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You've got 10 minutes with Einstein. What do you talk about? Black holes? Time travel?
Why not gambling? The Art of War? Contemporary parenting?
Each week, host Jason Gots surprises some of the world's brightest minds with ideas they're not at all prepared to discuss. Join us and special guests Neil Gaiman, Alan Alda, Salman Rushdie, Margaret Atwood, Richard Dawkins, Maria Popova, Mary-Louise Parker, Neil deGrasse Tyson and many more...
25 January, 2020
Roz Chast and Patricia Marx (cartoons, words, ukuleles) – the Beatles stole everything from us
The New Yorker-based comedy team on never exercising or going outside, and so much more.
Think Again Podcasts
Thelma and Louise, Ponch and John, Pancho and Lefty, Quixote and Sancho Panza, Marx and Engels, Marx and Chast…history and literature are full of magical buddy stories. Every now and then, for reasons no one can explain, Two people come together and produce something greater, or at least very different, from the sum of their parts.
I'm here today with one such team: the writer-cartoonist duo of Patricia Marx and Roz Chast. They're both longtime contributors to the New Yorker and fearsome humorists in their own rights. But together they form a third fearsome thing, a thing which has created books such as Why Don't You Write My Eulogy Now So I Can Correct it: A Mother's Suggestions, And their latest: You Can Only Yell At Me For One Thing At A Time: Rules for Couples. They're also the enigmatic figures behind yet a fourth thing, the legendary ukulele band Ukelear Meltdown.
COVID-19 amplified America’s devastating health gap. Can we bridge it?
The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
19 November, 2020
Credit: Joe Raedle/Getty Images
Sponsored by Northwell Health
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
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<p>In the last 100 years, we've made incredible advances in health care, advances that would be viewed as miraculous to any previous generation. To pick one example, the<a href="https://ourworldindata.org/life-expectancy" target="_blank"> U.S. life expectancy</a> in 1950 was 68.2 years. We've since added 10 years to that average. Social programs have helped the young and elderly, two of the most health-vulnerable populations, receive unprecedented levels of care and attention. And telemedicine has decoupled many Americans' health support and monitoring from brick-and-mortar hospitals, expanding access to care.</p><p>Yet, despite these advances and despite handily<a href="https://www.brookings.edu/research/a-dozen-facts-about-the-economics-of-the-u-s-health-care-system/" target="_blank"> outspending other OECD nations on health care</a>, the United States preserves vast health disparities. As James Madara, CEO and executive vice president of the American Medical Association,<a href="https://www.ama-assn.org/about/leadership/america-s-health-care-crisis-much-deeper-covid-19" target="_blank" rel="noopener noreferrer"> </a>wrote on the organization's site: "The U.S. health system that exists today is a hodgepodge of ideas, programs, and regulations that is both extraordinarily expensive and highly inefficient. And despite its size and technological advancements, our health system is beset by tremendous gaps and inequities that favor some groups while unfairly disadvantaging others."</p><p>Our current predicament has its origins in tectonic sociohistorical forces that have shifted and fractured the health care landscape. For those at the peaks, access to superior care, education, resources, and social networks serve to protect their health. For those in the canyons, the ground continues to weather away with each past and ongoing crisis—consider, for example, the disproportionate fallout from<a href="https://diabetes.diabetesjournals.org/content/60/11/2667" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.salon.com/2013/09/29/ronald_reagans_shameful_legacy_violence_the_homeless_mental_illness/" target="_blank" rel="noopener noreferrer">the dissolution of the Mental Health Systems Act</a>.</p><p>Then came COVID-19.</p>
COVID-19 deepens U.S. health disparities
<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.<blockquote>We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights.</blockquote>
Working to close the health gap
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health
<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
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01 February, 2020
Sharon Salzberg - On Balance
In this episode master teacher Sharon Salzberg considers whether it's ok to teach mindfulness to the armed forces, how practitioners of meditation and mindfulness should balance openness with discipline, and so much more.
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<p>Since 1974, <a href="https://www.sharonsalzberg.com/" target="_blank">Sharon Salzberg</a> has been sharing ancient meditation and mindfulness practices in a voice the contemporary West can understand. Her warm, funny, down-to-earth books, dharma talks, and guided meditations have helped struggling meditators worldwide establish a strong practice and reduce the suffering in their lives. In this episode Sharon sits down with Jason to consider whether it's ok to teach mindfulness to the armed forces, how western practitioners should deal with the almost militant tone of some eastern teachers when it comes to discipline and "right effort", and so much more. Sharon's latest book is <a href="https://www.sharonsalzberg.com/real-happiness-book/" target="_blank">Real Happiness: a 28 day program for realizing the power of meditation</a>, now thoroughly updated and revised for its 10th anniversary.</p>
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20 January, 2020
mindfulness and meditation teacher Joseph Goldstein – doubt comes masquerading as wisdom
In this first episode of 2020, beloved dharma teacher Joseph Goldstein is back for a conversation about struggle, doubt, and growth on the spiritual path.
Think Again Podcasts
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<p>Freedom. Everyone wants it, but knowing where to look for it is another matter. And to make matters worse, the world is full of things that feel like freedom but might just get us more tangled up in everything we're trying to escape. How much freedom can money buy? How much money? How free are you on a tropical vacation? Would uploading your consciousness into the cloud and downloading it into a robot avatar on Alpha Centauri make you more free? How about falling in love again? How about three margaritas with friends? Or six? How about falling in love again? A better government? Less government? No government at all? </p><p>I'm here today with <a href="https://www.dharma.org/teacher/joseph-goldstein/" target="_blank">Joseph Goldstein</a>, a beloved teacher of Buddhist ideas and practice in the West and a personal inspiration to me, to talk about freedom of the mind and spirit—and the kinds of effort and insight that can lead there. Joseph is the co-founder of <a href="https://www.dharma.org/" target="_blank">Insight Meditation Society</a> in Barre, Massachusetts and the author, most recently, of <a href="https://www.soundstrue.com/store/mindfulness-3372.html" target="_blank">Mindfulness: a Practical Guide to Awakening</a>.</p>
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21 December, 2019
Jad Abumrad (“Radiolab”, “Dolly Parton’s America”) – American Multiverse
To create the podcast series "Dolly Parton's America", Jad Abumrad and his producer Shima Oliaee took nine trips into the "Dollyverse"—that complex American multiverse of music and culture that surrounds country singer Dolly Parton. In this episode Jad and host Jason Gots talk about some of the astonishing discoveries he made along the way.
Think Again Podcasts
<p>If you'd told me a couple months ago that a podcast about Dolly Parton could move me deeply and raise all kinds of questions that go straight to the wounded heart of America today, I guess I would have been skeptical to say the least.</p><p>But that skepticism might be exactly the point. America is an image factory. Country music. Rock and Roll. New York City. Nashville. We paint with big, broad brushes. And if we're not careful, we miss a lot of the details. </p><p>My guest today is audio storytelling wizard <a href="http://jadabumrad.com/bio.html" target="_blank">Jad Abumrad</a>. He's the creator and a host of <a href="https://www.wnycstudios.org/podcasts/radiolab/podcasts/2" target="_blank">Radiolab</a>, <a href="https://www.npr.org/podcasts/481105292/more-perfect" target="_blank">More Perfect</a>, and now, of <a href="https://www.wnycstudios.org/podcasts/dolly-partons-america" target="_blank">Dolly Parton's America</a> – a nine part podcast series that achieves all those aforementioned implausible things. Jad's trips into the Dollyverse with his co-producer Shima Oliaee reveal the country singer as something between a bodhisattva and one of those fairytale mirrors that tell you the truth about yourself. </p><p>– <a href="http://jasongots.com" target="_blank">Jason Gots</a></p>
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