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.

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."

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."

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.

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.

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

Dr. Ziad Obermeyer

Dissecting racial bias in an algorithm used to manage the health of populations

Nightingale Open Science

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

Health inequities and the inappropriate use of race in nephrology

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.

Joel on TikTok

Joel on Instagram

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.

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.