The Dose

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

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

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

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

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

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

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

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

The U.S. housing crisis and health care are inextricably linked. Compared to the general population, people experiencing homelessness have higher rates of illness and mortality. These struggles are even more acute for transgender people, who often face discrimination when they seek both housing and health care. On the latest episode of The Dose, Pam Klein, Manager of Transgender Services at the Boston Health Care for the Homeless Program, talks about how to provide health care to transgender people who lack housing. As public acceptance of transgender people grows, and more and more people who openly identify as trans enter the field of health care, there is hope for the future, she says. Sign up here to get new episodes of The Dose in your inbox.

When the pandemic hit last March, mental health care, which was typically delivered in face-to-face sessions, rapidly moved online. At a time when the need for support was greater than ever, this was a welcome shift. But as we glance – with cautious optimism – toward a return to "normal," will telehealth be the dominant mode of delivering mental health services? On the latest episode, Latoya Thomas, senior director of policy and government affairs at Included Health, and Solome Tibebu, director of the Upswing Fund for Adolescent Mental Health, talk about the future of virtual mental health care, particularly for underserved groups. Sign up here to get new episodes of The Dose in your inbox.