Policy area, which deals with the planning, organization, management and financing of the health system
Poor nutrition is the leading cause of health issues in the United States, with nearly three in four American adults being overweight or obese, and obesity in children and young people being equally concerning. Today, we're talking with Dr. Sara Bleich, the new Director of Nutrition Security and Health Equity at the Food and Nutrition Service at the US Department of Agriculture. Dr. Bleich is leading the department's overall effort to tackle food and nutrition insecurity in the United States. Interview Summary Sara, it's always wonderful to chat with you, and doing so in different roles that you've been in. So last time we spoke, you were doing full-time work as a professor at Harvard, and now you're in this vital position at USDA. I mean, personally, I can't think of anyone more capable and qualified for this kind of work. And so I'd like to begin by asking if you could explain the purview of your work at USDA. I'd be happy to, and thank you. It's really kind of you to say that. And I do want to just underscore that for me, it really is an honor to have the opportunity to serve in this role and to help some of these populations that I care a lot about. And I do feel like so many folks in the public health community have been so generous with their time, their expertise, and have given really valuable feedback, so just really want to say thank you to those of you who are listening. You know who you are. You've really been a wonderful sounding board. So in terms of my transition to federal government, at the start of the Biden administration, I took a leave. I was previously at the Harvard School of Public Health, this was in January of 2021, and I spent the first year as the Senior Advisor for COVID in the Office of the Secretary. And now, in the second year of the administration, I have this new hat, which you mentioned, which is serving as the Director of Nutrition Security and Health Equity, and this is within the Food Nutrition Service. So what's really interesting for me is that both of these jobs are brand new to USDA, so it's been really fun to sort of craft them and have the opportunity to sort of start fresh and take on these new responsibilities in very important areas. Now, one thing that they both have reminded me of is just how much I love federal service. This is my second tour of duty in government, and I honestly thought, the first time around, that I wouldn't like it so much, but I have fallen in love with federal service, I really love working at USDA, it's such a fun place to work, and I think that's largely because it has such a broad and diverse mission, so it touches the lives of 330 million Americans every day. I don't know of another job where you can have that sort of impact. So for me, it's great to be back. It's great to have an opportunity to serve, and it's especially nice to be able to do it in a topic area that I have worked on in my professional life, from the academic side, for so many years. The enormous impact that this federal work has is clear, from what you just said, and everybody knows this, and in any administration, the country really relies on the service of people like you who are willing to take on these important tasks, so I'd like to say how much I appreciate you doing that. So it's heartening to know that the USDA is making nutrition security a key priority, and it's noteworthy that the term food security has become food and nutrition security. Can you explain why this transition has occurred in terminology and how is nutrition security being operationalized? Great question. Really glad you asked it, because we are hearing a fair amount of confusion about the concept of nutrition security itself. And then how does it differ from the longstanding efforts at USDA to address food insecurity. So let's start with, first of all, what is nutrition security? So the concept is designed, or aims, to help us better recognize the coexistence of food insecurity and diet-related diseases and disparities. So specifically, what nutrition security means is consistent access, availability, and affordability of foods and beverages that promote wellbeing and prevent disease, and in some cases, treat disease. And this is particularly true among racial/ethnic minority populations, lower-income populations, and rural and remote populations, which includes tribal communities. Now, at USDA, nutrition security builds on and complements our efforts around food security, but it's different in two distinct ways. The first is that it, it being nutrition security, recognizes that we're not all maintaining an active healthy life that's consistent with federal recommendations, and the second is that it emphasizes taking an equity lens to our efforts. So put simply, you can think of nutrition security as having consistent and equitable access to healthy, safe, and affordable food. Now, many listeners may be aware of this definition, and may realize that it directly builds on the JAMA commentary by Dr. Dari Mozaffarian, my assistant, Dr. Sheila Fleischhacker, and Chef Jose R Andres, that came out a little over a year ago. So right now, what we're spending a whole lot of time doing, and that's why it's such a privilege to be on this podcast, is really trying to clearly articulate that definition of nutrition security to a broad range of audiences to really try to get everyone on the same page about what we're doing and how it is a complement to these long-standing efforts around food insecurity. I'd like to explore this concept just a little bit more. So if you go back to when the country really started to take hunger seriously, in the 1960s, if the term security had been used back then, it probably would've been calorie insecurity, wouldn't it? There was an effort just to get food to people, irrespective of what it was, because they just needed to get more calories in them. But that's given way to a much more sophisticated concept that, if I'm hearing you right, not only do you want to get food to people, but the kind of food that specifically promotes health. That's exactly right. So what we know right now about burden of disease in the US is that every year, about 600,000 people die because of diet-related conditions. Those are preventable deaths. So the burden of disease looks very different than it did 40 or 50 years ago. And so at USDA, now, what we're concerned about is not just giving people calories or food that fills up their fridge, but we want to give them calories or food that is also going to promote their health and their wellbeing, and that is the critical pivot, and the point that we're at right now, with all the messaging that we're doing, with how we're positioning the programs, and how we're prioritizing action as we move forward. Sara, when we began the podcast, we talked about the very high rates of obesity in the country, and now you're talking about food insecurity, which people used to refer to as hunger, and a lot of people would see these as the opposite ends of the same spectrum, that they're somehow different and disconnected from one another, but they're not. Would you care to comment on that? Food insecurity and obesity are definitely related. They often coexist. So we know, for example, that both food insecurity and excess body weight, which you can think of as obesity, they tend to be aggregated among historically disadvantaged populations. So communities of color, low-income populations. And because these two conditions coexist, it's really important to think about how do we use the power of the federal nutrition assistance programs to help move people out of food insecurity and toward nutrition security. And the power of the federal nutrition safety net is that it has a number of programs which are designed to do both. So, for example, if we look at SNAP, the Supplemental Nutrition Assistance Program formally known as food stamps, it helps about 41 million Americans - in fact, more than 41 million Americans, afford food each month. There's strong evidence which suggests that it pulls people away from food insecurity, so it lifts families out of hunger. But what we also know is that with the historic reevaluation of the Thrifty Food Plan, which is the calculation that underlies the size of the SNAP benefit that increased the benefit amount by 21%. This happened back in the fall of '21. What that does is, it puts healthy food within reach for so many participants who are on SNAP. So we view this change to SNAP, this reevaluation, which is the first permanent increase in over 45 years, we view this as core to our nutrition security efforts because it allows families to actually purchase food and put those foods within reach that are going to promote their health and their wellbeing. Thanks for that explanation. So it sounds like some of your work lies at a very interesting intersection of two important priorities of the current administration. So on one hand, you have USDA Secretary Vilsack's goal of promoting and elevating nutrition security, which you've discussed, but also the President's goal of advancing racial equity. So what things are happening at this particular intersection of USDA? Well, first I'll say this is an exciting time to be in government because there is so much focus on core issues that matter a lot. And so a key reason why the Secretary of Agriculture, which is Secretary Vilsack, the key reason why he is so passionately focused on nutrition security is really due to the pandemic, and the President's goal of advancing racial equity. So what we all know is that COVID-19 brought health disparities and the vital need for access to healthy food right up to the forefront. There's a study, which many listeners may be familiar with, which estimated that nearly two thirds of COVID-19 hospitalizations in the United States were due to four diet-related conditions: obesity, diabetes, hypertension, and heart failure. And so for this reason, given the disproportionate impact of COVID, its impact on diet-related conditions, and we know that it really disproportionately impacted communities of color, equity is central to our work to promote and elevate nutrition security. And so just to keep us all on the same page, let me just quickly say what we mean by equity: everyone having an equal opportunity to live the healthiest life possible, no matter who they are, where they live, or how much money they make. But when we talk about equity that also dovetails with considerations around the context in which we live. This means we also have to consider structural racism, and this is how we bring in the racial equity lens. So structural racism is not just individuals having prejudices, but it's also when racism gets produced and reproduced by laws and by rules. It becomes embedded in the economy, and so therefore, confronting racism requires that we don't just change how individuals think, but we also start to transform policies. In our efforts to build awareness around nutrition security, we are also making very concerted efforts to explain how structural racism is real, it reaches back to the beginnings of US history, and it stretches across our institutions and economy. So we emphasize that structural racism harms health in ways that can be described, measured, and dismantled. And this is a really important needle to thread as we think about nutrition security, because social disadvantage is not random. It has real roots that we need to acknowledge, and then address wherever possible. So for example, we know that there are disparities in diet-related conditions that have existed for decades, and those are associated with structural limitations to retail food outlets that sell healthier foods, among a whole host of other longstanding historical inequities. And this is where the work of nutrition security comes in, where we at USDA, and hopefully, all the listeners of this podcast, can really make a difference. So I would challenge you all to lean in and ask yourself how can you be part of the solution. And maybe that's asking a critical research question, maybe it's trying to help connect eligible individuals with the federal nutrition assistance programs, but there are so many opportunities to promote and elevate nutrition security. And the key, going back to your question, is that the President cares about this, the Secretary of Agriculture cares about this. This is a window of opportunity to really make a difference in people's lives. And so I think that we really want to lean in as much as possible and take advantage of it. This work is really important, so following up on something you just said about ways that people can engage with this process, so what kind of things are you seeing on the horizon, and what are the best ways for people who might be listening, to engage? So I think it's going to depend on the lane that you sit in. If you're listening to this podcast and you're a researcher, I would ask yourself, "Given the data that I've collected, given the data that I plan to collect, could I do a secondary analysis that might help me understand some of the impacts of the COVID flexibilities that have happened during the pandemic?" For example, there was a temporary increase to the SNAP benefit, and then that became a permanent increase. There have been hundreds of waivers that have been issued which have made the programs more easily accessible. So for example, with WIC, you don't have to go in in person, you can do meetings over the phone. There are all sorts of things, all sorts of program modifications that have happened, and USDA doesn't have the bandwidth to do all that evaluation. So I'd say if you're a researcher, look at how your existing data, your existing portfolio, may be able to answer other important questions. Second, if you are industry, or if you're somehow in the private sector, ask yourself, "What could I do to lean in on this?" For example, there is a waiver that's allowed, it's called the SNAP Incentive Waiver. Retailers can apply for this and it allows them to incentivize SNAP participants to purchase things like fresh fruits and vegetables, and whole grains that are in alignment with the dietary guidelines for Americans. This has been around for a few years, and it's a really nice way that retailers could take advantage of an existing waiver to try to help promote healthy eating purchases among SNAP participants. Which, again, covers about 41 million Americans each month. There are so many different ways to think about leaning in on this particular issue. And I would say that one of the things that we have really tried hard to do over the past several months is that we at USDA are trying to really clearly define our role. How we are trying to make a difference - with the hope that it makes it obvious how others can do complementary activities, because yes - we are investing tens of billions of dollars towards this portfolio. We are very serious about it. This is a top priority. But USDA alone cannot solve the problem of diet-related diseases and disparities. It is going to take a whole-government, if not whole-country approach. And so this is where creative ideas about how to make a difference, leveraging existing resources, is where many of you who are listening can make a difference. Thanks for that. By the way, this focus on equity and this idea that the whole country can engage to help address these issues feels very optimistic, and just like there's hope for the future of really addressing these problems in a fundamentally different way. So back to your career: you've been in both academics and in federal service, as you mentioned earlier. So what makes you passionate about nutrition security as an issue, and do you have advice for people that might be interested in federal service? I love questions like this, largely because when I was starting off my career, it would've been so helpful to hear what motivates people. So for me, my north star is that I've always wanted to help historically underserved populations, communities of color. How do I help them achieve a better quality of life? I'm from inner-city Baltimore. I have a twin sister and an older brother. My parents still live in the same house that I was raised in, and they were public school teachers, they're now retired, and when we were young, our family received food stamps, now SNAP, we received WIC, we received school meals. So I've always been very motivated to give back to the communities that have given me so much. And I think that our current reality is that every child and every person in this country doesn't have an equal opportunity to live a healthy life. And that's not the way that it should be. So every day, I am very, very motivated to ask myself what can I do to help push us in that direction, and push us in a meaningful way. I think the challenge is always, you can push hard but you want to push hard on things that are moveable, where you can actually make a difference. Because everything is all about timing and you want to just be very strategic about where you're going to make investments or put your energy in an area. Because this is where there's an opportunity. And I would say that if we can achieve nutrition security, it is going to change people's lives. Diet-related diseases are preventable. Hundreds of thousands of people a year don't have to die from them. And that's particularly true among communities of color. I think that many of you listening probably feel the same, but these are things that need to change. As I mentioned earlier, I do think we are at a moment where there's a window of opportunity to make a difference. And I would say, more practically, if you're interested in federal service, I would strongly encourage you to just throw your hat in the ring and apply. So you can either go through the career staff route, you could go through the political route. If you go through the career staff route, the Food Nutrition Service at USDA is going to be hiring about 450 people in the not-too-distant future, and that process has started, so I would look at usajobs.gov and see what looks interesting. And I would also consider some of the political jobs, thinking about different fellowships that would allow you to insert yourself. I never expected to love government so much. I never expected to come back again, this is my second tour of duty, but I have just absolutely loved it. And then personally, it's such a pleasure to be able to work on the programs that I was able to benefit from as a child. So for me, it motivates me. I find it very exciting. And I think that for those who are in research and that choose to spend some time in government, I truly think it will make you a better researcher, because what it will teach you is that not every important question is urgent, and what are the urgent questions on which you should really focus your energy. Speaker Bio Sara Bleich, PhD was named Director of Nutrition Security and Health Equity for the Food and Nutrition Service in January 2022. Since joining the Biden-Harris Administration in January 2021, Bleich has served as Senior Advisor for COVID-19 in the Office of the Secretary. Previously, she served as a Professor of Public Health Policy at the Harvard T.H. Chan School of Public Health. Her research centers on food insecurity, as well as racial injustice within the social safety net. She is the author of more than 150 peer-reviewed publications. From 2015-2016, she served as a White House Fellow in the Obama Administration, where she worked in USDA as a Senior Policy Advisor for Food, Nutrition and Consumer Services. Bleich holds a PhD in Health Policy from Harvard University and a bachelor's degree in psychology from Columbia University.
In this 139th episode, Dr. Deborah Birx joins J. Stephen Morrison to discuss her new book, Silent Invasion. On that day, former President Trump responded to the book by, among other things, lamenting oddly that “Debbie Birx does not have a lot of dresses.” In her inside account, Deborah details the repeated failures both to acknowledge the power of silent transmission by fully vaccinated, asymptomatic infected individuals, and the need to keep a relentless focus on testing, masks and limiting the size of gatherings. The Trump administration's catastrophic failures stemmed from the president himself and those around him, including their prevailing worries about the economy and the quest for reelection. Her journey to 44 states and 30 universities brought home the fragility of the rural health system in much of America and the need to engage far more closely with local communities. In the Biden administration, repeated stumbles in guidance and communications have weakened public trust and confidence.
Today we are going to talk about a variety of topics from AI to care after COVID and Social Determinants of Health. With me is one of the nation's most well-known healthcare thought leaders. David B. Nash is the Founding Dean Emeritus, and he remains on the full-time faculty as the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy, at the Jefferson College of Population Health (JCPH). A board-certified internist, Dr. Nash is internationally recognized for his work in public accountability for outcomes, physician leadership development, and quality-of-care improvement. He has published and peer reviewed articles and given many lectures that highlighted critical healthcare issues. Dr. Nash has served on boards for public and private companies, health systems, healthcare accrediting organizations and many more. His contributions and accomplishments are too numerous for us to share but I will link his profile in the show notes. I'll wrap this introduction up by saying Dr. Nash has had an immeasurable positive impact in healthcare. Show Notes: Dr. Nash's LinkedIn Profile: https://www.linkedin.com/in/davidbnash/ He follows Robert Pearl, Merrill Goozner (Gooz News) and Leana Wen.
Millions of people in the UK are struggling to gain access to affordable dental care. Denis Campbell explores the crisis in NHS dentistry. Help support our independent journalism at theguardian.com/infocus
In this episode, Andrew Schwartz and J. Stephen Morrison are joined by Victor Cha to discuss the Covid-19 outbreak in North Korea - which CSIS predicted back in March, the impact of the pandemic on the unvaccinated country, and the road ahead amidst ongoing health and food crises worsened by an extreme lockdown.
Yana Panfilova, a 24-year-old Ukrainian woman born with HIV, fled Kyiv shortly after Russia's invasion and is currently based in Berlin with her mother, grandmother and cat. Eight years ago, she helped found Teenergizer, an organization supported by UNAIDS that seeks to end discrimination against youth in Ukraine living with HIV. Over time, its scope widened to include other youth groups and its services expanded into mental health counselling and sexual health training. Affiliates arose across Eastern Europe and Central Asia. In the face of Covid-19 and, most recently, the Russian invasion of Ukraine, Teenergizer greatly enlarged its network in Ukraine from 20 to over 120 counsellors. Using her experience living with HIV, Panfilova has reached more than 5 million teens living with HIV and those facing other forms of discrimination, providing them with the support she wished she had as an adolescent.
The Biden administration is trying to close a gap in the Affordable Care Act that blocks 5 million people from getting affordable health care.Guests: Liana Wolk, teacherOwen Marshall, musicianKatie Keith, JD, MPH; Director, Health Policy and the Law Initiative at the O'Neill Institute at the Georgetown University Law Center.Learn more and read a full transcript on our website.Want more Tradeoffs? Sign up for our free weekly newsletter featuring the latest health policy research and news.Support this type of journalism today, with a gift.Follow us on Twitter. See acast.com/privacy for privacy and opt-out information.
Dr. Richard Pierson is the scientific director of the Massachusetts General Hospital Center for Transplantation Science and a professor of surgery at Harvard Medical School. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. R.N. Pierson III. Progress toward Pig-to-Human Xenotransplantation. N Engl J Med 2022;386:1871-1873.
When medical offices shut down due to the COVID-19 pandemic and people were encouraged or required to avoid public spaces, there was a dramatic and rapid increase in the use of telemedicine. Telemedicine has the potential to open up access to care, particularly to people who are geographically isolated or have mobility limitations, but it can also exacerbate existing inequities given its relevance upon broadband internet access and other technologies.Caitlin Hicks from Johns Hopkins School of Medicine joins A Health Podyssey to discuss whether telemedicine expands or narrows care inequities.Hicks and colleagues published a paper in the May 2022 issue of Health Affairs examining the impact of Medicare's pandemic-era telemedicine coverage waiver on utilization by geographic area.They found that Medicare's telemedicine access expansion increased utilization overall and that those beneficiaries in areas of greater depravation, as measured by the Area Depravation Index, had greater odds of utilization than those who live in areas with more resources.Order the May 2022 issue of Health Affairs for research on telemedicine, disparities, pharmaceuticals, and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts
Susan L. Mitchell is a geriatrician and health services researcher at the Hebrew SeniorLife Marcus Institute for Aging Research, and at Harvard University. Shawn Bloom is CEO of the National PACE Association. David Gifford is a geriatrician and the chief medical officer at the American Health Care Association. David Grabowski is a professor of health care policy at Harvard Medical School. Jasmine Travers, is an assistant professor and health services researcher at New York University in the Rory Meyers College of Nursing. S.L. Mitchell and Others. Long-Term Care in the United States — Problems and Solutions. N Engl J Med. DOI: 10.1056/NEJMp2201377.
Dr. Jonathan Oberlander is a professor of social medicine and of health policy and management at the University of North Carolina at Chapel Hill. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. J. Oberlander. Health Care Reform under the Biden Administration — Broad Ambitions, Narrow Majorities. N Engl J Med 2022;386:1773-1775.
Yasmeen Abutaleb, health policy reporter at The Washington Post, joins Steve Morrison and Andrew Schwartz for this 136th episode. The Biden administration struggles on multiple fronts, from systemic dysfunction within agencies to increased polarization of virtually every measures to mitigate Covid-19. The administration wants to invest in a long-term vaccine strategy that protects against multiple variants in advance -- but lacks the resources. Omicron taught us: "You can't start buying stuff when the wave has started.” "The disinformation problem is so widespread" that "… everyone in the Biden administration is going to be distrusted by half of America." The US government has not staged a powerful Covid-19 messaging campaign on social media, and a national commission on the pandemic, with real bipartisan leadership, remains out of reach. Courts are exercising considerable sway over health security policy which require a careful political calculations. Would appealing federal Judge Mizell's April 18 injunction against the national mask mandate on transport ultimately leave the CDC in a weakened position? Americans continue to experience the pandemic in vastly different ways, depending on socio-economic profile. Many who have protections through vaccines and treatments may feel they will be exempt from infection, yet they make up a significant share of those experiencing severe illness.
Meet the Guests:This episode features three leaders previously showcased on Her Story and the powerful advice they received from mentors. Renee DeSilva is the CEO of The Health Management Academy. Melinda B. Buntin, Ph.D. is a Mike Curb Professor and Chair of the Department of Health Policy at Vanderbilt University. And JaeLynn Williams, the CEO of Air Methods.Key Insights:Mentors play an important role in career trajectory by providing advice, perspective, and direction.Personal and Professional Development. Renee's mentor provided an outside perspective, helping her understand her unique strengths and areas for improvement. (1:07)Maintaining Job Opportunities. Dr. Buntin's mentor pointed out that too many consecutive roles in government would limit her job opportunities in academia. Due to that advice, Dr. Buntin maintained her connections and continued to publish research to keep those doors open. (3:21)What is Your Ideal Job? Jaelynn was given the advice to start with the end in mind. To think about her ideal job and work backwards to determine the experiences and skills necessary to achieve that. This informed her choice to leave a company she worked at for many years to pursue a new opportunity. (4:51)
Dr. Lisa Harris is a professor of reproductive health, of obstetrics and gynecology, and of women's and gender studies at the University of Michigan, where she also directs the fellowship program in family planning. Rachel Gotbaum, the interviewer, is a freelance health care journalist. L.H. Harris. Navigating Loss of Abortion Services — A Large Academic Medical Center Prepares for the Overturn of Roe v. Wade. N Engl J Med. DOI: 10.1056/NEJMp2206246.
The health care sector has gone through various waves of consolidation with hospitals purchasing physician practices and hospitals, physicians, and health insurers merging with each other.We're in the midst of a wave of consolidation.Two years ago, Health Affairs published a paper that found more than half of US physicians and 72 percent of surveyed hospitals were affiliated with one of 637 health systems in 2018. More recently, some have estimated that the 10 largest health systems now control about a quarter of the health care market.Consolidation brings with it various opportunities for savings and efficiency but it also concentrates market power and creates opportunities to raise prices.Vilsa Curto from Harvard University joins A Health Podyssey to discuss the effects of consolidation and integration.Curto and colleagues published a paper in the May 2022 issue of Health Affairs assessing trends in vertical integration and joint contracting between physicians and hospitals in Massachusetts and exploring the affects on prices for physician services.They found notable price affects that varied according to system size and physician type.Order the May 2022 issue of Health Affairs for research on telemedicine, disparities, pharmaceuticals, and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts
The pandemic posed new challenges for patients and providers during pregnancy and childbirth. Pregnant people are at an increased risk for severe illness from COVID-19, especially if they are unvaccinated. More than two years after the start of the pandemic, health care professionals have protocols in place to address COVID transmission risks and to treat parents and newborns who have COVID. In Minnesota and across the U.S., though, there are historic health problems that have yet to be solved. Over the past couple of years, the pandemic has highlighted racial health disparities and large gaps in access to care. And there are new questions about legal rights to reproductive health care, which could complicate and worsen those gaps. Data from the Minnesota Department of Health, the Centers for Disease Control, and the National Institutes of Health indicates that Black women are more likely to die from pregnancy-related complications than white women, and to experience medical conditions like preeclampsia. Black women are more likely to experience preterm labor and birth, which can lead to medical complications for newborns. On Wednesday, MPR News host Angela Davis spoke with health care experts about how the pandemic has shaped pregnancy and childbirth. They also discussed new research in racial health disparities, how racism contributes to poorer health, and how anticipated restrictions in abortion care could affect reproductive health outcomes. Guests: Rachel Hardeman, PhD, MPH is a tenured Associate Professor in the Division of Health Policy & Management at the University of Minnesota's School of Public Health, the Blue Cross Endowed Professor in Health and Racial Equity, and the Founding Director of the Center for Antiracism Research for Health Equity. Dr. Sarah Cross is an OBGYN and assistant professor in the Department of Obstetrics, Gynecology and Women's Health at the University of Minnesota. She directs the Birthplace, Pregnancy Special Care Unit and the Newborn Family Care Center at M Health Fairview.
Dr. Dylan George is the Director of Operations for the Center for Forecasting and Outbreak Analytics (CFA), newly established at the Center for Disease Control and Prevention (CDC). Dr. George joins J. Stephen Morrison and Andrew Schwartz for this 135th episode following the April 19th White House CFA launch. Its mission: Predict, Inform, Innovate. Its data science team will strengthen advance warning of biological emergencies, with a heavy emphasis on improved communications. Building trust is a major challenge, including navigating privacy sensitivities. Sustained funding is essential, and an outstanding question. If successful, CFA will provide the tools people need to keep their families safe while improving decision-making at the local, state, and federal levels. Like extreme weather communications, CFA will make complex models accessible.
Kushal Kadakia is a student at Harvard Medical School with a background in delivery-system reform. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. K.T. Kadakia and H.M. Krumholz. Designing Cures 2.0 — From Corridors to Cornerstones. N Engl J Med 2022;386:1677-1679. J. Concato and J. Corrigan-Curay. Real-World Evidence — Where Are We Now? N Engl J Med 2022;386:1680-1682.
Alyssa Benalfew-Ramos, MPH the Associate Director at the Boston Public Health Commission, Racial Equity & Community Engagement, Executive Office. She is a motivated public health practitioner with a background in health policy and health equity. She is committed to amplifying trauma-informed approaches via working alongside communities and diverse stakeholders to aid positive health outcomes through addressing the social determinants of health and promoting equitable anti-violence strategies. She got her Bachelor's degree in Political Philosophy and Public Policy at University of Massachusetts Boston. She then got her Master of Public Health at Boston University School of Public Health. She is currently the Associate Director at the Boston Public Health Commission.Alyssa on LinkedIn: https://www.linkedin.com/in/alyssabenalfew-ramos/Omari on IG: https://www.instagram.com/thephmillennial/ Omari on LinkedIn: https://www.linkedin.com/in/omari-richins-mph/Website: https://www.thephmillennial.comShownotes: https://thephmillennial.com/episode102All ways to support The Public Health Millennial: https://thephmillennial.com/support/Support The Public Health Millennial: https://www.buymeacoffee.com/thephmillennialShop at The Public Health Millennial Store for discount: https://thephmillennial.com/shop/Email List: https://thephmillennial.com/signup/Support the show (http://paypal.me/thePHmillennial)Support the show (http://paypal.me/thePHmillennial)
More than 40 percent of Medicare enrollees are enrolled in Medicare Advantage (MA) plans, privately-sponsored health plans that provide Medicare benefits often along with other benefits not included in the standard Medicare package such as eye exams, hearing aids, and dental coverage.Medicare Advantage is growing rapidly. On the current trajectory, it's likely that the majority of Medicare enrollees will be in MA plans within a year or two.Since MA plans are paid on a capitated basis, insurers have a financial incentive to control health care costs. Recently, much attention has been focused on how addressing social needs can yield health benefits, which save MA plans money.In order to address those needs, health plans need to know the social needs of their enrollees.Brian Powers from Humana joins A Health Podyssey to discuss understanding the unmet social needs of Medicare enrollees.Powers and colleagues published a paper in the April 2022 issue of Health Affairs assessing the health related social needs of enrollees in Humana's MA plans. They found significant needs including financial strain, food and utility insecurity, poor housing quality, and unreliable transportation. These needs were distributed unevenly across enrollees by race, socioeconomic status, and sex.If you enjoy this interview, order the April 2022 issue of Health Affairs for research on access to care, hospitals and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts
Think outside the box. Don't just accept conventional wisdom. Ask good questions. Find good mentors and sponsors to help you navigate your career. Figure out your intrinsic motivator. These are just some of the nuggets of advice shared by this month's RLI podcast guest, Richard Duszak, Jr., MD, FACR. During this conversation, he shares his experiences growing up outside of Philadelphia, how his early interest in the intersection between the role of the physician and the broader political and economic ecosystem drew him to medicine and guided his career as well as some interesting consultantships he has been involved in.
In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Sarah Mah to discuss the gender imbalance in authorship in gynecologic oncology. Sarah Mah is a Gynecologic Oncology fellow at McMaster University who received her MSc in Quality Improvement and Patient Safety through the University of Toronto Institute of Health Policy, Management and Evaluation and completed residency at the University of British Columbia. Her research interests are in quality improvement with an equity and sustainability lens, knowledge translation, and cancer prevention. Highlights: Women now account for 55-70% of practicing Gynecologic Oncologists and >80% of Gynecologic Oncology fellows in the United States and Canada. Rates of female first authorship in Gynecologic Oncology journals are rising in proportion, but rates of female senior authorship lag behind, with male authors still overrepresented. Women remain underrepresented as members of Editorial Boards of Gynecologic Oncology journals, particularly in leadership positions. While the COVID-19 pandemic has not yet impacted the proportion of female authors, we discuss reasons for why this could be of future concern and the importance of ongoing surveillance. We discuss some of the literature regarding gender inequity in academia and publishing and explore possible strategies for improvement.
Dr. Larry Gostin is a professor of global health law and the faculty director of the O'Neill Institute for National and Global Health Law at Georgetown University. Dr. Gostin joins Steve Morrison and Andrew Schwartz for this 134th episode in the aftermath of the April 18 nationwide injunction to block government mask mandates on public transportation. In Judge Mizelle's opinion, the C.D.C. has exceeded its legal authority. But if the C.D.C. doesn't have the power to make someone do something as unintrusive as wearing a mask, what can it do? If this ruling stands, it changes the role of the government, and our regulatory institutions will lose the power to protect us. The C.D.C. has been in a weakened position since the Trump administration but is staffed by strong scientists who want to do their best for Americans. Dr. Gostin argues for a High-Level Commission to take a top-down and bottom-up review of the C.D.C. to determine what systems, data, scientists, funding CDC needs, and what powers are legitimate. He does have hope: the U.S. is approaching higher levels of immunity, and the darkest days of the pandemic may be behind us.
Dr. Abigail Friedman is an associate professor in the Department of Health Policy and Management at the Yale School of Public Health. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. A.S. Friedman and K.E. Warner. The E-Cigarette Flavor Debate — Promoting Adolescent and Adult Welfare. N Engl J Med 2022;386:1581-1583.
This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.Vaccine requirements have been much in the news lately tied to the COVID-19 pandemic, but disputes over requiring vaccines have been with us for decades.How to balance respecting individual autonomy with protecting public health is not a new issue. It's played out in particular force when it comes to children.All states have vaccine requirements for children as they enter school and those requirements are often pretty widely known. Less well known are those requirements related to child care, which can affect children long before they reach school age.Alexandra Bhatti from Merck joins A Health Podyssey to discuss vaccine requirements for child care in the United States.Bhatti and coauthors published a paper in the April 2022 issue of Health Affairs assessing child care vaccination requirements in the United States. They found considerable variation across the 50 states and Washington, DC.While all jurisdictions require children up through age five to meet certain requirements to attend school or child care programs, the states are uneven in their breadth, enforcement, and implementation of these requirements.If you enjoy this interview, order the April 2022 issue of Health Affairs for research on access to care, hospitals and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts
In this healthcare podcast, we're gonna zoom out and look at the entire healthcare industry. I am very confident that you know a lot about the healthcare industry and its basic stats. It's huge. The healthcare industry is approaching the $4 trillion mark, and it employs more people than any other industry in 47 states. Think about that momentarily. More people work in healthcare than in any other industry in every state except for Wisconsin, Indiana, and Nevada. We could get into (but we won't) how many of the gigantic, consolidated incumbents in the healthcare industry are either for-profits sporting very happy shareholders or investors. Then, of course, we have our “nonprofits”—especially mega-nonprofit health systems—who enjoy some pretty healthy margins while, at the same time, these health systems in general offer up some fairly embarrassing levels of charity care considering the amount of taxes they deprive their communities of. You also are probably eminently familiar with various ways that have been cited to transform the industry. So, the usual suspects here are, of course, changing incentives—offering true value-based care contracts, for example—and then the whole creative destruction angle, wherein upstarts come in with far superior products and services, à la the whole Kodak case study or what happened to Sears and Kmart. Maybe this will happen in healthcare. Other ideas to transform the healthcare industry include employers harnessing the latent power that they have in some markets and then, of course, getting rid of middle people, for sure. Or we could go single payer, of course. That's another suggestion/solution. Today's conversation is a rather holistic look at all of this. I dig into this with David Muhlestein, who is chief research and innovation officer at Health Management Association (HMA). And when I say dig in, I mean dig in. David made some very intriguing points that I had not heard before, actually—and I've heard a lot in my time, so that's saying something. I'm gonna tick off a couple of them, but I don't do them justice. So, you'll need to listen to David explain them and give context. First off, what's the problem with healthcare being a $4 trillion industry in this country—I mean, almost 20% of GDP—and employing more people than any other industry in 47 of our 50 states? There are other big sectors in our economy, after all, that get lots of love. Why is big healthcare “bad” and these other sectors “good” in economic terms when we talk about employment? That's one thing I wanted to know. And David made a point that may be self-evident for some but is worth reiterating in all cases. The government pays for roughly half of healthcare, and from a consumer or just American standpoint, it kind of sucks. I mean, I don't see many Insta selfies of someone rocking their brand-new insurance premium. Dollars going to healthcare or health insurance are not going to consumer goods. And that matters economically as well as retail therapy. For all you econ geeks out there, this industry offers no marginal utility. Here's a second interesting point: Just changing incentives might not be enough. Organizations downstream and upstream need to be on board with the spirit and objective of the incentive change. If they are not, then it's game on for every CFO and their revenue cycle managers to finagle how to find the loophole that enables revenue maximization. Revenue maximization. Period. Revenue. The end. Which brings me to another interesting point: Boards of directors, CEOs, people with fiduciary responsibility … they need to know thyself and consider their actual customer. Spoiler alert: 99% of the time, that actual customer is not patients, no matter what is printed in big letters on the front door. No change can really happen unless those who serve in the upper echelons of these businesses get really real about where their bread is buttered. Organizations are built to serve their customer, after all. So, if a patient isn't identified as a customer, the organization at its very core is gonna have a lot of difficulty serving the patient. So, now what? If I want my organization to move forward in a way that is more patient-centric and less financially toxic, say, what to do? Here's thoughts after chatting with David Muhlestein. Four main steps: As I just said, you gotta get your current state unemotionally understood. For reals, who is the organization built to serve? So, first step is being introspective in the harsh light of day. Consider the timeline of your existential demise. Ha ha, this show is so uplifting. But unless organizations really think out 5 years, 10 years, 25 years and really internalize the existential threat, it's going to be hard to motivate change. I see this all the time. So do you. Inertia is real. Nobody does anything until they absolutely have to. Sidebar: But if you need an eventual demise to bring up at your next strategy meeting, I just saw a paper come out saying that by 2030, cost-related nonadherence could become a leading cause of death in the United States, surpassing diabetes, influenza, pneumonia, and kidney disease. This is as per a study by the nonprofit West Health Policy Center and Xcenda. Nonadherence … what does that mean? It means the patient is not doing their treatment. They are not going to the doctor or getting medical care or not taking their drugs. Meaning no one is making money off of all of those patients, especially when they're dead. This is where the rubber meets all of those excess profits everybody is reaping in the short term. I hope that was helpful for anybody trying to motivate change today. Consider what legacy we want to leave behind. Do we all want to wait until we're forced to change to do so? Is this the healthcare system we want to leave behind to children and grandchildren? I mean, anybody who's got a loved one in the hospital with anything complex, fighting for their own patient records, on the phone for hours a day with insurance carriers while care is delayed with possibly devastating consequences, the family having to coordinate care and cross their fingers and pray they don't get a ridiculous bill for services that may or may not have been rendered and then use retirement savings to pay for them … if anyone is not looking to be a party to all of this, then let's think about our strategy moving forward and how it will change to meet the future we want to see. On to the evolve and change approaches: How exactly do you think about doing that? According to David Muhlestein, you can repair your current organization or remodel or rebuild. It sounds daunting, but as Dr. Eric Bricker said on our recent interview together (EP351) and as others have said as well, this is already happening in some regions across the country. There are pockets with real transformation. These changes are on the edges right now, but they're showing that this can and is possible. You can learn more at healthmanagement.com. David Muhlestein, PhD, JD, is chief research and innovation officer for Health Management Associates (HMA). He is responsible for the firm's self-directed research and supports strategic planning and innovation. David's research and expertise center on healthcare payment and delivery transformation, understanding healthcare markets, and evaluating how the broader healthcare system is changing. He is a self-identified data nerd and regularly speaks and writes about healthcare system evolution. David joined HMA via its acquisition of Leavitt Partners in 2021, where he was the chief strategy and chief research officer. Additionally, David is a visiting policy fellow at the Margolis Center for Health Policy at Duke University, adjunct assistant professor at The Ohio State University College of Public Health, and a visiting fellow at the Accountable Care Learning Collaborative. He previously served as adjunct assistant professor of The Dartmouth Institute (TDI) at the Geisel School of Medicine at Dartmouth College. David earned his PhD in health services management and policy, JD, MHA, and MS from The Ohio State University and a BA from Brigham Young University. 07:38 Is it an issue for the healthcare industry that it is one of the largest employers in the country? 08:42 “I think that we need to figure out what is an appropriate amount to spend on healthcare and get to that level.” 09:01 How do we not decrease the amount of healthcare we're receiving while paying less for that healthcare? 10:11 What are the two ways we can look at decreasing healthcare spend? 15:39 “I think that a regional approach may happen.” 16:56 “When somebody takes less, others are going to follow them.” 17:33 Who is really paying in our current healthcare system? 19:47 “Any sort of a model that you start with influences everything else that you do.” 20:09 What's the common challenge David Muhlestein sees in value-based care systems? 23:21 “There are countless things that you can do to improve the current system today.” 27:25 What are the three options for building up better healthcare? 28:19 David's advice for healthcare executives. 33:22 “To really lower the total cost of … healthcare, it's a 30-year process.” You can learn more at healthmanagement.com. @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth Is it an issue for the healthcare industry that it is one of the largest employers in the country? @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth “I think that we need to figure out what is an appropriate amount to spend on healthcare and get to that level.” @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth How do we not decrease the amount of healthcare we're receiving while paying less for that healthcare? @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth What are the two ways we can look at decreasing healthcare spend? @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth “I think that a regional approach may happen.” @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth “When somebody takes less, others are going to follow them.” @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth Who is really paying in our current healthcare system? @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth “Any sort of a model that you start with influences everything else that you do.” @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth What's the common challenge David Muhlestein sees in value-based care systems? @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth “There are countless things that you can do to improve the current system today.” @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth “To really lower the total cost of … healthcare, it's a 30-year process.” @DavidMuhlestein discusses #healthcaretransformation on our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O'Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley
On this 4/20, is sexual orientation a predictor of whether or not you're likely to use marijuana? An expert shares some interesting statistics. Also, trolls can't stop wasting their time making up stories about our community, well we have the perfect response! Plus, so much more! Special guests: Danielle Douglas-Gabriel- Education Reporter at The Washington Post. Gilbert Gonzales - Assistant Professor of Health Policy at Vanderbilt University
Dr. Lois Lee is an emergency medicine physician at Boston Children's Hospital and an associate professor of pediatrics and emergency medicine at Harvard Medical School. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. L.K. Lee, K. Douglas, and D. Hemenway. Crossing Lines — A Change in the Leading Cause of Death among U.S. Children. N Engl J Med 2022;386:1485-1487.
Dr. Yanzhong Huang is Professor at Seton Hall University's School of Diplomacy and International Relations, Senior Fellow for global health at the Council on Foreign Relations, and co-chair of the US-China Working Group of the CSIS Commission on Strengthening America's Health Security. He joined Steve Morrison in the our 133rd episode for a wide-ranging conversation: on China's huge immunity gap; its “dynamic Zero-Covid approach;” the spread of BA-2 beyond Shanghai to 45 cities affecting 25% of China's population and 40% of its GDP; the acute vulnerability of China's elderly; and the supply chain disruptions and huge economic consequences experienced inside China and, increasingly, felt across the globe. Deaths are underreported, and popular discontent has risen, even while it remains doubtful that majority opinion has shifted against Zero-Covid. While the Chinese government has made some modest adjustments to its fierce reliance on mass lockdowns, testing and quarantining, it has not fundamentally changed course. “Zero-Covid will continue.” Opposition is at the highest level -- at the Presidency itself: “the barrier is political.” It remains unclear when if ever the government will move to a mass campaign using a Western mRNA vaccine, a key step to creating immune protection and easing reliance on lockdowns. Successful development of a Chinese mRNA vaccine has thus far been elusive.
Dr. Beth Cameron, Special Assistant to the President and Senior Advisor for Global Health Security and Biodefense at the White House, joins Steve for Episode #132. The Biden administration is making progress on the Global Health Security and Pandemic Preparedness Fund, envisioned as a Financial Intermediary Fund at the World Bank. The fund will invest in a globally linked bio-surveillance and early warning system, aid to the most vulnerable countries to build their health security, and rapid research and development in regulatory systems to create, rapidly scale, and distribute medical countermeasures. We need to "finish the job" and get out of this phase of the pandemic and need truly global surveillance systems and stronger information sharing to prevent the next biological threat. The second Covid-19 Summit has been announced for May 12, with the dual goals of ending the acute phase of the Covid-19 pandemic and strengthening preparedness for variants and future pandemic threats.
This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.March 23 marked the 12th anniversary of the passage of the Affordable Care Act (ACA).This landmark legislation expanded health care access to millions of Americans and accelerated changes in how we organize and pay for health care. Having survived numerous legal challenges and strong political opposition by some, it continues to be the centerpiece of domestic health policy.If you want to understand the evolution of the Affordable Care Act from enactment to today, there's no one better to learn from than Katie Keith of the Georgetown University Law Center.Keith is a regular contributor to Health Affairs' Following The ACA Forefront article series and the recently launched Health Reform newsletter. Most recently, she's written about the No Surprises Act rules, the Department of Health & Human Services response to anti-trans youth policies, delay of the Sunset Rule, and much more.Today on A Health Podyssey, Health Affairs Editor-in-Chief Alan Weil and Katie Keith dive into the latest ACA news and explore the law's successes, shortcomings, and unfinished work.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts
Continuing our exploration of the pharmaceutical industry's influence on health and health policy at a global level, in this podcast, Dr. Eeks has a conversation with Emily Rickard about her research on how the industry influences the UK's All-Party Parliamentary Groups. She will explain what the All-Party Parliamentary Groups, particularly the health-related ones, are and what they do. She'll talk about both the direct and indirect ways the pharmaceutical industry influences those groups and why that matters from both a transparency issue and a health-policy one. Emily is a researcher and doctoral student with the Department of Social and Political Sciences at the University of Bath. To contact Dr. Eeks, do so through bloomingwellness.comOr follow her on Instagram here.Twitter here.Or Facebook here.Subscribe to her newsletter here!Read Dr. Eeks' book Manic Kingdom here.
Dr. Hilary Seligman is a professor of medicine and of epidemiology and biostatistics at the University of California, San Francisco. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. C. Gundersen and H. Seligman. How Can We Fully Realize SNAP's Health Benefits? N Engl J Med 2022;386:1389-1391.
Rates of dementia and Alzheimer's Disease are only increasing in developed nations as scientists race to find treatments and identify preventive strategies. In this episode of Causes or Cures, Dr. Eeks chats with Dr. Margaret Gatz about her research published in the Journal of the Alzheimer's Association titled: Prevalence of dementia and mild cognitive impairment in indigenous Bolivian forager-horticulturalist. In the podcast she will discuss these indigenous populations, including their lifestyle, diet and educational levels, how she conducted her research to assess their risks and rates of dementia, how their rates compare to the developed world, some intriguing findings, and what developed nations with growing rates of Alzheimer's disease can potentially learn from them in terms of risk factors for dementia and prevention. Dr. Gatz is a professor of psychology, gerontology and preventive medicine at the University of Southern California's Lenoard Davis School of Gerontology. Studies in her Gatz lab include age-related changes in cognition, depression, personality and preventive factors for Alzheimer's Disease and other kinds of dementia. To contact Dr. Eeks, do so through bloomingwellness.comOr follow her on Instagram here.Twitter here.Or Facebook here.Subscribe to her newsletter here!Read Dr. Eeks' book Manic Kingdom here.