Six reasons for optimism right now

The best antidote to pessimism is proximity to people making a difference.

In healthcare—and beyond—we’re barreling towards a new year that is propelled by a global mandate for change. Agendas are being reshaped. Coalitions are being redrawn. And in boardrooms and in living rooms this holiday season, diverging views on how to best move forward will be on everyone’s mind. 

During times of change it can be hard to know how to get things done. This anticipation led me to reflect on conversations with the people we’ve interviewed in 2024 for The Preprint, people who are unusually good at getting things done, irrespective of the circumstances. Each of these folks, in their own way, has informed my optimism that the dysfunction we experience in healthcare is as fixable as ever:

Dr. Rachel Hardeman, Professor of Public Health at the University of Minnesota.

In 2020, following the police killing of George Floyd, Rachel’s home city of Minneapolis became the epicenter of a national reckoning with racialized violence in America–and Rachel herself emerged as a leading voice on the public health impacts of structural racism. 

At first, efforts to inject anti-racism into science and policy benefited from broad support. But then the moment shifted and the coalition to achieve health equity fractured as many corporations and nonprofits alike visibly divested.

Yet Rachel’s influence as a leader appears unabated, and her commitment to ensuring marginalized communities are healthy remains stronger than ever. This Spring, shortly after joining Maven as our visiting scientist she was named to the TIME 100. Rather than framing her work as a battle, she describes it as a labor of love. 

She tells me, “In framing the work of antiracism and antiracist research through this lens of love, it's a level set. It allows us to say, okay, we are all human, we all honor each other's humanity, and, to that end, we're going to work together to do things differently.”

Dr. Dannagal Young, Professor of Communication at the University of Delaware.

Just months after giving birth, Danna lost her husband to a rapidly expanding brain tumor. She had to upend her life to serve as his caregiver and in her grief, she did what many do: she frantically searched for a culprit. 

Suddenly the healthcare workers in charge of her husband’s care seemed like foes, not allies. Suddenly internet message boards seemed to contain the only explanations she wanted to hear for why the person she loved most was dying. In the process, Danna learned firsthand how reasonable people can be made unreasonable–and undertook pathbreaking research on how scientists, clinicians, and other experts can become more trustworthy messengers.

She told me, “In order to communicate what you know in the same way that regular human beings communicate what they know, you should communicate based on experience. It violates the epistemology of science, but it embraces the epistemology of human beings to say, look, I'm not going to talk to you about like, peer review research. I'm just going to say I've been in this a long time, and here's what I see.”

Adaeze Enekwechi, CEO of Cayaba Care.

Money is a necessary ingredient for impact but is neither sufficient nor deterministic. Before becoming CEO of a start-up that serves mothers on Medicaid, Adaeze ran health care in the Office of Management and Budget in the Obama White House. This required a career pivot from managing a staggering $1 trillion budget to one that is orders of magnitude smaller.

To put things in perspective she reminded me that the innovation center inside the Centers for Medicare and Medicaid Services is a mere 1% of the budget–but still represents $1 billion per year. “It is really, really difficult to spend,” she told me. 

“Sometimes it's just not a question of how much money you have. In the public sector, people rejoice over ‘how much do we have to spend?’ Or in the private sector, ‘how much do I have to invest?’ But it's hard to make good decisions. And if you care about making good decisions, it's extra difficult.” By contrast, at a small nimble start-up she feels she is able to work directly at the root of the problem.

Christy Turlington, founder of Every Mother Counts.

As an iconic supermodel, Christy could have directed her advocacy in a variety of ways–and perhaps, may have been expected to serve as its face. Instead, she decided to use her platforms to amplify others and forge an unique approach to allyship that has galvanized other philanthropists to do the same. Like Adaeze, she feels that resources are not the sole determinant of success.

When we spoke about why she started Every Mother Counts she told me,  “At first, it was really listening and figuring out, do we need another organization? What should we be contributing in terms of value-add?” 

“I found that, certainly, it’s resources, because we do bring resources to the table, but the resources we contribute are so tiny, in terms of what's actually needed and required. It's really the resources plus identifying the skills of a community leader. We know the surest investment, best bang for the dollar, is the leadership.”

Elizabeth Carr, the first baby born from IVF in the U.S.

Elizabeth was born into the media spotlight and remained in its glare for her whole life. While admitting to the occasional fatigue, she has not wavered from her mission to advance access to fertility care against an ever-shifting status quo. 

In looking to the future she told me, “The trickiest part with fertility treatments is we just don't know what technology is coming down the pike. And so for many years, a lot of insurers got on the bandwagon of covering IVF, and then it was like, oh, well, we need to cover ICSI, we need to cover egg freezing.” 

“Unfortunately, we're so reactive. We need to shift our thinking to ‘what would we like to have as an optimal coverage ability, and who are the types of people that should access those things’? I push people to think beyond what we currently have right now, and to imagine the impossible. People were hesitant to adopt IVF as a technology right away, and then all of a sudden everybody was popping up with a clinic. It’s taken 42 years for this much of the population to be born by this technology.”

Robin Marty, Executive Director of West Alabama Women’s Center.

Robin is a no-nonsense, world-wizened changemaker who, given the choice between the easy path and the righteous path, will charge directly uphill if that’s what the mission requires. Case in point: she anticipated the likelihood of post-Roe America five years ago. Then, six months ahead of the official Supreme Court opinion, she “uprooted her husband, three children and two cats” from their longtime home, moving across the country to Tuscaloosa, Alabama. 

She is now Executive Director of the West Alabama Women’s Center, a free and sliding scale reproductive health care clinic that is a bastion to many of the most vulnerable pregnant people in the United States. 

She tells me, “One thing that we learned quickly about being an abortion clinic was that people wanted you to close constantly. After Dobbs happened, we realized we needed to stay open whatever it took. They file complaints. The state changes rules all the time. We could never guarantee that we were going to be open.” 

“So the last thing I wanted to do was be running a clinic and realize that I put money away to make sure that we could sustain, and then the state comes in and shuts us down for any given reason, and that money is still there, but we know that somebody got harmed because they couldn't access care. So the goal is: just keep going.”

What my team is reading, considering, and building against: 

• My dear friend Charles Johnson woke up after election day with a powerful message for everyone. He casts those who voted for both Trump and Harris into a common plight for change. No matter what’s next, we all have work to do.

• On election eve, I joined Ravi Gupta on the Lost Debate podcast to discuss trustworthiness in health care. Ravi is one of my favorite thinkers about social policy because of the way he engages people across the political spectrum in nuanced discussion.
  
  Just a few weeks earlier, he also spoke with my friend Dr. Marty Makary on the same topic. If that name sounds familiar it is because Marty was in the news last weekend. He is currently nominated to run the FDA, a $9 billion agency with tremendous power in regulating the healthcare industry. Marty has a reputation for contrarian views but he is also thoughtful, intelligent and principled in his criticism of orthodoxy. This episode is well worth a listen. I’m reminded that a decade ago we both held a contrarian view against the medical establishment which is now mainstream–that patients should not receive surprise medical bills.

• Joy, a new film just released on Netflix, is a historical drama about the quiet bravery of the team that brought IVF technology into existence. It provides a moving tribute to Jean Purdy, the nurse who became one of the first embryologists and (until now) was unrecognized by the scientific community.

• And finally–a tremendous ray of hope from the cutting edge of science: autoimmune diseases like lupus disproportionately impact women (but also impact men). The symptoms can be devastating and have long been thought incurable. But as Sarah Zhang explains in the Atlantic, new evidence strongly suggests they don’t have to be. 

Happy Thanksgiving and thank you for following The Preprint. Be well and see you in December.