The Dose
The Dose is the Commonwealth Fund’s podcast that presents fresh ideas, new perspectives, and compelling conversations about where health care is headed. Join host Joel Bervell this season for conversations with leading and emerging experts in health care and health policy. Get the Dose in your inbox: https://thedose.show/signup
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Climate Change Is Already Disrupting Health Care in the U.S.
10/25/2024
Climate Change Is Already Disrupting Health Care in the U.S.
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.
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Climate Change as a Public Health Issue
10/18/2024
Climate Change as a Public Health Issue
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.
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Reforming Mental Health Support for Students and Health Care Workers
10/11/2024
Reforming Mental Health Support for Students and Health Care Workers
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.
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Advancing Health Equity Through Disruptive Innovation
10/04/2024
Advancing Health Equity Through Disruptive Innovation
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 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.
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More Conversations from Aspen Ideas: Health
08/16/2024
More Conversations from Aspen Ideas: Health
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.
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Conversations from Aspen Ideas: Health
08/09/2024
Conversations from Aspen Ideas: Health
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.
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A New Day for Sickle Cell Patients
05/17/2024
A New Day for Sickle Cell Patients
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.
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Dr. Betancourt’s Blueprint for an Equitable Health Care System
05/10/2024
Dr. Betancourt’s Blueprint for an Equitable Health Care System
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.
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Lived Experience Is a Key to Health Equity
05/03/2024
Lived Experience Is a Key to Health Equity
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.
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On the Need for Diversity in Medical Illustrations
04/26/2024
On the Need for Diversity in Medical Illustrations
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 — 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.
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On the Need to Reclaim Gynecology’s Troubled Legacy
04/19/2024
On the Need to Reclaim Gynecology’s Troubled Legacy
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 , as she prepares to open a midwifery clinic and birthing center as well as a national education center for medical students.
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How to Improve Cancer Screening Among Young Adults
04/12/2024
How to Improve Cancer Screening Among Young Adults
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.
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Tackling Overtreatment and Overspending in U.S. Health Care
11/10/2023
Tackling Overtreatment and Overspending in U.S. Health Care
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.
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Private Equity Promised to Revolutionize Health Care. Is It Making Things Worse?
11/03/2023
Private Equity Promised to Revolutionize Health Care. Is It Making Things Worse?
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.
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How Medical Debt Makes People Sicker — and What We Can Do About It
10/27/2023
How Medical Debt Makes People Sicker — and What We Can Do About It
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.
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To Improve Cardiac Outcomes for Women, Increase Their Representation
07/14/2023
To Improve Cardiac Outcomes for Women, Increase Their Representation
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.
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What Support for Women and Families Really Looks Like
07/07/2023
What Support for Women and Families Really Looks Like
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.”
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Why Culturally Competent Care for Women of Color Matters
06/30/2023
Why Culturally Competent Care for Women of Color Matters
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.”
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Fighting NYC’s Ongoing Public Health Crisis — Racism
04/28/2023
Fighting NYC’s Ongoing Public Health Crisis — Racism
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.
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Understanding Obesity as a Disease
04/21/2023
Understanding Obesity as a Disease
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.
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Can AI Improve Health Without Perpetuating Bias?
04/14/2023
Can AI Improve Health Without Perpetuating Bias?
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
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Diagnosing Racism: How One Med Student Sparked a Big Change
04/07/2023
Diagnosing Racism: How One Med Student Sparked a Big Change
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
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The Dose Returns on April 7th with Joel Bervell
03/31/2023
The Dose Returns on April 7th with Joel Bervell
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.
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Uncared For: America the Outlier
12/16/2022
Uncared For: America the Outlier
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.
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Health Care’s Increasing Focus on the Drivers of Health
11/18/2022
Health Care’s Increasing Focus on the Drivers of Health
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.
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U.S. Women Struggle to Get Abortions in a Post-Roe World
11/04/2022
U.S. Women Struggle to Get Abortions in a Post-Roe World
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.
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Why the Midterm Elections Matter for Health Care
10/21/2022
Why the Midterm Elections Matter for Health Care
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.
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Improving Health Care for Trans Youth
10/07/2022
Improving Health Care for Trans Youth
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.”
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Who Gets to Decide When the Pandemic Is Over?
09/23/2022
Who Gets to Decide When the Pandemic Is Over?
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.
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What the Inflation Reduction Act Really Means for Health Care
09/09/2022
What the Inflation Reduction Act Really Means for Health Care
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.”
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