Today, we peer into long-term care in America — those services, both medical and non-medical, that patients in old age or with chronic illness need to perform activities of daily living.

More than half of older Americans will eventually require long-term care. And this number will only swell as we reach into the next decade when, for the first time in our nation’s history, there will be more elderly than children. Of these Americans, the vast majority would prefer to age at home and in their communities. But our long-term care system, such as it is, is ill-equipped to accommodate them. 

Nearly 1 million Americans nationally languish on waiting lists for home-based care, with an average wait time that exceeds 3 years. More than 50 million, meanwhile, serve as unpaid caregivers for their family. And 3 in 4 worry about not being able to afford a nursing home, which on average, costs $100,000 a year. By way of reference, the median household income among those 65 or older in 2018 was $44,000.

Medicare, the federal insurance program for older Americans, does not cover long-term care. Nor do most private insurance programs — which themselves exact exorbitant costs. Wealthy Americans can pay out of pocket, and Medicaid covers the very poor and disabled. But the vast majority — or “forgotten middle” — of Americans, have no sustainable option for accessing care.

Here to discuss this broken system — and why COVID-19 has exposed and exploited all those caught in its breach — is Dr. David Grabowski, Professor of Health Care Policy at Harvard Medical School and an acclaimed decades-long researcher of long-term and post-acute care. David has published dozens of articles on the economics of aging and is the perfect person with whom to explore both the challenges and the opportunities for long-term care in the United States. His reflections on this moment are not to be missed.

For more on Civic Rx, visit civic-rx.org.

While COVID-19 continues to dominate news headlines, another crisis lurks unabated and largely unaddressed: climbing maternal deaths. Among industrialized nations across the globe, the United States stands out as the most dangerous for pregnant women. Over 700 women die each year, 60% of them from preventable causes, during pregnancy or delivery. And Black women are 3 times more likely to die than White women.

Perhaps surprisingly, it didn’t used to be this way.

For much of the 20th century, the US enjoyed an almost unmitigated decline in its maternal mortality rate, driven by scientific advances and improvements in general living conditions. But in the late 1980s, that progress began to stall. The maternal mortality rate in 1987 was 7.2 deaths per 100,000 births; by 2017, that rate had more than doubled. Today, the US is the only country in the developed world to see its maternal mortality rate go up; American mothers are 50 percent more likely to die in childbirth than their own mothers were. And it has the highest maternal mortality rate of any wealthy nation in the world.

What’s provoked such a dramatic rise in America's maternal mortality rates — just as the rest of the developed world has pushed its' down? Why are women of color disproportionately vulnerable? And what can we do, at the hospital level and the state and federal levels, to redress maternal health inequities?

Few are better poised to shed light on these questions than Dr. Elizabeth Howell, Chair of the Department of Obstetrics & Gynecology at the University of Pennsylvania’s Perelman School of Medicine. Dr. Howell is a practicing ob/gyn and a nationally recognized leader in redressing maternal and child health disparities. And on today's episode, together, we begin to unpack America’s maternal mortality crisis.

For more, check out the below:

- to learn about the Black Maternal Health Momnibus Act

- to watch Dr. Howell’s TEDMED talk

- to understand the Alliance for Innovation on Maternal Health’s (AIM) safety bundles, and

- to get a “primer” on maternal mortality in the U.S., from the Commonwealth Fund

And to learn more about Civic Rx, go to civic-rx.org.

Just last week, Dr. Rochelle Walensky became the first CDC director in more than 20 years to call for federal action against gun violence. Meanwhile, President Biden both on the campaign trail and since has vowed his commitment to advancing meaningful gun reform, publishing six executive orders on the issue this April. And the NRA — long the swaggering villain in this saga — has been steadily losing sway, as it’s mired in bankruptcy and litigation.

Is this a tipping point in the fight for gun safety?

Today, we talk with Shannon Watts and DeAndra Dycus, two extraordinary mothers and founder and volunteer, respectively, of Moms Demand Action: America’s largest grassroots movement to prevent gun violence. Together, we explore why this fight is so often marked by cycles of tragedy and neglect, what might be done to break the political stalemate, why we need gun owners at the table, and which policy solutions are most likely to be effective — as well as the stories of Shannon and DeAndra themselves. 

It’s a humbling conversation. No matter your stance on gun safety, I hope you’ll join us and take a listen.

To learn more and join the gun violence prevention movement, visit momsdemandaction.org or text JOIN to 644-33.

We were just approaching the cusp of normalcy this summer when Delta, abetted by a silent revolt of the unvaccinated, pulled us back into a war against the coronavirus. Once again, now, COVID-19 cases are surging, hospitals are brimming, deaths are rising, and Americans across the country are being beseeched to don their masks.

For even the most resilient among us, this relentless tug between progress and regress on the pandemic is exhausting. But for thousands of Americans, this stress has morphed into something even more pernicious: According to a survey by the US Census Bureau, more than 42% of people last December reported symptoms of anxiety and depression, a dramatic increase from just 11% in 2019. Among 5,000+ US adults surveyed by the CDC, 13% reported starting or escalating substance use to cope with pandemic-induced stress. Young people, people of color, essential workers, and those previously diagnosed with mental illness have been disproportionately afflicted. But the challenge of this growing mental health epidemic transcends any single community: as Americans, we are all at risk. And the time to act is now.

Today, we talk with Dr. Ashwin Vasan, the President and Chief Executive Officer of Fountain House, a national organization delivering services to and aiding the recovery of the seriously mentally ill. Dr. Ashwin Vasan is an epidemiologist, a social entrepreneur, and a physician who has committed his career to the advancement of health equity. And today, he shares why it’s necessary to treat the seriously mentally ill with respect and with dignity, how his organization has mobilized to meet their needs, and why the pandemic has only magnified the urgency and the value of building a movement to advance the civil rights of the mentally ill.

For additional episodes and more about Civic Rx, check out civic-rx.org.

Here to talk with us about what this means is Dr. Ari Bernstein, a pediatrician, assistant professor, and the interim director of The Center for Climate, Health, and the Global Environment (C-CHANGE) at the Harvard Chan School of Public Health. Dr. Bernstein leads Climate MD, a program that prepares a climate-ready healthcare workforce. And he developed the Health Effects of Climate Change course, which has been taken by more than 100,000 students virtually in over 100 countries. 

In this episode, Dr. Bernstein and I delve into the varied and multiplying impacts of climate change on health: our bodily health, mental health, public health and health care delivery. We discuss the responsibility of the health system to advance climate resilience and environmental justice. And we explore the policies and the questions the Biden administration must grapple with to make a dent in this global crisis. 

We’re back!

Our first season featured the voices of everyone from Tony Fauci to former Australian Prime Minister Julia Gillard, each of them grappling with the pandemic and with the daily crises it created. But the stories we unspooled are only the beginning. There are still countless threats to our public health, from climate change to structural racism, that during COVID, have been either exacerbated or ignored.

Enter Season 2. This summer, I invite you to join me in cutting into these next big issues — beyond COVID — and talking to the scientists, the policymakers, the activists and storytellers who are lighting the path forward. I can’t wait to get started, and to share these discussions with you.

We’re back this July, at civic-rx.org, and wherever you get your podcasts. See you then.

The COVID-19 pandemic has unsparingly exposed the flaws of our fragmented and exorbitant healthcare system, but it has also highlighted opportunities to better deliver care. Chief among these are new models to bring care closer to patients, be it in the form of virtual medicine, mobile health clinics, community health workers, or home-based care.

Indeed, now more than ever, brick-and-mortar hospitals are working hand in hand with community-based organizations, public health departments, and local and state governments to deliver services and reach people who otherwise might fall through the cracks.

As a post-pandemic future draws nearer, I wanted to talk with someone who has lived that evolution, and could speak to what this new approach meant for the future. Which is why I’m excited to introduce Dr. Meena Seshamani, Vice President of Clinical Care Transformation at MedStar Health -- a large, Maryland-based health system -- where she is charged with leading value-based care initiatives across the system’s 10 hospitals and 300+ outpatient care sites.

Today, Dr. Seshamani shares MedStar’s experience adapting its practice and operations to a once-in-a-century pandemic. She offers lessons, in innovation and in crisis management, for other health systems navigating this period. And she explores what changes need to be made more broadly to foster an equitable, better integrated, more wholesome approach to care delivery — leveraging the insights gleaned over the last 15 months.

For more ideas on how to reform our ailing American health system, and how the pandemic might spur us forward, check out:

 - "Ten Actions For Better Post-Pandemic Health Care In The United States," in Health Affairs
- "After COVID-19: Thinking Differently About Running the Health Care System" in The Journal of the American Medical    Association
- "9 ways COVID-19 may forever upend the U.S. health care industry" in STAT
- "Covid-19 - Implications for the Health Care System" in The New England Journal of Medicine

For more on Civic Rx, visit civic-rx.org.