The Dose

Data is the engine of health innovation, but too often it can't tell the full story. On this week's episode of The Dose, Dr. Sema Sgaier joins host Joel Bervell to talk about the future of equitable health care: how we collect data, who's included, and what it means for clinical trials, mental health, and the role of AI. Tune in to hear Dr. Sgaier explain why solving health care's toughest challenges starts with understanding the human side of health — and how inclusive data can lead to smarter policies, safer treatments, and better care.

We're in a pivotal moment for health care equity and public health. Systems for tracking data on maternal mortality and chronic disease are being dismantled, with consequences that could last generations. On this week's episode of The Dose, Dr. Marcella Nunez-Smith joins host Joel Bervell to talk about who's represented in the health data we collect, and who isn't, and why it's so important for “people to feel safe in sharing” their data and “to have trust that it's protected.” Dr. Nunez-Smith also explains how her experience as a parent of a child with a rare disease frames how she approaches her work in health equity.

When private equity firms buy your local hospital, your primary care doctor's office, or your local nursing home, they profit. But what happens to those health care institutions, the patients they serve, and the people who work there? On The Dose this week, Dr. Zirui Song, a renowned expert on private equity in health care, talks with host Joel Bervell about the ways private equity maximizes profits — from cherry-picking patients and reducing staffing to putting the institutions they buy in debt. He also discusses efforts underway to protect patients and communities.

As the American Medical Association's first chief equity officer, Dr. Aletha Maybank guided the legacy medical institution through a difficult reckoning with its past exclusion of Black and women physicians. In a new episode of The Dose, host Joel Bervell talks to Dr. Maybank about how she did it, what lessons the AMA holds for our current moment, and why she has hope that American institutions can evolve into places that serve all of us.

Yes, the planet is getting hotter, tropical storms are becoming ever more fierce, and the Arctic is melting — but what's that got to do with health care? This week on The Dose podcast, host Joel Bervell explores the intersection of climate change and public health with Admiral Rachel L. Levine, M.D., the U.S. Assistant Secretary for Health. Levine, who oversees the federal Office of Climate Change and Health Equity, talks about how weather-related events are already having a serious impact on our fragile health system supply chain, even though those effects can go unnoticed by the broader public. In communities repeatedly ravaged by storms or heat waves, a lack of blood donations is leading to delays in surgeries and treatment for diseases like sickle cell. In rural Alaska, where the melting permafrost is wreaking havoc on wildlife populations, native tribal communities are forced to rely on shipments of food items that are typically high in sugar and salt — a diet contributing to rising rates of hypertension, diabetes, and heart disease. “Climate change is the most significant threat to human health in the 21st century, and climate change is having those serious impacts on health right now,” says Levine.

As climate change intensifies and New Yorkers face record-breaking heat, the city is taking new measures to protect residents' health. Landlords will soon have to provide air conditioning to tenants, school bus fleets are going electric, and efforts are underway to make housing more affordable.  Cameron Clarke of WE ACT for Environmental Justice is on the front lines of the push to build a healthier New York City. One recent initiative focused on developing an asthma policy agenda. “We wanted to talk about housing, transportation, education, and the actual landscape of the built environment and craft a policy agenda that connects all of these different things to environmental justice — all through the lens of asthma,” Clarke explains. On this episode of The Dose podcast, recorded during Climate Week NYC in September, host Joel Bervell talks to Clarke about advancing health and environmental justice in New York and providing people with the tools they need to navigate a complex health system.

Evidence of a mental health crisis is everywhere — from the recent surgeon general advisory about social media's effects on our youth to the pandemic's documented impact on medical professionals. To whom does a college student turn for help so far from home? And who cares for the mental health of those caring for us? Enter Dr. Jessi Gold, a psychiatrist and the University of Tennessee's first chief wellness officer, who aims to change the way student mental health is addressed on campus. She favors an open, flexible approach to helping students find the kind of help that's right for them. Off campus, Dr. Gold has been conducting research into the overlooked mental health needs of our medical professionals. On this episode of The Dose podcast, host Joel Bervell talks with Dr. Gold about the systemic changes needed to support mental wellness across our college campuses and the entire ecosystem of medical professionals.

Moving the needle on health care access and health disparities is no easy task. Inequities for people of color are embedded in the U.S. health system, shaping their health care journeys and often leading to outcomes worse than those experienced by white Americans. That's where Dr. Chris Pernell, director of the NAACP's Center for Health Equity, comes in. “Sometimes you got to make those systems bend, and other times you got to disrupt those systems, innovate and invent, and create and design.” In this episode of The Dose podcast, host Joel Bervell talks to Dr. Pernell about her work on health equity, the systems that need to be disrupted, and the innovations needed to build a more inclusive health system.

In this special two-part edition of The Dose, we're bringing listeners along to an exhilarating gathering of health care's most innovative thinkers and changemakers — Aspen Ideas: Health. In part 2, host Joel Bervell talks to two people who are reshaping how we think about community health: Mary Oxendine, a Lumbee and Tuscarora woman and the former North Carolina Food Security Coordinator at Durham County; and Shameca Brown, a mental health provider and advocate for Black and brown people in Tulsa, Oklahoma, and former member of the Mental Health Association of Oklahoma's board of directors.

In this special, two-part edition of The Dose, we're bringing listeners along to an exhilarating gathering of health care's most innovative thinkers and changemakers—Aspen Ideas: Health. In part 1, host Joel Bervell speaks with two people dedicated to supporting communities that have been excluded from our health care system: Lola Adedokun, executive director of the Aspen Global Innovative Group at the Aspen Institute and leader of the Healthy Communities Fellowship; and Elizabeth Lutz, executive director of The Health Collaborative in San Antonio, Texas.

This month, a 12-year-old boy in Washington, D.C., became the first person in the world to undergo a grueling gene therapy treatment that could cure his sickle cell disease. It is a game-changer for a disease whose history has been plagued by the racism baked into our health care system.   On The Dose podcast, host Joel Bervell sits down with Dr. Cece Calhoun, a leading adolescent sickle cell specialist from Yale University. The two dive into what it means to be a young Black person in America with the disease; why it took nearly 100 years for us to get to this point; and how health inequities continue to pose life-and-death challenges for sickle cell patients.

In Dr. Joseph Betancourt's vision for the future of U.S. health care, “any patient who goes to any health care system around the country should get the highest quality of care, no matter who they are or where they're from.” As the Commonwealth Fund's new president, he's tackling some of the biggest challenges facing the U.S. health system while trying to ensure equity is embedded in health care policy, coverage, technology, and practice.  Join Joel Bervell, host of The Dose podcast, for a wide-ranging conversation with Betancourt about AI and health care, America's primary care crisis, and what the corporatization of health care means for doctors and patients. 

As a physician, researcher, and educator, Dr. Cheryl R. Clark wants her students to understand what vision, love, and equity can bring to health care if we prioritize them — and why she believes doing so is critical to advancing health equity.    In the latest episode of The Dose podcast, host Joel Bervell talks with Clark about how she brings health equity to life, taking medical residents to Mississippi to break bread with the Civil Rights leaders who founded community health centers. They also discuss her work at the forefront of emancipatory research to connect the dots between academics, clinicians, and communities' lived experiences.

In medical school, students learning about illness, pathology, and disease are trained almost exclusively on images of white patients. Even materials on illnesses that predominantly affect Black people, like sickle cell disease, and textbooks used in medical schools in countries where most people are Black, are filled with illustrations of white bodies and white skin. This leaves doctors underprepared to care for Black patients. For Nigerian medical student and illustrator Chidiebere Ibe, accurate representation is a starting point for health care equity. Ibe has founded Illustrate Change, the world's largest open-source digital library of medical illustrations featuring people of color. In the newest episode of The Dose podcast, host Joel Bervell talks to Ibe about his efforts to make inclusive imagery widely accessible — a critical step toward building health systems that can provide Black patients with the care they deserve. This is the third episode in a new series of conversations with leaders at the forefront of health equity.

Montgomery, Alabama's capital, is known as the birthplace of gynecology. It's a brutal history, as the field's “founding father,” J. Marion Sims, advanced his work through the experimentation on enslaved women and babies. Artist and health care activist Michelle Browder has forced a reckoning with this legacy with one clear goal — we need to talk about the mothers. On the newest episode of The Dose podcast, host Joel Bervell talks to Browder about her efforts to honor Sims's victims — the names of only three of whom we know today: Anarcha, Betsey, and Lucy. They also discuss Browder's work to channel the painful legacy of the past into a healthier future for Black women and their babies, as she prepares to open a midwifery clinic and birthing center as well as a national education center for medical students.

This year in the United States, an estimated 2 million people will receive a new cancer diagnosis, and a growing proportion will be younger adults and people of color. Many of these cases could be prevented — nearly 60 percent of colorectal cancers, for example, could be avoided with early detection. Physician and UCLA researcher Dr. Folasade May is trying to understand why cancer screening rates are lagging, and what we can do to get people these potentially lifesaving tests.  In the newest episode of The Dose podcast, host Joel Bervell talks to Dr. May about what might be behind the rise in colorectal cancer among younger people, the barriers to widespread cancer screening — especially for underserved communities — and her work empowering people to save their lives. This episode kicks off a new series of conversations with leaders at the forefront of health equity.

Overtreatment is a big problem in American health care. The proliferation of unnecessary medical tests and procedures not only harms patients but costs the United States billions of dollars every year. Between 2019 and 2021, Medicare spent as much as $2.4 billion on unnecessary coronary stents alone. At some hospitals, it's estimated that more than half of all stents are unwarranted. For this week's episode of The Dose podcast — the latest in our series on the affordability of health care — host Joel Bervell talks to Vikas Saini, M.D., a cardiologist and the executive director of the Lown Institute, a think tank that examines overspending and overtreatment in the health care system. Dr. Saini unpacks how health care practices are misaligned with patient needs and discusses strategies for “rightsizing” U.S. health care.

Health care is a $4.3 trillion business in the United States, accounting for 18 percent of the nation's economy. It should come as no surprise then that the industry has become attractive to private investors, who promise cost savings, expanded use of technology, and streamlined operations. But according to Yale University's Howard Forman, M.D., “most private equity money does seem to be making matters worse rather than better.” One issue is that investors chase the healthiest and most profitable patients, undermining another kind of equity — health equity — in an already deeply unequal health care system. In the latest episode of The Dose podcast, host Joel Bervell charts a wide-ranging discussion with Dr. Forman, a professor of radiology and biomedical imaging, public health, management, and economics, about private equity's growing role in American health care. This is the second episode of our new series of conversations about health care affordability.

Nearly one in five Americans has medical debt. Black households are disproportionately affected, carrying higher amounts of debt at higher rates. Berneta Haynes, senior attorney with the National Consumer Law Center, describes Black Americans' medical debt burden as a continual cycle fed by higher rates of chronic illness and lower rates of wealth. As a result, many are left without savings or family resources to tap into when faced with an unexpected medical bill.  Join host Joel Bervell on the newest episode of The Dose podcast, where he talks to Haynes about the history of medical debt and efforts to ease pressure on the families and communities hit hardest, including the Consumer Financial Protection Bureau's initiative to change what kinds of medical debt can show up on a person's credit report. This episode kicks off a new series of conversations about affordability, including everything from the role of private equity in health care to why Americans pay more for care than any other high-income country. 

Forty-four percent of U.S. women now live with some form of heart disease, a number that's been climbing steadily over the past decade. And although it's the leading cause of death among women, just 14 percent of cardiologists are women. This week on The Dose podcast, host Joel Bervell interviews cardiologist Martha Gulati, M.D., associate director of the Barbra Streisand Women's Heart Center at Cedars-Sinai Heart Institute in Los Angeles and president of the American Society for Preventive Cardiology. She talks about women's historical exclusion from clinical trials for heart disease, why sex and gender matter in the search for better treatments, and the persistent gaps in women's cardiology care and research — especially related to women of color. “In cardiology, we are still thinking about men more than we are about women,” Dr. Gulati says.

Even though the U.S. has the highest maternal mortality rate of any developed country, federal programs that have been proven to improve maternal health outcomes are often the target of budget cuts. This week on The Dose podcast, guest host Rachel Bervell speaks with Dr. Jamila Taylor, president and CEO of the National WIC Association, the nonprofit voice of the federal program that provides nutritious foods to more than 6.3 million women, infants, and children. They discuss the potential policy and funding solutions that can advance health for women, especially women of color. Their conversation ranges from the debt ceiling legislation's impact on WIC to the pending “Momnibus” package of measures for improving health equity and quality of care for Black mothers. “Those essential programs are always the first to be on the chopping block,” Taylor says. “That's something that we really need to change in our approach to funding.”

Research shows that Black women and other women of color experience the worst health outcomes of any group in the United States — regardless of income level. On The Dose podcast this week, host Joel Bervell talks to public health innovator Ashlee Wisdom, founder of a digital platform that connects women of color to culturally competent health care providers. Black people make up 13 percent of the U.S. population but less than 6 percent of physicians, making it difficult for Black patients to connect with Black doctors. As Wisdom, founder of Health in Her HUE, explains, technology can be a tool for bridging that access gap until the physician workforce becomes more diverse. A new focus, she says, is fibroids, an oft-misdiagnosed condition in Black women that can lead to referrals for invasive interventions like hysterectomies. The health care system, Wisdom says, is starting to put things in place. “We're seeing people shift away from the status quo and think about ways that they can learn how to provide culturally competent care.”

This week on The Dose podcast, host Joel Bervell talks to Michelle Morse, New York City's first-ever chief medical officer. Starting in her role at the height of the COVID pandemic, Dr. Morse quickly understood the importance of establishing strong connections between the health department and the city's health care providers to help close gaps in equity, choose where to focus resources, and coordinate testing and vaccination efforts. In a wide-ranging conversation, Dr. Morse talks about Black New Yorkers' disproportionately high rates of premature death, having racism declared a public health crisis in New York City, using community health workers to reach people where they live, and tracking the connection between wealth gaps and health outcomes. She also discusses the use of race in clinical algorithms that have “solidified racial inequities instead of trying to fix them and end them.” Listen, and subscribe wherever you get your podcasts.

On this week's episode of The Dose, host Joel Bervell talks with Dr. Fatima Cody Stanford about obesity: its history, including the racist origins of the body mass index (BMI), as well as the flawed science, misperceptions, and stigma that people with obesity encounter. Stanford, who's based at Massachusetts General Hospital, calls obesity “a really complex, multifactorial, relapsing, remitting chronic disease.” She discusses genetic differences that account for the prevalence of obesity in racial and ethnic minority communities, the financial profitability of the weight loss and pharmaceutical industries, and the biases and dangerous risks of misdiagnosis that patients with obesity face every day at doctors' offices.

On this week's episode of The Dose, host Joel Bervell speaks with Dr. Ziad Obermeyer, from the University of California Berkeley's School of Public Health, about the potential of AI in informing health outcomes — for better and for worse. Obermeyer is the author of groundbreaking research on algorithms, which are used on a massive scale in health care systems — for instance, to predict who is likely to get sick and then direct resources to those populations. But they can also entrench racism and inequality into the system.  “We've accumulated so much data in our electronic medical records, in our insurance claims, in lots of other parts of society, and that's really powerful,” Obermeyer says. “But if we aren't super careful in what lessons we learn from that history, we're going to teach algorithms bad lessons, too.” Citations Dr. Ziad Obermeyer Dissecting racial bias in an algorithm used to manage the health of populations Nightingale Open Science

On this special season of The Dose, guest host Joel Bervell is hosting a series of conversations with experts and leaders in health equity. In examining how we can uproot racism in our healthcare system, we are starting at the beginning of many healthcare careers: medical school. Naomi Nkinsi was one of the few Black students in her cohort at University of Washington School of Medicine. She noticed that the images in her lectures depicted Black patients living in impoverished and hygienic conditions, while pictures of white patients showed polished school photos. Nkinsi recognized that the disparity in images reinforced harmful biases for her classmates, and she began to advocate for a change.  Through a back-and-forth with her university's administration, Nkinsi continued to advocate against racism. She eventually sparked a conversation that led to the reversal of the race-based component of the eGFR equation in many settings, thus removing a barrier to proper kidney treatment for thousands of Black patients. On the latest episode of The Dose, Nnkinsi joins Joel Bervell to discuss why and how she continues to challenge racism, despite institutional pushback, and shares what medical schools can learn from their students.  “The days I didn't say anything, I felt worse than when I did,” Nkinsi says. “I had already been outspoken, I already had the reputation of the angry Black student. Other classmates already viewed me as unprofessional… ​​​​So if I already have that reputation, then I should just keep speaking out because it's not going to get worse.”   Citations Health inequities and the inappropriate use of race in nephrology  

Joel Bervell joins The Dose to host a special season examining equity in health care.  Joel has garnered hundreds of thousands of followers on TikTok and Instagram debunking medical myths and dissecting racism in health care. This season, he'll host a series of compelling conversations with emerging and established leaders working to transform the health care system's approach to equity. The first episode releases on April 7th.  Joel on TikTok Joel on Instagram

The maternal mortality rate in the United States is more than double that of our peers – and it's especially high among Black birthing people. Why? The Commonwealth Fund collaborated with Lemonada Media to create Uncared For, a six-part podcast series, hosted by award-winning journalist SuChin Pak (Add to Cart, MTV News) to take a personal and wide-ranging look at maternal health care around the globe to find the answer.  On today's episode of The Dose, we're sharing the first episode of Uncared For. SuChin Pak talks to Brandi Jordan, a doula who was an essential support for Pak's own childbirth. Even though Jordan has decades of childbirth experience, when it came time for her own pregnancies, she was repeatedly ignored and neglected by her doctors. Unfortunately, Jordan is not alone in experiencing a system that disproportionately fails Black birthing people. The first episode of Uncared For examines some of the factors that contribute to the systemic racism that Black birthing people face in the United States and unpacks the historical roots of these inequities. Over the course of the series, the show explores health care systems in Germany, the Netherlands, and Costa Rica to find solutions for a health care system that's safer for all birthing people. All six episodes of Uncared For are now available wherever you get your podcasts.

What people eat, where they live, and how much they earn can impact their overall health more than the medical care they receive — sometimes much more. Now, for the first time, federal policymakers are trying to measure and screen for what are known as the drivers of health.  On this week's episode of The Dose,Shanoor Seervai talks with Alice Chen, M.D., chief medical officer at Covered California, the state's health insurance marketplace, about gathering momentum in the health sector to acknowledge and address nonmedical risk factors for health.  Chen, a physician with years of experience caring for underserved patients (as well as a former Commonwealth Fund Harvard Fellow in Minority Health Policy), explains how food insecurity, housing instability, and transportation issues, among others, are all inextricably linked to people's health.  “As people started thinking about how you actually improve health and not just provide transactional health care services, you start to widen your lens and realize, oh, there are all these other factors that are actually driving population health,” she says.  For the next few months, The Dose will be going on hiatus. We'll be back in touch in the new year with more conversations about how to make health care better for all Americans.

In post-Roe America, many women seeking abortions are treading on landmines, particularly in states where access is banned or severely restricted. On the latest episode of The Dose, host Shanoor Seervai talks to Raegan McDonald-Mosley, M.D., about a tool that makes it easier for people to determine what the laws are in their state and where they can get care. Mosley, the CEO of Power to Decide, talks about the huge risks for women – particularly low-income women of color – who can't get the reproductive health services they need. “Instead of… investing in maternal health services on the ground in communities that need it, [some states are] literally doing the opposite to make it harder for people to connect to care and services,” she says.

The midterm elections are around the corner, and health care is likely to be a major factor in how Americans vote. Abortion and reproductive health access will motivate many people, as will inflation (which impacts the cost of care). On the latest episode of The Dose, host Shanoor Seervai talks about the most pressing health care battles to watch with Katie Keith, director of the Health Policy and the Law Initiative at Georgetown University Law Center's O'Neil Institute. Keith talks about how access to abortion may play out at the federal and state level, legal challenges to the Affordable Care Act's guarantee of free preventive care, and the impact of the impending end of the public health emergency.

Bills targeting the rights of LGBTQ+ people are under consideration in state legislatures across the country. Many aim to make it more difficult for transgender people to get health care — something that's already a challenge for many, particularly trans youth. On the latest episode of The Dose, host Shanoor Seervai interviews Austin Johnson, an assistant professor of sociology at Kenyon College and the research and policy director for the Campaign for Southern Equality, an advocacy and direct services organization. One way to expand access to care for transgender youth, Johnson says, is to “make sure you center trans experience, center trans people's understandings of their health care, education, and family life, and rely on … scholarship that is led by trans people.”

Earlier this week, President Biden declared the pandemic over. This tracks with public opinion: most Americans have long abandoned their masks, and federal funds may soon dry up for testing, treatment, and even vaccines. Of course, this doesn't mean the virus has disappeared. In fact, hundreds of Americans are still dying each day from COVID-19, and thousands more are suffering from long COVID, a host of protracted symptoms that could lead to severe health complications down the line. On the latest episode of The Dose, host Shanoor Seervai talks to Dr. Bob Wachter about what it's like to live with COVID in 2022. Dr. Wachter, professor and chair of the Department of Medicine at the University of California, San Francisco, is one of the nation's foremost experts on the pandemic.

Among other things, the Inflation Reduction Act is being hailed as a potential breakthrough in making health care more affordable. But what does this landmark legislation, enacted last month, really mean for Americans – now and in the future? To open the new season of The Dose, host Shanoor Seervai interviews Stacie Dusetzina, an associate professor in health policy and cancer research at Vanderbilt University. Dusetzina breaks down the key health provisions of the new law, from drug price negotiation in Medicare to the redesign of Part D coverage. We've “repeatedly been burned by the health care system… [so] we're all suspicious when something sounds really too good to be true,” she says. “The changes here for people who have very expensive drugs are almost too good to be true.”

Social programs like Medicaid are supposed to help people, but often they reproduce racial inequities — and sometimes actually create them. That's because even well-intentioned policymakers can't always see the disproportionate impact their decisions have on people of color. But what if there were a tool to help legislators and government officials identify when and how they should be thinking about racism? Well, Jamila Michener has developed one. And on this encore episode of The Dose podcast, she explains how it can be applied to Medicaid's transportation benefit specifically and to health policy more broadly. Michener, an associate professor in Cornell University's Department of Government, speaks about how her research on, and personal experiences with, Medicaid has highlighted the importance of hearing from people impacted by policy choices. “You can't really address the ways that racism manifests… unless you have people who experience it directly at the table, not only having voice, but also having some power,” she says. This encore episode was originally released on 2/11/2022.

Climate change can have a devastating impact on our health. When people are injured or exposed to disease related to floods or fires, it's up to health systems to pick up the pieces. But health care itself is one of the world's most carbon-intensive industries, responsible for 4.5 percent of all greenhouse gas emissions. What can health systems do to address climate change? In the United Kingdom, the National Health Service (NHS) has set some ambitious goals to reduce its carbon footprint. On this encore episode of The Dose, Nick Watts, the NHS's chief sustainability officer, talks about how the health service is meeting these goals, and whether its efforts could be replicated in countries like the United States. A low-carbon health care system, he says, is actually just a good health care system. This encore episode was originally released on 1/28/2022.

The Dose will be taking a short summer break while our team works on brand-new episodes for the next season. Listen to our season finale, in which we highlight some of the accomplishments of our guests. Join us in the fall, for new conversations with health policy experts as they share ideas about how the U.S. can improve health care for everyone. Episodes Mentioned: Priti Krishtel on "For Global Vaccine Access, Overhaul the Patent System" Kevin Simon on "Closing the Mental Health Care Gap for Black Teens" Rachel Hardeman on "The Quest for Equity in Reproductive Health"

A well-functioning public health system is vital to keeping individuals, and the population at large, safe and healthy. Except that success is often invisible when it comes to public health—we don't notice it until the system breaks down. The U.S. public health system has taken a drubbing from COVID-19. But the pandemic has also driven home just how critical it is to invest in this key component of national infrastructure. On the latest episode of The Dose, Dr. Dave Chokshi, who led New York's pandemic response as the city's health commissioner, talks about how we can apply the lessons of the past two years in rebuilding the U.S. public health system. “If we take the opportunity to build [a] community-based public health infrastructure, to embrace a mission of health equity as fundamental to health, then that's what will help to protect… our community as a whole,” he says.

Racial bias in medical care extends all the way to the prescription pad. Research shows that people of color are less likely to receive the most effective treatments for life-threatening conditions, including cancer and heart disease. One way to address this is by aiming for “pharmacoequity” — where all patients, regardless of race, socioeconomic status, disability, or other characteristics, have access to the highest-quality evidence-based medical therapies that meet their health needs. On the latest episode of The Dose, the man who coined this term, Utibe Essien, M.D., an assistant professor of medicine at the University of Pittsburgh, explains what it will take to achieve pharmacoequity. “The data are not lying about how we're prescribing medications,” Essien says. To eliminate such biases, he believes we must be honest about the data and develop strategies to ensure greater equity.

Nurses in the United States are experiencing burnout at unprecedented rates. More than two years into the pandemic, they are still processing the trauma of what they witnessed in the early days. Staffing shortages, meanwhile, are creating unmanageable workloads. On the latest episode of The Dose podcast, host Shanoor Seervai interviews Rebecca Love, a nurse and president of SONSIEL, the Society of Nurse Scientists, Innovators, Entrepreneurs, and Leaders, a nonprofit dedicated to creating new opportunities for nurses in health care innovation. Love talks about what it would take to fix the nursing crisis, from changes in nursing reimbursement to new ways of training and empowering nurses to provide the best possible patient care.

When a federal judge lifted the national mask mandate on airplanes, trains, and other public transportation, some Americans broke out the champagne. Others wrung their hands, dreading the removal of a relatively simple public health tool at a time when COVID-19 cases are rising across the U.S. On the latest The Dose podcast, Celine Gounder, M.D., Senior Fellow and Editor-at-Large for Public Health at the Kaiser Family Foundation and Kaiser Health News, talks about why people without privilege — like those who are poor or uninsured and many people of color — will be hit the hardest if we rush to return to normal. “Having safety nets becomes really important,” she says. Measures like improved indoor air quality, paid sick and family medical leave, and better access to health insurance would help control the health, social, and economic impacts of the pandemic.

Access to health care is a constitutional right for the 2 million Americans in our criminal justice system. For some of those incarcerated – overwhelmingly people with low income and people of color – the first time they receive care is behind bars. But when individuals transition back into their communities, this care often vanishes. On the latest episode of The Dose, Emily Wang, M.D., director of the SEICHE Center for Health and Justice at Yale University, explains why we need to ensure continuity of care for people cycling in and out of the criminal justice system. The first few weeks after release are critical, she says. “You want people to return home to reintegrate… to reestablish a life, get a house, get a job, contribute meaningfully as a member of our community.”

  In the face of overwhelming demand for behavioral health services, the unmet needs of one group stands out: Black and brown teenagers.   One reason they're not getting the care they need is the shortage of child and adolescent mental health providers in the U.S. — particularly providers of color. Making matters worse are the racial stereotypes that play out in how Black and brown teens are perceived by school officials, health care providers, and some others in their communities. On the latest episode of The Dose, Kevin Simon, M.D., a psychiatrist at Boston Children's Hospital and Commonwealth Fund Fellow in Minority Health Policy at Harvard University, talks about how to address the problem.   In the long term, we need to diversify the mental health provider workforce, he says. But for now, providers currently practicing can work with families, teachers, and others to strengthen the system. They can demonstrate cultural humility and express genuine curiosity in the lived experiences of Black and brown youth.

Although primary care is the lifeline of a health care system, the United States spends less on it, and more on specialty care, than other high-income countries. This sends a message to our primary care workforce: we don't value what you do. The result? Burnout, high turnover, physician shortages—all of which were dire crises before the pandemic but are even worse now. On the latest episode of The Dose, host Shanoor Seervai asks Asaf Bitton, M.D., executive director of the health innovation center Ariadne Labs, what it will take to rebuild the nation's broken primary care system. “What we've learned over these last 15 or 20 years is that primary care is a team sport,” says Bitton. A modern practice cares for a well-defined population using “technology in a different way… to start building a much more integrated primary care of the future.”

Americans pay more for prescription drugs than people in other countries do. As medicines become increasingly unaffordable — particularly for people with low incomes — policymakers in both parties are feeling the urgency to address the problem. But what could they do? On the latest episode of The Dose podcast, Robin Feldman, a professor at the UC Hastings College of Law and an expert on intellectual property and pharmaceutical law, offers some answers. She talks about the problems with our current patent system, and how it could be redesigned to allow for innovation and to protect consumers from going into debt to pay for their medications.

Social programs like Medicaid are supposed to help people, but often they reproduce racial inequities — and sometimes actually create them. That's because even well-intentioned policymakers can't always see the disproportionate impact their decisions have on people of color. But what if there were a tool to help legislators and government officials identify when and how they should be thinking about racism? Well, Jamila Michener has developed one. And on the latest episode of The Dose podcast, she explains how it can be applied to Medicaid's transportation benefit specifically and to health policy more broadly. Michener, an associate professor in Cornell University's Department of Government, speaks about how her research on, and personal experiences with, Medicaid has highlighted the importance of hearing from people impacted by policy choices. “You can't really address the ways that racism manifests… unless you have people who experience it directly at the table, not only having voice, but also having some power,” she says.

Climate change can have a devastating impact on our health. When people are injured or exposed to disease related to floods or fires, it's up to health systems to pick up the pieces. But health care itself is one of the world's most carbon-intensive industries, responsible for 4.5 percent of all greenhouse gas emissions. What can health systems do to address climate change? In the United Kingdom, the National Health Service (NHS) has set some ambitious goals to reduce its carbon footprint. On the latest episode of The Dose, Nick Watts, the NHS's chief sustainability officer, talks about how the health service is meeting these goals, and whether its efforts could be replicated in countries like the United States. A low-carbon health care system, he says, is actually just a good health care system.

The Omicron variant is sweeping across the United States and the rest of the world, breaking previous records of COVID-19 cases and hospitalizations. While it may cause milder illness, its transmissibility and ability to evade vaccines make this surge particularly challenging to navigate. On the latest episode of The Dose podcast, host Shanoor Seervai asks Alison Galvani, founding director of the Yale Center for Infectious Disease Modeling and Analysis, to bring listeners up to speed on this phase of the pandemic. Galvani and her colleagues have found that increasing the number of boosters administered each day could save thousands of lives.  Vaccination is relatively inexpensive, particularly compared with the costs associated with hospitalizations and productivity losses, even from mild cases, she says.

A year after adults in the U.S. began getting vaccinated against COVID-19, children ages 5 and up are now eligible for the shot. So far, uptake has been slow – in part because of parents' concerns over vaccine safety. On the latest episode of The Dose, pediatrician and American Academy of Pediatrics board member Michelle Fiscus, M.D., and the Commonwealth Fund's Rachel Nuzum shed light on challenges and opportunities in raising child vaccination rates. One downstream concern is a growing trend of resistance to other childhood vaccines. As Dr. Fiscus says, if “vaccine hesitancy continues to build with the routine childhood vaccines, I am very concerned about the types of outbreaks that we're going to be fighting over the next years.”

The U.S. maternal health crisis has been well documented. Black Americans are three times as likely as white Americans to die from pregnancy-related causes. Why do these disparities persist? And what would it take to dismantle structural racism in reproductive health care? On the latest episode of The Dose, Rachel Hardeman, tenured associate professor at the University of Minnesota School of Public Health, discusses her research exploring ways to center equity in reproductive health care. She says it's a huge priority “to make sure that birthing people, regardless of the setting they're birthing in, have access to culturally centered maternity care.” Listen, and then subscribe wherever you find your podcasts. Sign up here to get new episodes of The Dose in your inbox

Vaccines have saved thousands of lives and are an incredible tool in the seemingly endless battle against the coronavirus. But even with COVID surging anew in Europe as winter approaches, the rate at which Americans are getting vaccinated has plateaued.   On the latest episode of The Dose, Alison Galvani, founding director of the Yale Center for Infectious Disease Modeling and Analysis, and Eric Schneider, M.D., senior vice president for policy and research at the Commonwealth Fund, bring listeners up to speed on the state of the pandemic.   Galvani and Schneider have been using data to show how effective the vaccines are at preventing deaths and hospitalizations — and how, in the absence of successful vaccination campaigns, we are still losing people to the virus. Increasing vaccine uptake through mandates and administering boosters will help curb this pandemic. But to stave off future threats, it's vital that we also strengthen the public health system and make it easier for all Americans to access health care, they say.