The Other 80 Claudia Williams

If there’s one thing politicians do little of these days it’s change their minds. But, that’s exactly what North Carolina’s General Assembly did in 2023. Ten years after the ACA was passed, and in a historic bipartisan move, they changed their minds and voted to expand Medicaid. NC Secretary of Health & Human Services Kody Kinsley joined us to talk about what it took to get this done and how it’s been going so far. 
We discuss:
How to get stuff done in a politically divided stateOne move that would dramatically increase access to healthy food in America - automatically enroll all Medicaid beneficiaries in SNAP Why NC Medicaid has gone deep on peer to peer support for prenatal care and mental healthThe importance of building a better narrative about the role and value of public health
Kody points out NC’s strategy of investing in community organizations is creating  both health and economic opportunities:
“75% of our community based organizations are minority or women owned throughout those 33 counties. So, this isn't just about getting good access to what drives health in the long run. This is also about building that infrastructure and having a financing model that sustains it that is in the balance, a good value for the taxpayer.”
Relevant Links
NC enrollment dashboard
Crisis warmline
Healthy Opportunities pilots
“NC Launches Additional Phone Support for People Experiencing Mental Illness or Substance Use Disorfer” [RELEASE]
About Our Guest
Kody Kinsley serves as North Carolina’s Secretary of Health & Human Services, overseeing a department with over 18,000 staff and a $38 billion budget. With experience centered on health policy and operations, Kinsley worked on digital healthcare transformation, national education and labor policies, and served as COO and CFO of the U.S. Treasury. 
Secretary Kinsley’s three priorities for the department include: Investing in behavioral health and resilience, improving child and family well-being, and building a strong and inclusive workforce. Under his leadership, North Carolina expanded Medicaid and received the largest investment to bolster the mental health system in over a decade. Kinsley grew up in Wilmington, earning his bachelor’s degree from Brevard College and his master’s in Public Policy from the University of California at Berkeley. 
Source: https://www.ncdhhs.gov/about/leadership/kody-kinsley
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For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email claudia@theother80.com and follow us on twitter...

One thing is clear from the last four years: public health leaders need to seriously upgrade their skills in communication and partnering. In this episode Anne Zink, who is stepping down as Alaska’s Chief Medical Officer, brings us a master class in both topics.  Guiding the state through COVID she inspired both a Facebook fan group and the hashtag #ThinkLikeZink. Take a listen and you will see why.
We discuss:
How we might have avoided the politicization of COVID Partnering with Alaska’s tribes to get vaccines to every corner of the stateThe ways her background as a fine art major, mountaineer and emergency medicine doctor shapes her leadership approach
Anne is committed to breaking the silos between medical care and public health: 
“Public health is population health and if you want to make a difference  … public health and health care have to be braided together. We need to not think about this in terms of separate systems, but we need to think in terms of patients and to get there, public health is that key chief strategist for population health and needs to be at the table.”
Relevant Links
NPR Story on #ThinkLikeZink
Article on the Five Reasons Dr. Zink is crushing it as a crisis communicator
An interview with Alaska’s top doctor
Article on the rural Alaskan towns leading the country in vaccination
Case study on the partnership between public health and tribes for vaccine distribution in Alaska
Information on the Watson Fellowship
About Our Guest
Anne Zink grew up in Colorado and moved through her training from College in Philadelphia to Medical School at Stanford and then Residency at the University of Utah. As a mountaineering guide she had fallen in love with Alaska and after residency in Emergency Medicine became lucky enough to call Alaska home. Not only does she love the people and the place, but also the medicine. She quickly became involved in helping improve systems of care as the medical director of her group, then in her hospital and with state and federal legislation, including state legislation to improve care coordination, opioid addiction treatment options, and integration between private systems and the VA, DOD, and IHS facilities and more.
Dr. Zink became Alaska’s Chief Medical Officer in July 2019. In all the work she does, she strives to create work environments, policies and practices that are data-driven, foster collaboration and build system efficiencies that put patients first. Zink was a visible public presence in the early months of the pandemic,...

Today’s guest is Susannah Fox, author of Rebel Health: A Field Guide to the Patient-Led Revolution in Medical Care. The book is a deep dive into the expert network of patients, survivors and caregivers who are charting a new path of innovation and research. It is for anyone who feels alone, forgotten or lost in the shadows of suffering as they navigate a new diagnosis. But, it’s also for anyone working inside healthcare who is fed up with the status quo. 
We discuss:
How patients – like those first affected by long COVID - accelerate solutions by making invisible problems visible That data liberation is often the foundation for patient rebel movementsThe pop up peer groups forming in Amazon reviewsA framework for understanding, and embracing patient expertise: seekers, networkers, solvers and champions
Susannah reminds all innovators to talk with people living with rare and life-changing diagnoses:
“If you are going to try to understand the intersection of healthcare and technology, you need to put down your clipboard – which is the classic status symbol of a survey researcher – and get out there and just talk to people. Talk to people especially who are dealing with rare and life-changing diagnoses, because those are the people who are going to use technology in ways that we can't even imagine.”
Relevant Links
Susannah’s book Rebel Health
Susannah’s blog: Wow! How? Health
Patient-Led Research Scorecards
An article about how patient-led research could speed up medical innovation
A story about Tidepool Loop receiving FDA clearance
OpenAPS and #WeAreNotWaiting
Hugo Campos’s TedX talk about not being able to access his cardiac device data
Graphic used by Sarah Riggare to show the time spent in self-care for Parkinson’s disease
About Our Guest
Susannah Fox is a health and technology strategist. Her book, Rebel Health: A Field Guide to the Patient-Led Revolution in Medical Care, was recently published by MIT Press. She is a former Chief Technology Officer for the U.S. Department of Health and Human Services during the Obama Administration, where she led an open data and innovation lab. Prior to federal service, she was the entrepreneur-in-residence at the  Robert Wood Johnson Foundation. For 14 years she directed the health portfolio at the Pew Research Center’s Internet Project where she helped define a new market at the intersection of health, social media, and patient engagement.  Fox currently serves on the board of directors of Cambia Health Solutions of Portland, OR, and Hive Networks of Cincinnati, OH. She is an advisor to Alladapt Immunotherapeutics, Archangels, Article 27, Atlas of Caregiving, Before Brands, Citizen, Equip Health, Faster Cures, and the Lemelson Center for the Study of Invention and Innovation at Smithsonian Institution. Fox is a...

We'll be unpacking lessons from the COVID 19 pandemic for many years to come. Dr. Tomás Aragón, who leads public health for the State of California, joins us to discuss what he learned guiding America's most populous state through this challenging and disruptive period. 
We discuss:
That public health’s deepest power lies in the ability to help diverse groups reach consensus under great uncertaintyHow California redeployed an army of census workers to support the COVID responseThe biggest opportunities to use AI for public healthThree great book recommendations: “How Emotions Are Made” by Lisa Feldman Barrett, “High Conflict” by Amanda Ripley and “Fifth Discipline” by Peter M. Senge
Dr. Aragón shared insights about leadership: 
“The other thing is to really appreciate the importance of human psychology. It is so incredibly important … You're going to come up against people who are going to “resist”. I don't think of it as resistance. I just think they're being human. That's just all it is. People have variability in how they process information … And so rather than seeing things as resistance, you really just see it as part of the diversity of ingenuity that exists in an organizational culture.” 
Relevant Links
Dr. Tomás Aragón’s UC Berkeley Public Health profile
Dr. Tomás Aragón’s GitHub blog
Article on Bay Area pandemic response: The epidemiology and surveillance response to pandemic influenza A (H1N1) among local health departments in the San Francisco Bay Area
“How Emotions Are Made” by Lisa Feldman Barrett
“High Conflict” by Amanda Ripley 
“Fifth Discipline” by Peter M. Senge
About Our Guest
Dr. Tomás Aragón, MD, DrPH, has served as the director of the California Department of Public Health and the State Public Health Officer, since January 4, 2021. Prior to coming to CDPH, he was the health officer for the City and County of San Francisco and director of the public health division. Dr. Aragón has served in public health leadership roles for more than 20 years (communicable disease controller, deputy health officer, health officer, community health and chronic disease epidemiologist), including directing a public health emergency preparedness and response research and training center at the University of California, Berkeley School of Public Health.
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For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email claudia@theother80.com and follow us on twitter @claudiawilliams and LinkedIn.

Using AI in healthcare comes with a lot of promise - but access to data, lack of clarity about who will pay for these tools and the challenge of creating algorithms without bias are holding us back.
In 2023, TIME named Dr. Ziad Obermeyer one of the 100 most influential people working in AI. As a professor at UC Berkeley School of Public Health, and the co-founder of a non-profit and a startup in the AI healthcare space, his work centers on how to leverage AI to improve health and avoid racial bias.
We discuss:
The idea of a safe harbor for companies to discuss and resolve AI challengesHow his company Dandelion Health is helping solve the data log jam for AI product testingWhy academics need to spend time “on the shop floor”The simple framework for avoiding AI bias he shared in his recent testimony to the Senate Finance Committee
Ziad says without access to the right data, AI systems can’t offer equitable solutions: 
“I think data is the biggest bottleneck to these things, and that bottleneck is even more binding in less well-resourced hospitals… When we look around and we see, ‘well, there are all these health algorithms that are in medical journals and people are publishing about them’. The majority of those things come from Palo Alto, Rochester, Minnesota [and] Boston. And, those patients are wonderful and they deserve to have algorithms trained on them and learning about them, but they are not representative of the rest of the country – let alone the rest of the world. And so, we have these huge disparities in the data from which algorithms are learning. And then those mirror the disparities and where algorithms can be applied.”
Relevant Links
Dr. Obermeyer’s profile at UC Berkeley School of Public Health
Ziad Obermeyer’s testimony to the Senate Finance Committee on how AI can help healthcare
More about Nightingale Open Science
More about Dandelion Health
Article on dissecting racial bias in algorithms
Article On the Inequity of Predicting A While Hoping for B. AER: P&P 2021 (with Sendhil Mullainathan)
About Our Guest
Dr. Ziad Obermeyer is the Blue Cross of California Distinguished Associate Professor of Health Policy and Management at UC Berkeley School of Public Health. His research uses machine learning to help doctors make better decisions, and help researchers make new discoveries—by ‘seeing’ the world the way algorithms do. His work on algorithmic racial bias has impacted how many organizations build and use algorithms, and how lawmakers and regulators hold AI accountable. He is a cofounder of Nightingale Open Science and Dandelion Health, a Chan Zuckerberg Biohub Investigator, a Faculty Research Fellow at the National Bureau of Economic Research, and was named one of the 100 most influential people in AI by TIME. Previously, he was...

Black women in the US are 3-4 times more likely to die than white women from a pregnancy-related cause and overall the US has the highest rate of maternal mortality in the industrialized world. These deaths are preventable.
Dr. Monica McLemore, a Professor at the University of Washington School of Nursing, says we should stop blaming women for their own deaths and instead address the underlying social and healthcare drivers that impact pregnancy outcomes. In other words, we need to focus on the other 80.
We discuss:
The Momnibus, a comprehensive legislative package to improve maternal health in the US which has still not been passed into lawHow disruptive periods, such as the COVID-19 pandemic and Dobbs, provide opportunities to re-imagine maternal and child health in the USWhy community-centered research is essential for improving health equity
Monica says we need to change our views on scientific evidence: 
“There is no way we're going to get … changes in health outcomes at a population level if you don't bring the social and the clinical together, it's just not happening. And so that requires a change in mindset of the scientific community about what is evidence, who generates evidence, who can contribute to evidence, what evidence is needed and what methods are we going to use to obtain said evidence? Because community is over extraction. They are over participating in studies and not getting anything back. They are over funding science as taxpayers and not being able to access it.”
Relevant Links
CDC’s Report on Maternal Mortality 
JAMA Articles on trends in maternal mortality:
https://edhub.ama-assn.org/jn-learning/audio-player/18796651https://jamanetwork.com/journals/jama/fullarticle/2806661?utm_source=podcast_platforms&utm_medium=referral&utm_campaign=related_article_links
Summary of JAMA webinar on maternal mortality
Op-Ed: How We Can Reimagine Black Maternal Health in the Changed Landscape of Dobbs
Centering the health of mothers
To Prevent Women from Dying in Childbirth First Stop Blaming Them
About Our Guest
Monica McLemore is a preeminent scholar of antiracist birth equity research, community-informed methods, and policy translation. Dr. McLemore is a Professor in the Department of Child, Family, and Population Health Nursing at the University of Washington School of Nursing. She earned a bachelor’s degree in Nursing from The College of New Jersey in 1993 after declaring at eight years old that she would become a nurse. She has a Master’s in Public Health from San Francisco State University and a PhD in Oncology Genomics at the University of California, San Francisco. She’s worked her entire career in reproductive health, rights, and justice. Monica retired from active...