The Dose

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

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

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

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

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

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

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

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

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

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