The Dose

***Originally Aired Feb 2020*** More than 800 women across the globe die each day from complications related to pregnancy. Some of them bleed to death. Some of them develop infections or severe life-long medical conditions because they are delivering their babies in unsafe environments. Many of these deaths could be prevented if more young people had access to birth control and other reproductive health care. Pathfinder International is a nonprofit working with communities in 20 countries to make this a reality. On this episode of The Dose, Pathfinder CEO Lois Quam, a member of the Commonwealth Fund's board, recounts some of the stories she's heard from young people around the world. Quam tells host Shanoor Seervai about the challenges they face in deciding whether and when to have children — and how their lives change when they are able to make this choice.

***Originally Aired Oct 2019*** African American women die of pregnancy-related causes at three times the rate for white women, even after accounting for income, education, and access to other resources. What is it about being born black in America that leads to such outcomes? To answer this question, Shanoor Seervai interviews Kennetha Gaines, clinical nurse manager for UCSF Health in San Francisco, for the latest episode of The Dose podcast. Gaines, a Pozen Commonwealth Fund Fellow in Minority Health at Yale University, speaks candidly about her personal experiences and her work to transform the way health care providers treat black women. Does the health care system treat people differently based on race? Tell us what you think – send an email to thedose@commonwealthfund.org.

When the pandemic hit, millions of Americans found themselves in a tight spot – practice social distancing to avoid COVID-19, but what if you have a health condition that requires seeing a doctor? Technology could transform the way people access health care, and the U.S. has made huge investments in this over the past decade. But, as health technology expert Aneesh Chopra explains on the latest episode of The Dose, we still haven't realized the full potential of digitization when it comes to delivering health care.

On June 12, the Trump administration eliminated federal protections against discrimination in health care for transgender people. This means that transgender Americans can be denied access to health coverage and care – simply because they are trans. With the U.S. still grappling with COVID-19, the decision could make it more difficult for trans people to seek testing or treatment for the disease. And it deepens the health risks for a population already facing barriers to care. The Commonwealth Fund's Corinne Lewis, Yaphet Getachew, and Mekdes Tsega talk about the implications of the new rule, particularly for trans people of color, on this episode of The Dose podcast.

COVID-19 cases in the U.S. are climbing again, and data show that Black and Latinx Americans are contracting and dying of COVID-19 at higher rates than white Americans. The reasons for are complex, including: people of color are more likely to be poor, work in industries that expose them to the virus, live in crowded spaces, and have chronic health conditions. Then there's race -- the discrimination and violence that people of color experience on a daily basis puts their health at risk, further exposing them to the coronavirus. Against the backdrop of a nationwide reckoning over police brutality against people of color, Dora Hughes, a professor of health policy at George Washington University, talks about the disproportionate impact of the pandemic on Black and Latinx people, and what policymakers could do to address these racial inequities.

Every day, primary care providers are on the front lines of the COVID-19 pandemic, treating sick patients even as they worry about bringing the virus home to their families. Many still lack adequate protective gear, and many worry about the financial stability of their practices. With the U.S. starting to reopen, we need our primary care practices to keep their lights on — not only to test and treat people with mild symptoms but also to address health concerns that people have neglected while staying home. On this episode of The Dose podcast, health policy expert Farzad Mostashari, M.D., who advises and supports hundreds of primary care practices across the country, explains what it will take to ensure doctors can continue caring for Americans throughout the pandemic.

Health care is about so much more than medical tests or treatments. But, too often, health care providers forget to ask patients what they think would make them feel better. Community health workers can help people take charge of their own health. Often living in the same communities and coming from similar backgrounds, they are able to share life experience with their clients and engender trust. On this episode of The Dose, we talk about one community health worker program, IMPaCT, that is helping some of the poorest and sickest Americans meet their health and social needs. As the COVID-19 pandemic upends all our lives, this idea of putting patients in charge — rather than telling them what to do — has particular resonance. Listen to our conversation with guest Shreya Kangovi, a primary care doctor and professor at the University of Pennsylvania, and then subscribe wherever you find your podcasts.

Getting and staying healthy depends on more than just medical care. In some instances, a patient also needs legal services. What if doctors could "refer" their patients to lawyers for help in dealing with a housing dispute, immigration status, or any number of legal issues? On this episode of The Dose, we hear from Norma Tinubu and Emily Foote about how attorneys from the New York Legal Assistance Group work with health care providers at NYC Health + Hospitals, the largest public health care system in the U.S. Through this medical-legal partnership, some of the city's poorest patients can get the support they need to resolve legal problems that, if ignored, could take a toll on their health.

Earlier this week, Germany became one of the first countries to start easing COVID-19 restrictions. That's because its initial response to the pandemic helped keep the death rate low. Germany: Caught the coronavirus early Does lots of testing Has a robust health care system. As the pressure mounts to reopen economies across the globe, other countries may have something to learn. On this episode of The Dose, Michael Laxy, a health economics researcher at the Helmholtz Center in Munich, talks about the German approach.

The coronavirus pandemic is impacting everyone, but the older you are, the more severe the health consequences. The recommendation is stay home, away from other people. What does that mean for an older person managing a chronic health condition (like diabetes) and needs to fill an insulin prescription? What about someone who may be used to seeing their grandchildren every weekend, and is not able to because they could be risking their health? On this episode of The Dose, the Commonwealth Fund's Gretchen Jacobson, vice president of the Medicare program, lays out just how tough COVID-19 has made life for older Americans.