A Health Podyssey

In a bonus episode of A Health Podyssey, Harriet Washington discusses the history of racism in medicine and research with Vabren Watts, Health Affairs’ director of health equity, and Aletha Maybank, chief health equity officer and senior vice president of the American Medical Association. Washington is the author of several books on medical ethics, including Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. This featured podcast coincides with the release of "Racism & Health," the February 2022 issue of Health Affairs. Alongside the publication of this special issue, it was important for Health Affairs to provide historical context about the impact of racism on health to inform the research published in the issue.Listeners can view the video recording of this interview on our website and YouTube page. Get your copy of the Racism & Health theme issue today.Find out more on Racism & Health.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Racism manifests in different ways for different people in different environments.For many Black women, experiences with sexual and reproductive health reveal cross-cutting themes of racism, sexism, and classism, all expressed in the context of strong social norms and prejudices regarding Black women and reproduction. Attention to poor health outcomes for Black women has grown recently in part due to stories of negative maternity experiences of prominent Black women, such as Serena Williams. Congress has gotten into the act as well and taken steps to address the crisis of high rates of maternal mortality among Black women. But what are the individual experiences behind this crisis?Monica Simpson, executive director of Sister Song, joins A Health Podyssey to discuss a paper her and coauthors published in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health. They examined the reproductive health experiences of Black women in the South.They found that Black women's experiences navigating sexual and reproductive care were informed by both structural and individual racism, often leading to poorer quality care and likely worst health outcomes.If you enjoy this interview, order the February 2022 Health Affairs Racism & Health theme issue.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Listen to this bonus episode from Health Affairs' Narrative Matters podcast, which highlights personal stories from the front lines of care.  In this episode, host Jessica Bylander interviews Wanda Irving, chair of the board of Dr. Shalon’s Maternal Action Project, before Irving reads an essay from the February 2022 issue of Health Affairs, dedicated to the theme of racism and health.This essay remembers the life and legacy of Shalon Irving, whose 2017 death brought national attention to maternal mortality among Black women in the US. Subscribe to the Narrative Matters Podcast.If you enjoy this essay, order the February 2022 Health Affairs Racism & Health theme issue.

"Members of racial and ethnic minority groups have long suffered from health inequities in the United States. These inequities result, in large part, from racial and ethnic minority populations' inequitable access to health care, which persists because of structural racism in health care policy.Racism includes a complex array of social structures, interpersonal interactions, and beliefs by which the group in power categorizes people into socially constructed 'races' and creates a racial hierarchy in which racial and ethnic minority groups are disempowered, devalued, and denied equal access to resources."These words come from the opening paragraphs of one of four overview papers in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health.Ruqaiijah Yearby from Saint Louis University joins the A Health Podyssey to discuss how structural racism is embedded in US health policy.Yearby and coauthors describe structural racism within the US health care policy today and in the past. Structural racism has created a tiered system of care with racial and ethnic minority groups experiencing poorer access and lower quality care than White Americans.If you enjoy this interview, order the February 2022 Health Affairs Racism and Health theme issue.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The February 2022 issue of Health Affairs focuses entirely on racism and health. It includes papers that trace the long history of racism to present day policies and practices that are the reasons for large and sustained health disparities.Racism and bias come in many forms and given the social stigma associated with them, they can be difficult to study. When a study comes along that provides new empirical data on bias, it makes a major contribution to our understanding of this important topic.One such study in the February issue from Michael Sun, a medical student from the University of Chicago, and colleagues is the focus of today's A Health Podyssey.Sun and coauthors studied bias in how patients are characterized by clinicians through the history and physical notes entered into a patient's electronic health record, or EHR. When a patient is admitted as an inpatient or an outpatient, the notes document the patient's reason for seeking medical care and summarize the patient's medical, family, and social history. The notes can also describe the plan to address the patient's medical problems. But what if the way the patient is characterized in these notes is distorted by clinician bias? Sun and colleagues examined racial bias in EHRs and found that Black patients had over 2.5 times the odds of having negative descriptors in their medical records when compared to white patients.If you enjoy this interview, order the February 2022 Health Affairs Racism and Health theme issue.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The COVID-19 pandemic has made the relationship among research, policy, and public health strikingly clear. People who may have given little thought to health policy and research began following the latest study results to guide their own behavior and push governments and businesses to make decisions that reflect a combination of science and their own values and risk tolerance.Health journals like Health Affairs responded by accelerating editorial processes and publishing free content to meet growing consumer demand. The new environment affected health services researchers as well as placed a new emphasis on timeliness and attention to issues affecting the public.In this context, George Wehby from the University of Iowa College of Public Health joins Health Affairs Editor-in-Chief Alan Weil for a new A Health Podyssey Excursion.Wehby co-authored the most read Health Affairs article in 2020. In that paper, Wehby and coauthor Wei Lyu showed the value of state-level mask mandates in the early phase of the COVID-19 pandemic.More recently in January 2022, Wehby and colleagues published two more papers in Health Affairs, one related to children's educational attainment and the other on racial and ethnic disparities in dental service use among lower income adults receiving Medicaid.Join Alan Weil and George Wehby as they discuss these topics and how health services research has changed in recent years. If you enjoy this interview, order the January 2022 Health Affairs issue.Pre-order the February 2022 Racism and Health issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Precision medicine is built on a platform of big data, or large data bases that permit analysis of correlations among environmental and personal factors, treatments, and health outcomes.Data bases that once included only paper records now include tissue samples, air and water samples, and more. There's vast potential for significant advances in health care from precision medicine.But existing large data bases tend to be drawn almost entirely from European and Asian populations, limiting the reach of the benefits of precision medicine. Since big data analytics are often hidden from the patient (and sometimes even the clinician), non-representative data also contributes to mistrust in a health care system that has a long history of excluding certain people.Kayte Spector-Bagdady from the Center for Bioethics and Social Sciences in Medicine from the University of Michigan Medical School joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss the representativeness of data banks and what to do about it.Spector-Bagdady and coauthors published a paper in the December 2021 issue of Health Affairs examining the lack of racial and ethnic diversity in data bank recruitment and enrollment at Michigan Medicine, a major academic medical center.They found failures of representation were in part due to recruitment practices and in part due to the disproportionate rate at which black, Asian, and Hispanic patients declined enrollment when offered, relative to non-Hispanic white patients.If you enjoy this interview, order the December 2021 Health Affairs issue.Pre-order the February 2022 Racism and Health issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Advance care planning is a term used to describe when a person prepares for future management of serious or terminal illness, including developing an advance care directive or what is sometimes is called a living will.Beginning in January of 2016, Medicare made it possible for certain clinicians to bill for their work for patients to develop advance care plans.Despite the new billing option, uptake has been quite slow.In health care, we often use financial incentives to motivate behavior change. You might have expected that simply creating a payment option for advance care planning would make it happen.Keren Ladin from Tufts University joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss the reasons Medicare's payment policy has not led to the greater pursuit of advance care planning.Ladin and coauthors published a paper in the January 2022 issue of Health Affairs examining the limited use of advance care planning billing codes among clinicians. Their qualitative study revealed a number of potential explanations for low use that can help us  understand why a seemingly simple payment change doesn't automatically yield a desired result.Barriers to use of the advance care planning billing codes include institutional practices, concerns about the effects on patients and more.If you enjoy this interview, order the January 2022 Health Affairs issue.Pre-order the February 2022 Racism and Health issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

"Let us hope that this is a one in a hundred years pandemic. We don't want to build our health care system to operate at all times as if tomorrow will be COVID." - Sherry GliedOn December 15, Health Affairs published ahead-of-print, “National Health Care Spending In 2020: Growth Driven By Federal Spending In Response To The COVID-19 Pandemic,” the annual national health expenditures article prepared by the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary. Always one of Health Affairs’ most-read articles, this year’s provides the first official report on spending that reflects the effects of COVID-19. During a live Lunch and Learn event, a discussion was held on the findings with economists Sherry Glied from the Robert F. Wagner Graduate School of Public Service at New York University and Craig Garthwaite from Northwestern University’s Kellogg School of Management. The event was held on January 5, 2022.Listen to Health Affairs Senior Editor Laura Tollen interview Sherry Glied and Craig Garthwaite about what's behind the numbers regarding the latest national health care spending report, long COVID, health care spending reform, which hospitals gained the most during the pandemic, delayed care, and more. Lunch and Learn events hosts top researchers and analysts on timely topics and initiatives impacting health policy. Interested in attending future events? Sign up for Health Affairs Today or Health Affairs Sunday Update newsletters to be the first to hear about the upcoming events. If you enjoy this interview, order the January 2022 Health Affairs issue.Pre-order the February 2022 Racism and Health issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

When you think of the health care workforce, nurses and physicians are probably the first professions which come to mind.But there are actually more personal care aides in the US than physicians. Together with home health aides and nursing assistants, personal care aides comprise one-fifth of the US health care workforce. These workers provide essential supports to people who face limitations in basic activities such as eating, bathing, and moving around.As the US population ages, the demand for home health and personal care aides is projected to increase by nearly 1.2 million additional jobs by 2030.Esther Friedman from the University of Michigan joins A Health Podyssey to discuss the changing size in employment in the personal care workforce.Friedman and colleagues published a paper in the December 2021 edition of Health Affairs investigating state level changes in the nursing home and home care workforce between 2009 and 2020. While almost all states experienced an increase in the overall size of their home care workforce, most saw a decrease in their nursing home workforce relative to the number of people who need these services.If you enjoy this interview, order the December 2021 Health Affairs issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts