The urgent need for better health care for Black moms
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Alan Murray: Leadership Next is powered by the folks at Deloitte, who, like me, are exploring the changing rules of business leadership and how CEOs are navigating this change.
Apolo Ohno: I would like to live as long and as healthy as possible.
Ohno: Okay? To where I could like, reach down, grab my grandkids, and hold them up. Like, that, to me, is a good, healthy, strong life.
Murray: And what steps are you taking to ensure that you can do that?
Ohno: Okay, four foundational principles.
Murray: Here we go. All right, we got to get these four. I’m sorry, Sasha. Yeah, we’re about to learn how to live long, healthy lives. I’m not going to cut the conversation off.
Ohno: These are things that I think about that are very simple. How am I sleeping? How am I eating? How am I moving? And how am I thinking? Not just about, like the world and my social environments, but how am I healthy here within myself? When I look in the mirror, am I okay with who I see?
Murray: Welcome to Leadership Next, the podcast about the changing rules of business leadership. I’m Alan Murray.
Michal Lev-Ram: And I’m Michal Lev-Ram.
Murray: What you heard there at the top was a clip from my interview with the Olympic speed skater, also Dancing with the Stars champion, and now business person, Apolo Ohno, at last week’s Fortune Brainstorm Health conference. I was apologizing to Sasha, who keeps us on time at these conferences, because I kept the conversation going a little too long. And Apolo Ohno was about ready to give us the secrets to his success.
Lev-Ram: I was hoping we’d get a few more secrets to be honest. I mean, it’s great to know what his, you know, four key takeaways are, but I wanted to know more specifically, like, what does he eat to keep his body healthy? You know?
Murray: Yeah. And how much does he sleep? You know, the last one was how is he thinking about himself? How do you make sure that you have a positive attitude about yourself and what you’re doing? But hey, it’s an Olympic champion. Come on, give him a break. It was a start.
Lev-Ram: It was a great conference. This was just one of many incredible experts that we heard from at last week’s conference, which took place over two days in L.A. We had Chelsea Clinton. We had the Surgeon General. I mean, it was a who’s who in the industry, Alan.
Murray: All credit to you for heading up the program development for the conference. Great job. In today’s episode of Leadership Next, we’re going to hear some of the best moments from that event. But before we get to that, any big takeaways for you, Michal?
Lev-Ram: You know, I think one of my big takeaways is just how quickly this industry has moved, from just extreme high, and not to say that we’re at an extreme low now, but I think there are a lot of challenges coming out of COVID, coming out of this really intense period of investment and innovation. And what the industry as a whole does next in these next few years I think is going to, you know, set the stage for so much. Is it going to keep evolving? Or is it going to be the status quo going forward?
Murray: Well, the thing that struck me, I guess I always feel this way about health conferences. At one moment you’re talking about the very frontiers of high technology. I mean, we had a demonstration of a stethoscope that can actually diagnose certain heart conditions on the spot using A.I.—really, really powerful. So at one moment, you’re talking about the very high, and then at the next minute, you’re talking about sort of the very basic stuff, loneliness, and how the pandemic increased loneliness, and all the health effects of that. So it’s, it’s a complex industry, and it’s a fascinating mix of a very high technology and very low basic blocking and tackling.
Lev-Ram: Yeah, I totally agree. I mean, as much as we’ve seen so much innovation and A.I. enter the picture, you know, I feel like it can’t be a health conference without doctors complaining about electronic health records. So there’s that. It does go back to the basics, too.
Murray: And I know we’re just at the beginning of the use of A.I. in medical applications. It’s going to be really interesting, Michal, to see where this goes. That piece of the industry seems to be moving very fast.
Lev-Ram: Yeah. And again, going back to some of the innovations we’re seeing, I also had the chance to interview Dr. Robert Wachter, the chairman of medicine at UCSF at the conference. And I don’t know if you all follow him on Twitter, but he basically became the doctor to follow on Twitter during the pandemic, where almost 300,000 followers turned to him for practical, straightforward advice about how to navigate COVID. And he agrees with you, Alan, he also thinks this is moving just very, very fast. But he said that an upside of the pandemic, the era that we just all lived through, is that It really accelerated the digital transformation of healthcare. There’s good and bad to it.
Robert Wachter: I think it moved us forward quite a bit. It probably leapfrogged us by five years, in terms of our use of data, presenting data to people in forms that allows them to make better decisions. So I think we’re better off in the big picture of, how do we create a health care system that’s better, and safer, and more equitable, and less expensive? In part because it accelerated the digital transformation of medicine.
Murray: No question, digital transformation of medicine has moved rapidly. And technology is clearly an incredible tool, but it’s also insufficient. I liked what Dr. Neel Shah, the chief medical officer of Maven Clinic, had to say on the panel about Black maternal health.
Neel Shah: An app isn’t going to fix health care, right? It’s not going to fix structural racism. But I think there’s an opportunity for, especially the people in this room, to think with precision about what digital health is and what it isn’t. There are things that have to happen in person. You cannot deliver a baby through a screen. Then actually, there are things that you can uniquely only do digitally. You know, the existential issue for the health care system right now is trustworthiness. And it’s not the job of the people that we’re serving to be more trusting of us. It’s the job of the people in this room to be held accountable to be trustworthy. And part of that, by the way, is making sure that you’re matching people to services where they have shared lived experience. And then the other thing you have to do, which honestly the brick-and-mortar system is terrible at, and probably will continue to be terrible at, is reliably show up for people when they expect you to and when they need you to, and that’s what you can do digitally.
Murray: So there is no doubt that the opportunities for A.I. in health care are large. But we should take a moment and highlight some of the other big concerns people had about the use of A.I. in health care.
Lev-Ram: Yeah, those exist for sure. Just an example: In a recent Pew Research poll, 60% of people said they’d feel uncomfortable with their provider relying on A.I. in their health care. To highlight one of the concerns respondents had, 70% of respondents said that racial and ethnic bias was a problem in health care, and half of that 70% said that A.I. in health care would make that bias worse, or just keep it the same, which is also pretty bad. Here is Dr. Monique Smith, the founding director of the Acute Care Design + Innovation Center at Emory University, on the presence of racial bias in A.I.
Monique Smith: So, I’ll give you an example. During early pandemic, our emergency department partnered with our bioinformatics core. We wanted to use very well-known facial recognition technology to do some very simple vital signs. Do you have a fever? Are you turning blue, because you can’t breathe and you’re short of breath? And use that to differentiate where people should go. And that’s the, you know, something that looks at your face and decides. I mean, we had a great group that really put together the technology and they said, Hey, we’re not going to [inaudible]. This as far as we can take it based on our training data set. And this is a training data set based on the population of Atlanta, which is reasonably diverse, but still didn’t have a wide variety of melanin in the facial recognition software, which causes problems, and you’re thinking about thinking about blueness around the mouth. Even for the element of sensing temperatures for facial recognition. You know, much to my chagrin, about four months later, I had a well-known and established technology vendor come with me to a company they had acquired, and this company, they were doing facial recognition for vital signs. I was like, this is great, you know, we’re doing really great things in telemedicine, maybe this can be incorporated. I’m so glad you’ve solved for this problem. Tell me about your training dataset. Absolute crickets. I never heard back from them.
Murray: So this is a very big issue, Michal, as you know. I mean, A.I. only learns what it’s taught, it depends on the data you put into the machine in terms of what comes out.
Lev-Ram: Yeah, absolutely. And, you know, obviously, we’re seeing similar concerns across the board as all these applications are taking off. But you know, we’re talking about health care here, the stakes are pretty high, so I get that the concerns are also really, really high. On the flip side, Dr. Smith was less concerned about the supposed threat of A.I. replacing or outperforming human medical professionals, and that’s good to know.
Smith: So I don’t worry about my job stability. One, because I resuscitate patients, and no algorithm is going to do chest compressions for you. But also, because there’s this element of human interaction that matters, right? I don’t think anyone’s talking about replacing physicians and the role of that knowledge. They’re actually just talking about how can we [inaudible]? How can we make this more efficient, less painful, less burnt out? And there’s a lot to be figured out in that mix, particularly because medicine in and of itself is already a little bit flawed. The data that we have to work out in the baseline already has biases that are embedded within it.
Murray: Yeah, Michal, the interesting thing at the conference was that not only was there not a lot of talk about people losing jobs, there was a concern, a serious concern about the nursing shortage and how we get the nurses we need to deal with the aging of our population.
Lev-Ram: Keeping these concerns in mind, I do want to end our conversation about the digital transformation in health care on a somewhat hopeful note. So let’s turn back to Dr. Neel Shah, who a few minutes ago told us that digital tools have the power to make healthcare more reliable, and trustworthy. He reminded us that if A.I. and other digital tools are deployed with care, they really do have the power to create much safer, healthier outcomes for all of us.
Shah: If I were to tell the doctors at my hospital to text their patients back, they’d probably quit. And it’s not because they’re bad people, right? Like, a bad system will beat a good person every time. They want to communicate with people. They’re just not set up to do it. So when you build a platform where someone can show up at 3 a.m., and help you breastfeed your baby with a lactation consultant, that’s the difference between a 34-week delivery and months in the NICU or a 39-week delivery and a mom bringing her baby home.
Murray: Jason Girzadas, the CEO-elect of Deloitte US, is a sponsor of this podcast and joins me today. Welcome, Jason.
Jason Girzadas: Thank you, Alan. It’s great to be here.
Murray: Jason, everyone in business is talking about A.I. It clearly has the potential to dramatically disrupt almost every industry, but a lot of companies are struggling. What are some of the barriers that companies are facing in creating business value with A.I.?
Girzadas: Yeah, Alan, I think A.I. is on every client’s agenda. I think every CEO and board interaction and conversation that I’m a part of proves the fact that the promise of A.I. is widely held, and the hope is far and deep that it creates business value. But there’s challenges to be sure. What we’ve seen is that the probability of success increases dramatically with strong executive sponsorship and leadership. There has to be a portfolio of investments around A.I., as well as to link the business ownership with technology leadership to see the value of A.I.-related investments. Over time, we’re optimistic and confident that the value will result, but it will be a portfolio where either short-term opportunities for automation improvements around productivity and cost takeout and then longer-term, medium-term opportunities for business model innovation that are truly transformational. So this is a classic case where it won’t be a single approach that realizes value for A.I.
Murray: It sounds like you take it a step at a time.
Girzadas: I think it’s definitely time, and also a portfolio recognizing that some investments will have short-term benefit where you can see immediate use cases creating financial and business impact, but longer-term opportunities to really invent different customer experiences, different business models, and ultimately create a longer-term benefit that we can’t even fully appreciate at this point in time.
Murray: Jason, thanks for your perspective and thanks for sponsoring Leadership Next.
Girzadas: Thank you.
Lev-Ram: It’s fitting that we just heard Dr. Shah highlight two examples of how digital tools can support new and expectant mothers. At this year’s Brainstem Health, we wanted to draw focus to the state of maternal health, and I think we really did that, especially the state of Black woman’s maternal health in this country, which, quite frankly, is not good.
Murray: Yeah, it was kind of shocking, Michal. The U.S. has the highest infant mortality rate of any industrialized nation, and Black women are three times more likely to die from pregnancy-related complications than white women.
Lev-Ram: It’s just such a frightening statistic, and unimaginable in today’s world that that’s the case. There are many things that contribute to that statistic, including structural racism, social determinants of health, and implicit bias, like we mentioned before in health care. The live events team assembled a panel at our event to just discuss the roots of the mortality crisis in Black maternal health, and what can be done to fix it. And it was one of the most powerful sessions of the conference, in my opinion.
Murray: One of the things that made the session so powerful was how it started with a personal story from Charles Johnson, who became a maternal health advocate after the death of his own wife, Kira, following the birth of their son in 2016.
Charles Johnson: I was fortunate enough to meet a woman that absolutely changed my life. And so we talk about my wife, Kira, we’re talking about a woman that was sunshine personified. Neel knows me well, he knows that she was way out of my league, a woman that you know, ran marathons, was a pilot, spoke five languages fluently. And on April 12 of 2016, we walked into Cedars-Sinai Medical Center, about 12 miles from here, fully expecting it to be the happiest day of our lives, and walked straight into a nightmare. My wife, in the interest of time, my wife was allowed to bleed internally for more than 10 hours while myself and my family begged and pleaded the staff at Cedars-Sinai to take action. And I’m always transparent about the fact that when we walked into that hospital, the thought that my wife would not walk out to raise her boys, it never crossed my mind. But as the days turned into weeks, I began to hear stories of other women who had horrific birthing experiences. Experienced obstetric violence, and some mothers that had made the ultimate sacrifice, giving the gift of life. And I felt like I owed it to my boys, I felt like I owed it to my wife to do something to try and prevent what happened to our family, to happen to others. And so, for the past almost seven years, we’ve worked to not just improve maternal health outcomes, but to completely eradicate the maternal health crisis in our country.
Lev-Ram: Charles and Kira’s story emphasizes a crucial point of this conversation about Black woman’s maternal health. The threat to Black woman’s lives cuts across geographical location and income level, as we know. Reproductive justice activist Professor Loretta Ross made this point really, really clear to our audience.
Loretta Ross: And too many times, people are describing Black maternal health, mortality, maternal mortality as either a genetic issue or a behavioral issue, but not as a sociopolitical issue. You know, poor white women in Appalachia have the same relative maternal mortality statistics as upper income Black women in New York City. And so we have to be able to look at these outside influences that aren’t about race, that aren’t about behavior, but about the conditions that we’re creating as a society that we’re failing to address.
Murray: Michal, did the panelists have any suggestions about how to solve the problem?
Lev-Ram: Yeah, they did, Alan. One suggestion is simply include more Black women in medical research. It’s that simple. As a starting point, at least, here’s Dr. Irogue Igbinosa, from the Stanford School of Medicine.
Irogue Igbinosa: So what I will just say, as an obstetrician in maternal fetal medicine, so I see high-risk, obstetrics, high-risk patients. When you look at clinical trials, like less than 2% are applicable to pregnant woman. So that there is a gap, like so we’re basing so much information on a narrow scope of data. So that’s an area that medical schools are actually actively encouraging your future clinicians like, Hey, this is a population that needs to be included in research.
Lev-Ram: So Alan, another suggestion actually came not from this panel, but in an interview with Chelsea Clinton on the first day of the conference. Chelsea serves as the vice chair of the Clinton Health Access Initiative, and she’s focused on having advocates in the room during childbirth.
Chelsea Clinton: Something that I am a huge believer in, and I’m so happy to be able to manifest that kind of belief, you know, as an investor and an advocate, is in having more midwife-centered and OBGYN-supported care. We have not only reams of data over the last years and decades, but arguably, you know, far longer of how important kind of midwife-centered and empowered care is.
Lev-Ram: Okay, the last potential solution I’ll mention is a legislative one. The first report on American maternal mortality rates was published in 2020, just a few years ago, partly thanks to Charles Johnson’s advocacy. Here’s Johnson on the importance of government intervention.
Johnson: Governmental intervention, legislation is a big part of this. But this is a complex set of challenges. It’s going to take a complex approach, right? And a comprehensive set of solutions. We’re really proud of some of the legislative things that have taken place on both a state and a federal level. We have seen on states, like my home state of Georgia, expanding Medicare, Medicaid, postpartum from six weeks to a year postpartum, something that people never thought would ever happen, particularly in Georgia right now. Georgia, Georgia, right. You know, we’ve seen amazing legislation passed here in California. And on the federal level, we are working on a set of bills that we’re extremely proud of called the Black Maternal Health Momnibus, which is a comprehensive package of 13 different pieces of legislation, all addressing the very, very, very vast challenges with this issue. And so for those of y’all who may wonder, why do we need legislation specifically for Black women? The short answer is because when we fix this for Black when we fix it for everybody.
Lev-Ram: There’s one thing Dr. Shah of Maven Clinic said on that panel that I really can’t stop thinking about, which is making sure women survived childbirth is the bare minimum for our health care system.
Shah: The idea that people should survive childbirth is a very low bar, right? This is a panel on maternal mortality, but we should not be aiming for the floor and designing a better system. We should be aiming for the ceiling, which is a system that is empowering.
Murray: Michal, I think Dr. Shah made a good point. It’s why I say what is both interesting and sometimes a little frustrating about those conferences that you go from, from the exciting possibilities of new technology to just getting over the bare minimal health care that you think we should be providing to every American.
Lev-Ram: Yeah, it’s a it’s a little bit of cognitive dissonance, I think, when it comes to In this industry. You know, there’s a ton of focus when it comes to women’s health on pregnancy and reproductive rights. And rightfully so, because it’s often said that maternal health is the bellwether for the health of a society. But to reach that ceiling of a health care system that empowers people, there needs to be more focused on gynecological issues that are unrelated to pregnancy, like endometriosis and menopause, and we touched on that as well at the conference. And business can play a big role here in helping us improve the state of women’s health. Here’s Alyssa Jaffee, partner at 7wire Ventures.
Alyssa Jaffee: I’m incredibly bullish about women’s health. Women’s health is not just about women, it’s human health. Women are over 50% of our population, yet we make 80% of healthcare buying decisions. It’s not just reproductive rights. It’s not just maternal health care. Women in this country, over one in five have two or more chronic conditions, autoimmune conditions. The way that we treat healthcare can’t just be service to one type of person, it really has to be to everybody. So I think, quite frankly, as an investor, we have a competitive advantage when we invest in women’s health companies. We saw two come out this year as unicorns, and we expect a whole slew next year coming more.
Lev-Ram: Now, Alan, before we go, I know you’re still buzzing from one interview in particular. So I wanted to make sure that we highlight it.
Murray: Yeah, Michal. I think you’re talking about my interview with the U.S. Surgeon General Dr. Vivek Murthy. You know, we’re all kind of used to surgeon generals talking about the opioid epidemic or cigarette smoking. But Dr. Murthy has focused on something very different, what he calls America’s loneliness epidemic. And you’re right, I am still buzzing from that very moving conversation.
Lev-Ram: Before we get into it. I just want to offer the audience one stat. According to a 2022 Kaiser Family Foundation poll, 90% of American adults believe the country is in a mental health crisis.
Murray: Wow. Yeah. And Dr. Murthy has really been on a crusade to highlight this crisis, and to suggest very practical ways of combating it. I’ve read his book, it’s called Together: The Healing Power of Human Connection in a Sometimes Lonely World, and I would recommend it. It really highlights a serious problem. The interesting thing about the book is it was written before the pandemic, and the pandemic clearly only exacerbated all of this.
Vivek Murthy: We now know that loneliness is associated with an increased risk of anxiety and depression and suicide. But it’s also associated with an increased risk of heart disease and premature death, as well as dementia. And when you actually look at the mortality impact of the increased risk of premature death related to loneliness, it’s actually comparable to the increased risk of premature death related to smoking 15 cigarettes a day. It’s greater than the risk associated with obesity. And so, there are real mental and physical health consequences to loneliness. And it’s also extraordinarily common, you know, around one in two Americans are experiencing loneliness.
Lev-Ram: Dr. Murthy talked a lot about the impact of loneliness on kids specifically, as well. And he highlighted how today’s kids experience loneliness and how social media both ameliorates and contributes to that feeling.
Murthy: But I also think that it’s important to acknowledge here that when we talk about kids in particular, the young people seem to have the highest rates of loneliness across the population, which may surprise some people who might think well, aren’t they very connected on social media and technology? And they certainly are. Here is my concern. I think there are some benefits that some children may be able to get from social media in terms of finding community, forging connection, staying in touch with friends. And this can be particularly helpful if you’re, let’s say, a member of a community that traditionally, you know, has been marginalized or you don’t have folks who share your experience. LGBTQ community members say to you know, share this with us often, kids in particular. But what I am concerned about, though, is a growing number of stories that I hear from kids around the country who are saying social media does three things to them: makes them feel worse about themselves, makes them feel worse about their friendships, but they also say they can’t get off of it. And when we look at the data, we’re seeing more and more data showing an association between social media use, particularly heavy social media use, and adverse mental health outcomes. And so what we don’t have here with social media is we haven’t had effective safety standards. You know, most of the products in my house had to actually meet some sort of safety standard in order to be sold, and especially if they’re products that my children use, right.
Lev-Ram: He had some suggestions aimed at adults, too. And it may or may not surprise you, but he thinks that the workplace can play an integral role in helping adults feel more connected to each other.
Murthy: The workplace has a profound impact on our mental health, and on our sense of connection and community. Now, this actually is important not only for workers, but for businesses as well, because it turns out, and very interestingly, when people feel a greater sense of connection to each other in the workplace, it positively impacts their creativity, their productivity, and actually their engagement in the workplace, which has downstream impacts on retention. Creating opportunities on a regular basis for people to actually come to know one another and build relationships with each other, it’s not just nice to have, it’s actually good for businesses as well. And so I’ll give you an example what we do in our office, just one simple example. Every week, during our all staff meeting, we spend 10 to 15 minutes where we have one member of our staff interview another, and it’s about things unrelated to work. It might be about their childhood, about things that they dreamed of doing when they were when they were growing up. It might be about hobbies they have or about challenges that they encountered. It could be about their family about their kids. But I’ll tell you, Alan, that during those 10 or 15 minutes, we come to know people often with greater depth, and feel a greater intimacy and closeness to them than we had felt perhaps in many months of working side by side with them. So a little bit of structure a little bit of time can go a long way to fostering connection in the workplace.
Murray: Well, Michal, another successful Fortune conference in the books. We were only able to highlight a fraction of the stories, advice, and conversation that happened over those two days. And there were a lot of predictions for how the health care industry will change over the next several years. What are the trends and stories you’ll be paying close attention to over the next year, Michal?
Lev-Ram: Um, one of the things that interests me is, again, just going back to all of the investment in the area and some of the innovations, you know, what happens next, we’re seeing a lot of quite a bit of slowdown there. But at the same time, you know, like we’ve touched upon in in this episode, there are some really, really basic problems including Black maternal health and others that are still, you know, plaguing the industry. So, what about you, Alan?
Murray: I liked what Annie Lamont, the venture capitalist at Oak HC/FT, had to say. When someone said, what’s the effect of money drying up for this industry? She said, look, I don’t see any shortage of opportunities. We have lots of opportunities in health care, and I think that’s a story we’re going to want to keep watching for a long time to come.
Lev-Ram: Absolutely. We’re going to continue to keep our listeners up to date on all of these trends in health care, and of course, other industries as things continue to evolve quickly.
Murray: We certainly will, Michal. See you next week.
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