenings, and Dr. Fauci's remembrance of his dear friend and AIDS activist, Larry Kramer, who passed away in May  And for more on Civic Rx, visit www.civic-rx.org. 

Peter Sands is the Executive Director of the Global Fund to fight AIDS, Tuberculosis, and Malaria, a multilateral organization that invests $4 billion a year to combat these three epidemics — and this year, too, COVID-19.   To put that in perspective, the Global Fund serves as the single largest provider of external health financing for all the low- and middle-income countries in the world. A significant proportion of these resources go toward equipping health systems to respond to crises exactly like this one. And yet, as we discuss, much of the world has been found unprepared for COVID-19— while the political wrangling between the United States and other key leaders jeopardizes any type of coordinated response. Peter and I cover a lot of ground in this episode — from the uneven impact of COVID-19 around the world, to the complications it poses for existing global health campaigns like those against TB and malaria. We also discuss why the private sector should be incentivized to invest in pandemic preparedness, and how Peter’s past as CEO of Standard Chartered Bank has informed his response to questions about the pandemic’s economic costs.   Links of interest: For more on the Global Fund, check out: https://www.theglobalfund.org/en/ Peter’s post, “When Finance Fails: Why Economists Didn’t See a Coronavirus Collapse Coming”:: https://www.theglobalfund.org/en/blog/2020-03-25-when-finance-fails-why-economists-didnt-see-a-coronavirus-collapse-coming/ Peter’s editorial on the necessary parallels between the 2008 financial crisis and today’s public health crisis, and how we must invest robustly in global health security: https://www.ft.com/content/c8eae26c-6204-11ea-abcc-910c5b38d9ed Want to learn more about the show? Check out civic-rx.org. 

Hi, everyone, my name is Dr. Sejal Hathi, M.D., M.B.A., and this is Civic Rx: a podcast and a project to help all of us make sense of the million different ways our world has shifted in the wake of the novel coronavirus: Every episode, I bring you conversations with people whose work and ideas are challenging and transforming the way we live, work, and build community. Together, we reflect on how we can foster a healthier and more equitable society.   Learn more at: www.civic-rx.org