Chasing Life

'Hey there, welcome to Chasing Life. We got a very special episode for you today, but I want to start off by reminding you of something about my own life. You've no doubt heard me say many times that I am the father, proud father of three daughters. They are some of the most important people in my life alongside my wife, my mom, and even my mother-in-law. I am surrounded by these strong, powerful, amazing women in my live, and they provided so many things for me: love, companionship, sometimes even a stern lesson or two. But here's the thing that might surprise you, despite representing half the population, women are often facing a lot of inequality when it comes to many things in our society, especially health and healthcare. Get this, women spend 25% more of their lives in debilitating health as compared to men. They're just sicker and they're more often sicker at pivotal times in their life. That's something we're going to talk about today. And despite that, they are often underrepresented when it comes to finding treatments for the things that ail them. Women get overlooked and underserved too often when it come to their health. So today we're going to talk about it. We're going talk about with someone who knows a lot about this issue and is trying to do something about it, Melinda French Gates. She's a philanthropist. She's going to be making an important announcement on the podcast today regarding her organization, Pivotal. She's going to be giving a lot of money away. We're talking hundreds of millions of dollars away to try and address some of the concerns that you're going to hear about today, some of concerns that maybe you've already dealt with in your own life. This is money that is earmarked specifically for women's health in the reproductive years, during menopause, and all throughout their lives when it comes to mental health, the critical sort of care that women need at the critical times in their life. We're going to talk about who's going to get that money, what they're going to do with it, and the impact that it might make. Melinda French Gates, again, she's our guest today. I'm Dr. Sanjay Gupta, CNN's chief medical correspondent, and this is Chasing Life.

I went back and looked at some of our old interviews in preparation for this one. And these are some profound conversations we've had over the years. And I think even going back to 2015 timeframe, when you, I think that was a timeframe, you found it Pivotal. We were talking about some of these issues back then and, you know, I have three daughters, so I think about this in maybe even different ways than when you and I first started chatting about it. So all that to say, I appreciate your time and thank you for being here. Welcome to Chasing Life.

Thanks, how old are your daughters now?

Just celebrated a 21st birthday, a 19 year old, and a 17 year old.

You're getting there.

They're getting there. They're good. They're good kids. But it is, you know, it's interesting. It's a very, it's a very different world for them versus their mom or their grandmom. And so, you know, 20, 25 year gap and all these changes in women's health, which I guess is part of the reason maybe you've started this organization.

Well, my initial inspiration for Pivotal Ventures was really looking at the societal issues that women face here in the United States. So I was doing a lot of work in global health already, and I've been on the global health issues probably now 25 years, but then I just started to realize that in the U.S., so many women were facing issues that we really weren't tackling as a society. And so I founded Pivotal Ventures then to really focus on women and families in the U.S. And now I'm really broadening out that work or including in that work, I should say, women's health specifically.

Why are women's health issues minimized compared to men's health issues?

'Well, we have funded men's health issues for a very long time, but we have underfunded and under-researched conditions that affect women. And so for so long, the medical community assumed the male body as the default body. And then we would take medications and say, okay, we'll take it down by a certain amount of a dosage for a woman. That's just not true. A woman's body is very different than a man's. And so, we just have not funded this area, and if we're going to accelerate progress, we really do need to fund women's health.

I don't want to belabor this particular point, but why, though? Why weren't women's issues funded in the same way? I mean, presumably, people cared about them, or are you saying this was a lack of concern from the outset? Or why wasn't it happening?

Well, I think you have to look at, go back in the history of the United States and the NIH and say, who was making the decisions around funding? This is why I'm so... Pivotal's real job is how do we get women into positions of power so that we lift them up and they lift their families up? When women hold positions of power, then they move funding to different things. They have a different lens on society than a man has. It's not better, not worse, just different. But partly, in the past, men didn't see these issues that women were having and so they funded what they knew. They didn't fund, say, okay, well half the population is different, how should we look at those issues? Now that you're finally seeing far more female doctors are graduating medical school, we're getting far more of female researchers, you're starting to see them move to the top levels and now they're starting say, hey, we need to go after these issues. It's not okay to treat a man's body as the default body, you've got to look at the women's issues too and what's going on for them.

It's always struck me, and maybe it's one of those things that I just... I remember talking to this researcher years ago about Alzheimer's disease in particular. And you find that women are twice as likely to develop Alzheimer's Disease, but half as likely to be enrolled in a clinical trial. And I thought that, look, that just doesn't fundamentally make sense, just as a pragmatist, right? Why wouldn't you study the people most affected by a particular disease? And you know, you get all kinds of answers. Well, you know women, especially before menopause, if they have hormonal fluctuations, it may interfere with certain medications, so you want to study men and then potentially take those same dosing and apply it to women. Didn't make a lot of sense, but that was, I guess, the most logical sort of explanation. What you're sort of depicting is something where it seems like they were just largely ignored.

Yes.

There was no scientific rationale for this.

It was almost as if whole areas of a woman's life were invisible in the medical research, right? Like, we've expected women for so long to put up with pain and suffering instead of saying, look, every woman goes through these transitions in life. They go through their reproductive years, and then they go through these perimenopause and menopause years. Let's look at a full woman's life cycle and not just her reproductive years. Let's look at the whole thing and say, how can we help her through? Women spend nine years of their life ill. We often think of the later years like the Alzheimer's years or the geriatric years that they face. That is only about half of it. Half of those years are in her most productive part of life. But if she's dealing with perimenopause and she's not getting the right information, she's got massive insomnia, often. She might have a lot of anxiety. We know about hot flashes. Like, she's dealing with metabolic issues in her body and yet we're not helping her with the right information or the right services.

Is the United States particularly poor at this? You alluded to maternal mortality, which, I mean, we're a country that spends $4.5 trillion on healthcare. Some of the stats when I was doing the background research kind of boggle your mind that we spend that kind of money and then have, at least among developed countries, some of the highest maternal mortality rates in the world. Presuming for a second, people care about these issues, why are women who are pregnant and delivering babies more likely to die in the United States?

Because the medical system, we often overlook what women are telling us about their bodies. We're often quite biased or the way they're treated, particularly if you say the huge number of women dying in the United States are Black. Black women die at two to three times the rate in childbirth than a white woman. Well, what's happening to her? I was down in Louisiana, visiting many clinics late last year. I was just in Tuscaloosa, Alabama, visiting clinics. And what happens is they go into the system and the system doesn't listen to what's actually going on with them. And they will sometimes turn them away and say, go home. I met a woman who she was turned away and said, oh, yes, you're late in your third trimester, but you're okay. She calls back in 24 hours later, she still is in trouble. And do you know, in the end, by the time she got into the hospital, she lost that baby. Because no one listened to the symptoms she was having. That just shouldn't be. And so we need to catch women in our system and listen to them and get them the health services they need. And these days that includes mental health, right? We're seeing a huge number of women who are falling into anxiety and also depressed after they have a baby. That postpartum depression is a real thing. And if you don't catch them until that first checkup for their child, they're too far into the depression. It takes a very long time to pull them out. And yet a mental health screening is not something that's hard to do.

Is there a place or a system that you try to emulate when thinking about how to solve these problems? I mean, how do you begin to tackle something as widespread as what we're talking about?

'Well, I think we have to look at where the biggest disparities are. You have to look at where the big death and disability is happening, and then you have to go there. And so we know preeclampsia is a big issue for women, and so making sure the clinics are doing the right things. Predominantly in the U.S. we do that. We take women's blood pressure when we go in, which is not true in many places in the world. Bleeding is a bit issue, so making sure that practitioners understand and doctors understand how bad the bleeding is, but we have to go to these places and look at why are women being turned away? Why are they being dismissed? Why are being told they need a C-section when they don't? Some of it is because many of these are low income women and if they're on Medicaid, even the way they're scheduled for appointments, if they are even scheduled, a lot of times it's come in on this day and you wait in the waiting room until you're seen. Right? It's not even, Hey, let's triage and figure out who's in the worst situation. So you have to go where the problems are to take it apart. And part of the thing that I'm learning is that you have look at women's mental health. Women are coming into clinics and saying, look, I can barely afford childcare. I can't barely afford to feed my kids. I might lose my job. I'm trying to figure out how to cobble a couple of days together. I already have a child and now this one's on the way. And so somebody needs to be reaching them and caring for them. And if we do wraparound services in the right kind of clinics, that can be done. And then they can be accompanied to a hospital by a doula. If you go with a doula, you're often heard more clearly.

Has your lens on this changed since Pivotal was founded?

'My lens on women's health has changed and been informed by what I have seen all over the world through the more than 25 years in philanthropy. I have seen the difference that contraceptives make for women. I have it with my own two eyes. I have been it in the data. The longest-standing global health research goes back to the 1970s, we know when a woman can time and space the births of her pregnancies, she's healthier, the children are healthier, the family is wealthier. So I've been on that piece of that journey for a long time. Then with the foundation, we looked a lot at maternal mortality around the world. And now with my Pivotal journey, I'm looking at what else do we need to do? How do we look at contraceptives and the reproductive years and maternal health in the U.S.? But also, what is it we need to do for these other phases in life that we just don't talk about for women? We have been invisible when it comes to perimenopause and menopause all over the world, and that just shouldn't be.

And we're going to have much more of my conversation with Melinda French Gates about her efforts to advance women's health in the United States and all over the world.

Welcome back to Chasing Life. My guest today is Melinda French Gates. And I should tell you that her organization, Pivotal, just made a big investment in women's health. Here's what it's all about.

I'm announcing an additional $215 million towards women's health to focus on really two areas. Women's reproductive health years, I'm doubling down on my commitments in reproductive health, but then I'm adding on a new area, which is women's second part of life, their midlife, forties and on, perimenopause and menopause, trying to bring voice and focus and resources to the most important part of women's lives that are really their most productive years. So they're not dropping out of the workforce because of these conditions that we're dealing with.

And it sounds like mental health.

And mental health.

That's another part of what's going to be funded through this announcement.

Exactly. So when I talk about reproductive health and maternal health, I want wraparound services, mental health services, particularly in maternal mortality, in the maternal years, because when women are going through these years of pregnancy, we're not diagnosing their anxiety and their depression. So yes, money will absolutely go there, and money towards making sure women get the right information about contraceptives.

What specifically is going to happen? I mean, when you're making an announcement like this, what transpires? Organizations get money, accountability, how do you sort of address that?

'Yes. So everything I do with the funding that comes from Pivotal is in partnership with others, others who are out working in these spaces. So this is part of my $600 million commitment to women's health. I've already made some research grants, some announcements around research grants last year that have to do with women's cardiac health and eventually women's chronic illness, now this additional $215 million is really about how do we make sure young women get the right information they need about contraceptives? How do we makes sure in the maternal health space we do wraparound services with communities so that women have access to a doula or have access all the providers who know more about mental health or who accompany them on their journey? And then, the biggest part of the funding is going to be in this menopause space, this sort of invisible space we have not addressed as a world, and yet, women go from their reproductive years into those transitional years. And so, I'm really looking at in the menopause space, how do we make sure, like today, a third, a third of OB-GYNs are learning about menopause, one third. I think they should all learn about it. I also think that service providers, mental health practitioners, your primary care doctor should be able to give you good advice about menopause. It's too hard right now to get the right information that you need. And it shouldn't be this invisible time in life for women. It should be, hey, this is a natural transition and let's make sure everybody's trained to help women through this time.

When you look at Pivotal, how do you ultimately measure success? What would be a barometer of success?

'Well, I look at our women at all places in society. Like for me, the goal of Pivotal is to lift women up and lift families up. And women are predominantly the ones that help lift their families up, right? And so if the investments that Pivotal and our partners and others that I can crowd in, if we start to see true progress, it's like, so for instance, I measure how many women are in state legislatures. All of those seats in state legislatures. You know, women are half the population. We don't have half the seats in the state legislatures yet. So I am working on getting more and more women up and into state legislructures. And guess what? That will feed the Hill. That will feel Congress. When you get more women in the halls of Congress, we will make different policies that I believe and that I'm seeing at the state level will be more family-friendly. Things like paid family medical leave that people need to take care of their elderly parents or to take of the babies when they're born. So when I see more women in state legislatures at the highest places in politics and getting close to equal or more women CEOs or more woman's businesses being funded, that's when I know we're having success that we got the flywheel started and we're getting women along the way.

It's impossible to disentangle anything from politics nowadays, it seems. But what you're describing, does that mean you would fund campaigns?

'I would fund policy work. And I do fund policy work. So I have funded a number of organizations who worked very, very hard, many partners to get a paid family medical leave policy at the federal level. We came within one vote of getting that into a bill. It failed there. That is the truth. Is it money well spent? You bet it is. I'm still glad and I will still go after that when there's an opening again. But we also funded, I mean, I try to be very strategic, we also fund it at the state legislature. Well, when I got into this work, there were very few states that had paid family medical leave. We now have over 13 and the District of Columbia. And so you have to create momentum and get the flywheel working in society, particularly, we're talking about some very, very large issues, you know, changing culture. But what I know to be true, is when you look at the other high-income countries that have paid family medical leave and have had it now for over 30 years, it changes society. Guess what? Men stay home at the birth of the child because they're like, I'm not going to miss out. And then what happens? Well, he participates more. He enjoys it more. The child benefits from it, right? But without paid family and medical leave, he nor she can stay home. And so when I go to places like Sweden, the men look at me like, that's a silly question. When I ask them, Well, did you stay home at the birth of your child? They're like, Well, of course I did. I wouldn't miss out on that, right? And so they might've started taking paid leave at first because they didn't want to leave money on the table, like, oh, okay, you know, I'm getting this leave. Now they're saying, it's just the right thing to do and I want to be there as part of my kid's life. And so, these policies matter. And so, yes, I do fund policy work as well.

Yrah, it is pretty staggering. I was in Denmark recently and I think it's 12 months of parental leave... 12 months. I mean, for people listening to that, that sounds like a utopian sort of order but that is the norm, I think, in many of these Scandinavian countries, which is remarkable. You're a grandparent now. Congratulations.

I am, thank you.

Yes. Two grandchildren?

Two granddaughters, ages 18 months and three years old. They're a delight.

How has that changed your your your viewpoints on things?

Well, first of all, having grandchildren, as everybody told me, is one of the best things in life. But it is very hard to think that my two granddaughters have fewer rights than I have in this country. Because of the Dobbs decision, they have fewer right than I had growing up. That is the oddest thing in the world. We had a policy on the books for almost 50 years for women. And we rolled it back. That is very bizarre to me. So I think a lot about the world that they are launching in. And that is part of my work now is like, how do we make sure we don't roll things back? Women deserve to decide if and when to have a baby. We know the longest global health research that was done goes back to the 1970s, we know that when a woman can time and space the births of her pregnancies, she's better off, the baby's better off, the family's better off, and yet we rolled something back. And we have attacks on contraceptives or mifepristone? Come on, these are not political decisions. These are decisions that families are making. And the country is going through incredibly difficult economic times. And so people deserve to decide when they're going to have a child and if they're going to have a child, and when to do it and how to space those.

'I had never heard it put that quite that way, that your grandchildren are born at a time when they're going to have fewer rights, or at least have fewer right now than you did. That feels like a de-evolution of society. It feels like we're going backwards.

It is. It is. And it's why we all have to speak out and be outraged about this. We are making things worse for women, not better. And we should be making them better.

Just going back to you now for a second. You know, you're doing well. What are your days like? How do you spend your time nowadays?

Well, I used to be focused more on global health. I'm still doing some global health, but I'm not traveling quite as much to the continent of Africa or Southeast Asia. So I'm doing more domestic work. I'm more like 70% domestic, 30% international. So I am visiting health clinics around the United States. I am meeting with partners. I'm looking at research. We're figuring out what can be done on a policy level that can change things. I'm also talking to a lot of other funders about, look, are you looking at the women's health space? Are you looking how we get more females lifted up in the state legislature? So I'm having, given that I'm in my early 60s, I'm have a lot more philanthropists that as funders come to me and say, how do I get started? How do I think about this? So, I spend my days in kind of a mix of ways through all of those things.

A lot of people go through divorce. How do you, how do you chase life after that?

'Oh my gosh, I think. I guess what I would say is, you know, I'm five years post-divorce, and what I want people to know, anybody who goes through that, I don't wish divorce on any family, right? The whole family goes through it. But what I want to tell you is, there's also a whole lot of life on the other side, right, and there are new openings and new beginnings and I have new friends, and you start to find out who's there for you. You learn how to have very open and difficult conversations, because you need more support from your friends while you're going through it. But conversely, it also bonds you, I think, to your friends. And so I don't know, I can't say for everybody, but for me, after getting through the very painful time of it, it's been a gigantic opening in life. And, yeah, and I'm just happy now on the other side.

You look happy, you look healthy.

Thank you.

So yeah, is there a final message you want to give to, this will be played around the world. I mean, women anywhere in the world, what would you say to them?

I want to say to women around the world that the right care at the right time makes a difference and we deserve better than our health systems are doing now. And if we all raise our voices and we make investments and we talk to others and get others educated, we can change the system for even the better. It's doing okay, but it should be doing excellent for women.

'Well, on behalf of myself, but also my three daughters my wife my mom my mother-in-law, you know, thank you for that I'm glad you're you're doing everything that you do Melinda. I always enjoy talking to you and congratulations on this announcement.

Thank you.

Hopefully you'll come back and we can chat about the impact that it's had

Thanks for having me, Sanjay, I've enjoyed this.

Okay, that was my discussion with Melinda French Gates. I mean, I don't know about you, but I learned a lot. I didn't actually know ahead of time that women were that much more likely to be sick for that many more days or weeks or months of their life. And frankly, I'm really glad that we have someone like Melinda French Gates, who's going to try and do something about that. We're going to keep tabs on the success of Pivotal and hopefully have her back to talk about what has happened. Thanks so much for joining us on Chasing Life and we'll see you next week.