Along the way, she learned about her own family’s history with such trauma.

This formed the multimedia “Silence in Sikeston” project from KFF Health News, Retro Report, and WORLD as told through a documentary film, educational videos, digital articles, and a limited-series podcast. Hear about Anthony’s journey and join this conversation about the toll of racialized violence on our health and our communities.

Explore more of the “Silence in Sikeston”project:

LISTEN: The limited-series podcast is available on PRX, Apple Podcasts, Spotify, iHeart, or wherever you get your podcasts.

• Episode 1: “Racism Can Make You Sick”
• Episode 2: “Hush, Fix Your Face”
• Episode 3: “Trauma Lives in the Body”
• Episode 4: “Is There a Cure for Racism”

WATCH: The documentary film “Silence in Sikeston,” a co-production of KFF Health News and Retro Report, is now available to stream on WORLD’s YouTube channel, WORLDchannel.org, and the PBS app.

READ: KFF Health News Midwest correspondent Cara Anthony wrote an essay about what her reporting for this project helped her learn about her own family’s hidden past.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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In the series finale of the podcast, a confident, outspoken Sikeston teenager shares her feelings in an uncommonly frank conversation with Chief James McMillen, head of Sikeston’s Department of Public Safety, which includes Sikeston police. 

Host Cara Anthony asks what kind of systemic change is possible to reduce the burden of racism on the health of Black Americans. Health equity expert Gail Christopher says it starts with institutional leaders who recognize the problem, measure it, and take concrete steps to change things. 

“It is a process, and it’s not enough to march and get a victory,” Christopher said. “We have to transform the systems of inequity in this country.” 

Host

Cara Anthony
Midwest correspondent, KFF Health News

@CaraRAnthony

Read Cara's stories

Cara is an Edward R. Murrow and National Association of Black Journalists award-winning reporter from East St. Louis, Illinois. Her work has appeared in The New York Times, Time magazine, NPR, and other outlets nationwide. Her reporting trip to the Missouri Bootheel in August 2020 launched the “Silence in Sikeston” project. She is a producer on the documentary and the podcast’s host.

In Conversation With …

Gail Christopher
Public health leader and health equity expert 

click to open the transcript

Transcript: Is There a Cure for Racism?

Editor’s note: If you are able, we encourage you to listen to the audio of “Silence in Sikeston,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast. 

[Ambient sounds from Sikeston, Missouri’s 2021 Juneteenth celebration — a DJ making an announcement over funky music, people chatting — begin playing.] 

Cara Anthony: It’s 2021. It’s hot and humid. We’re at a park in the heart of Sunset — Sikeston, Missouri’s historically Black neighborhood. 

Emory: Today is Juneteenth, baby. 

Cara Anthony: The basketball courts are jumping. And old-school funk is blaring from the speakers. Kids are playing. 

Cara Anthony: [Laughter] Are you enjoying the water?  

Cara Anthony: People are lining up for barbecue. 

I’ve been here reporting on the toll racism and violence can take on a community’s health. But today, I’m hoping to capture a little bit of Sikeston’s joy.  

Taneshia Pulley: When I look out to the crowd of my people, I see strength. I see power. I just see all magic. 

Cara Anthony: I drift over to a tent where people are getting their blood pressure, weight, and height checked … health screenings for free. 

Cara Anthony: I’m a journalist. 

Community Health Worker: Ooooh! Hi! Hi! 

Cara Anthony: The ladies working the booth are excited I’m there to report on the event. 

Cara Anthony: OK, and I’m a health journalist. 

Community health worker: Baby, that’s what I told them. Yeah, she healthy. [Laughter] 

[Dramatic instrumental music plays.] 

Cara Anthony: This Juneteenth gathering is happening a little over a year after Sikeston police officers shot and killed 23-year-old Denzel Taylor. 

We made a documentary about Denzel’s death and the death of another young Black man — also killed in Sikeston. 

Denzel was shot by police. Nearly 80 years earlier, Cleo Wright was lynched by a white mob. 

Both were killed before they got their day in court. 

In these years of reporting, what I’ve found is that many Black families worry that their kids don’t have an equal chance of growing up healthy and safe in Sikeston. 

[Dramatic instrumental ends.] 

Rosemary Owens: Being Black in the Bootheel can get you killed at any age. 

Cara Anthony: That’s Rosemary Owens. She raised her children here in Southeast Missouri. 

Cara Anthony: About 10 Sikeston police officers showed up to Juneteenth — for security and to connect with the community. Some are in uniform; some are in plain clothes. 

Rosemary has her doubts about why they came today. 

Cara Anthony: You see the police chief talking to people. What’s going through your mind as you see them milling about? 

Rosemary Owens: I hope they are real and wanting to close the gap between the African Americans and the white people. 

Anybody can come out and shake hands. But at the end of the day, did you mean what you said? Because things are still going on here in Sikeston, Missouri. 

Cara Anthony: For Rosemary, this brings to mind an encounter with the police from years ago. 

[Slow, minor, instrumental music plays softly.] 

When her son was maybe 16 years old, she says, she and her sister gave their boys the keys to their new cars — told them they could hang out in them. 

Rosemary had gotten her new car for Mother’s Day. 

Rosemary Owens: A brand-new red Dodge Caravan. We, we knew the boys were just going from the van to the car. You know, just showing out — they were boys. They weren’t driving. 

Cara Anthony: Someone nearby saw the boys …  

Rosemary Owens: … called and told the police that two Black men were robbing cars. 

 When the boys saw the police come up, there was three police cars. So they were like, something’s going on. So their intention, they were like, they were trying to run to us. And my brother said, stop. When they looked back, when the police got out of the car, they already had their guns drawn on my son and my nephew.  Cara Anthony: That’s what Rosemary thinks about when she sees Sikeston police at Juneteenth. 

[Slow, minor, instrumental music ends.] 

[“Silence in Sikeston” theme song plays.]  Cara Anthony: In this podcast series, we’ve talked about some of the ways racism makes Black people sick. But Juneteenth has me thinking about how we get free — how we STOP racism from making us sick. 

The public health experts say it’s going to take systemwide, institutional change. 

In this episode, we’re going to examine what that community-level change looks like — or at least what it looks like to make a start. 

From WORLD Channel and KFF Health News, distributed by PRX, this is “Silence in Sikeston.” 

Episode 4 is our final episode: “Is There a Cure for Racism?” 

[“Silence in Sikeston” theme song ends.] 

James McMillen: How you doing? 

Juneteenth celebration attendee: Good. Good.  

James McMillen: Good to see you, man.  

Juneteenth celebration attendee: What’s up? How are you?   

Cara Anthony: When I spot Sikeston’s director of public safety in his cowboy hat, sipping soda from a can, I head over to talk.  James McMillen: Well, you know, I just, I, I’m glad to be … on the inside of this. 

Cara Anthony: James McMillen leads the police department. He says he made it a point to come to Juneteenth. And he encouraged his officers to come, too. 

James McMillen: I remember as being a young officer coming to work here, not knowing anybody, driving by a park and seeing several Black people out there. And I remember feeling, you know, somewhat intimidated by that. And I don’t really know why. 

I hadn’t always been, um, that active in the community. And, um, I, I have been the last several years and I’m just wanting to teach officers to do the same thing. 

Cara Anthony: The chief told me showing up was part of his department’s efforts to repair relations with Sikeston’s Black residents. 

James McMillen: What’s important about this is, being out here and actually knowing people, I think it builds that trust that we need to have to prevent and solve crimes. 

Cara Anthony: A few minutes into our conversation, I notice a teenager and her friend nearby, listening. 

Cara Anthony: Yeah, we have two people who are watching us pretty closely. Come over here. Come over here. Tell us your names. 

Lauren: My name is Lauren. 

Michaiahes: My name is Michaiahes. 

Cara Anthony: Yeah. And what are you all … ? 

James McMillen: I saw you over there. 

Cara Anthony: So, what do you think about all of this?  

Michaiahes: Personally, I don’t even know who this is because I don’t mess with police because, because of what’s happened in the past with the police. But, um … 

Cara Anthony: As she starts to trail off, I encourage her to keep going. 

Cara Anthony: He’s right here. He’s in charge of all of those people. 

Michaiahes: Well, in my opinion, y’all should start caring about the community more. 

Cara Anthony: What are you hearing? She’s speaking from the heart here, Chief. What are you hearing? 

James McMillen: Well, you know what? I agree with everything she said there. 

Cara Anthony: She’s confident now, looking the chief in the eye. 

Michaiahes: And let’s just be honest: Some of these police officers don’t even want to be here today. They’re just here to think they’re doing something for the community. 

James McMillen: Let’s be honest. Some of these are assumptions that y’all are making about police that y’all don’t really know. 

[Subtle propulsive music begins playing.] 

Michaiahes: If we seen you protecting community, if we seen you doing what you supposed to do, then we wouldn’t have these assumptions about you. 

James McMillen: I just want to say that people are individuals. We have supervisors that try to keep them to hold a standard. And you shouldn’t judge the whole department, but, but just don’t judge the whole department off of a few. No more than I should judge the whole community off of a few. 

Cara Anthony: But here’s the thing … in our conversations over the years, Chief McMillen has been candid with me about how, as a rookie cop, he had judged Sikeston’s Black residents based on interactions with just a few. 

James McMillen: Some of, um, my first calls in the Black community were dealing with, obviously, criminals, you know? So if first impressions mean anything, that one set a bad one. I had, um, really unfairly judging the whole community based on the few interactions that I had, again, with majority of criminals. 

Cara Anthony: The chief says he’s moved past that way of thinking and he’s trying to help his officers move past their assumptions. 

And he told me about other things he wants to do …  

Hire more Black officers. Invest in racial-bias awareness education for the department. And open up more lines of communication with the community. 

James McMillen: I know that we are not going to see progress or we’re not going to see success without a little bit of pain and discomfort on our part. 

Cara Anthony: I don’t think I’ve ever heard the chief use the term institutional change, but the promises and the plans he’s making sound like steps in that direction. 

Except … here’s something else the chief says he wants …  

[Subtle propulsive music ends with a flourish.] 

James McMillen: As a police officer, I would like to hear more people talk about, um, just complying with the officer. 

Cara Anthony: That phrase is chilling to me. 

[Quiet, dark music starts playing.] 

When I hear “just comply” … a litany of names cross my mind. 

Philando Castile. 

Sonya Massey. 

Tyre Nichols. 

Cara Anthony: After Denzel Taylor was killed, people felt unsafe. I talked to a lot of residents on the record about them feeling like they didn’t know if they could be next. 

One thing that you told me was, like, well, one thing that people can do is comply with the officers, you know, if they find themselves having an interaction with law enforcement. 

James McMillen: Well, I mean, I think that’s, that’s a good idea to do. 

And if the person is not complying, that officer has got to be thinking, is this person trying to hurt me? So, asking people to comply with the officer’s command — that’s a reasonable statement. 

Cara Anthony: But, it’s well documented: Black Americans are more likely than our white peers to be perceived as dangerous by police. 

That perception increases the chances we’ll be the victim of deadly force. Whether we comply — or not. 

[Quiet, dark music ends.] 

That’s all to say … even with the promise of more Black officers in Sikeston and all the chief’s other plans, I’m not sure institutional change in policing is coming soon to Sikeston. 

[Sparse electronic music starts playing.] 

Cara Anthony: I took that worry to Gail Christopher. She has spent her long career trying to address the causes of institutional racism. 

Cara Anthony: We’ve been calling most of our guests by their first name, but what’s your preference? I don’t want to get in trouble with my mom on this, you know? [Cara laughs.] 

Gail Christopher: If you don’t mind, Dr. Christopher is good. 

Cara Anthony: OK. All right. That sounds good. I’m glad I asked. 

Cara Anthony: Dr. Christopher thinks a lot about the connections between race and health. And she’s executive director of the National Collaborative for Health Equity. Her nonprofit designs strategies for social change. 

She says the way to think about starting to fix structural racism … is to think about the future. 

Gail Christopher: What do you want for your daughter? What do I want for my children? I want them not to have interactions with the police, No. 1, right? 

Uh, so I want them to have safe places to be, to play, to be educated … equal access to the opportunity to be healthy. 

Cara Anthony: But I wonder if that future is even possible. 

[Sparse electronic music ends.] 

Cara Anthony: Is there a cure for racism? And I know it’s not that simple, but is there a cure? 

Gail Christopher: I love the question, right? And my answer to you would be yes. It is a process, and it’s not enough to march and get a victory. We have to transform the systems of inequity in this country. 

Cara Anthony: And Dr. Christopher says it is possible. Because racism is a belief system. 

[Hopeful instrumental music plays.] 

Gail Christopher: There is a methodology that’s grounded in psychological research and social science for altering our beliefs and subsequently altering our behaviors that are driven by those beliefs. 

Cara Anthony: To get there, she says, institutions need a rigorous commitment to look closely at what they are doing — and the outcomes they’re creating. 

Gail Christopher: Data tracking and monitoring and being accountable for what’s going on. 

We can’t solve a problem if we don’t admit that it exists. 

Cara Anthony: One of her favorite examples of what it looks like to make a start toward systemic change comes from the health care world. 

I know we’ve been talking about policing so far, but — bear with me here — we’re going to pivot to another way institutional bias kills people. 

A few years ago, a team of researchers at the Brigham and Women’s Hospital in Boston reviewed admission records for patients with heart failure. They found that Black and Latinx people were less likely than white patients to be admitted to specialized cardiology units. 

Gail Christopher: Without calling people racist, they saw the absolute data that showed that, wait a minute, we’re sending the white people to get the specialty care and we’re not sending the people of color. 

Cara Anthony: So, Brigham and Women’s launched a pilot program. 

When a doctor requests a bed for a Black or Latinx patient with heart failure, the computer system notifies them that, historically, Black and Latinx patients haven’t had equal access to specialty care. 

The computer system then recommends the patient be admitted to the cardiology unit. It’s still up to the doctor to actually do that. 

The hard data’s not published yet, but we checked in with the hospital, and they say the program seems to be making a difference. 

Gail Christopher: It starts with leadership. Someone in that system has the authority and makes the decision to hold themselves accountable for new results. 

[Hopeful instrumental music ends.] 

Cara Anthony: OK, so it could be working at a hospital. Let’s shift back to policing now. 

Gail Christopher: There should be an accountability board in that community, a citizens’ accountability board, where they are setting measurable and achievable goals and they are holding that police department accountable for achieving those goals. 

Cara Anthony: But, like, do Black people have to participate in this? Because we’re tired. 

Gail Christopher: Listen, do I know that we’re tired! Am I tired? After 50 years? Uh, I think that there is work that all people have to do. This business of learning to see ourselves in one another, to be fully human — it’s all of our work. 

[Warm, optimistic instrumental music plays.] 

Now, does that preclude checking out at times and taking care of yourself? I can’t tell you how many people my age who are no longer alive today, who were my colleagues and friends in the movement. But they died prematurely because of this lack of permission to take care of ourselves. 

Cara Anthony: Rest when you need to, she says, but keep going. 

Gail Christopher: We have to do that because it is our injury. It is our pain. And I think we have the stamina and the desire to see it change. 

Cara Anthony: Yep. Heard. It’s all of our work. 

Dr. Christopher has me thinking about all the Black people in Sikeston who aren’t sitting around waiting for someone else to change the institutions that are hurting them. 

People protested when Denzel Taylor was killed even with all the pressure to stay quiet about it. 

Protesters: Justice for Denzel on 3. 1, 2, 3 … Justice for Denzel! Again! 1, 2, 3 …  Justice for Denzel! 

Cara Anthony: And I’m thinking about the people who were living in the Sunset neighborhood of Sikeston in 1942 when Cleo Wright was lynched. 

Harry Howard: They picked up rocks and bricks and crowbars and just anything to protect our community. 

Cara Anthony: And Sunset did not burn. 

[Warm, optimistic instrumental music begins fading out.] 

[Piano starts warming up.] 

Cara Anthony: After nearly 80 years of mostly staying quiet about Cleo’s lynching, Sikeston residents organized a service to mark what happened to him — and their community. 

Reverend: We are so honored and humbled to be the host church this evening for the remembrance and reconciliation service of Mr. Cleo Wright. 

[Piano plays along with Pershard singing.] 

Pershard Owens: [Singing] It’s been a long, long time coming, but I know a change gonna come, oh yes it will. It’s been too hard a-livin but I’m afraid to die and I don’t know what’s up next, beyond the sky … 

[Pershard singing and piano accompaniment fade out.] 

Cara Anthony: I want to introduce you to that guy who was just singing then. His name is Pershard Owens. 

Remember Rosemary Owens? The woman who told us about someone calling the police on her son and nephew when they were playing with their parents’ new cars? Pershard is Rosemary’s younger son. 

Pershard Owens: Yeah, I definitely remember that. 

Cara Anthony: Even after all this time, other people didn’t want to talk to us about it. We couldn’t find news coverage of the incident. But Pershard remembers. He was in his weekly karate practice when it happened. He was 10 or 11 years old. 

Pershard Owens: My brother and cousin were, like, they were teens. So what do you think people are going to feel about the police when they do that, no questions asked, just guns drawn? 

Cara Anthony: Pershard’s dad works as a police officer on a different police force in the Bootheel. Pershard knows police. But that didn’t make it any less scary for him. 

Pershard Owens: You know, my parents still had to sit us down and talk and be like, “Hey, this is, that’s not OK, but you can’t, you can’t be a victim. You can’t be upset.” That’s how I was taught. So we acknowledge the past. But we don’t, we don’t stay down. 

Cara Anthony: So years later, when Chief James McMillen started a program as a more formal way for people in Sikeston and the police to build better relationships, Pershard signed up. They started meeting in 2020. 

The group is called Police and Community Together, or PACT for short. 

  [Sparse, tentative music begins playing.] 

Pershard Owens: It was a little tense that first couple of meetings because nobody knew what it was going to be. 

Cara Anthony: This was only five months after Sikeston police killed Denzel Taylor. 

PACT is not a citizens’ accountability board. The police don’t have to answer to it. 

The committee met every month. For a while. But they haven’t met in over a year now. 

Pershard Owens: We would have steps forward and then we would have three steps back. 

Cara Anthony: People have different accounts for why that is. Busy schedules. Mutual suspicion. Other things police officers have done that shook the trust of Black residents in Sikeston. 

Pershard Owens: And people were like, bro, like, how can you work with these people? 

The community is like, I can’t fully get behind it because I know what you did to my little cousin and them. Like, I know what the department did back in, you know, 15 years ago, and it’s hard to get past that. 

So, I mean, I’m getting both sides, like, constantly, and listen, that is, that is tough. 

[Sparse, tentative music ends.] 

Cara Anthony: But Pershard says something important changed because he started working with PACT. 

Pershard Owens: Chief did not like me at first [Pershard laughs]. He did not. 

Chief didn’t … me and Chief did not see eye to eye. Because he had heard things about me and he — people had told him that I was, I was anti-police and hated police officers, and he came in with a defense up. 

So, it took a minute for me and him to, like, start seeing each other in a different way. But it all happened when we sat down and had a conversation. 

[Slow instrumental music begins playing.] 

Cara Anthony: Just have a conversation. It sounds so simple; you’re probably rolling your eyes right now hearing it. 

But Pershard says … it could be meaningful. 

Pershard Owens: I truly want and believe that we can be together and we can work together and we can have a positive relationship where you see police and y’all dap each other up and y’all legit mean it. I think that can happen, but a lot of people have to change their mindsets. 

Cara Anthony: That’s a challenge Pershard is offering to police AND community members: Have a conversation with someone different from you. See if that changes the way you think about the person you’re talking to. See if it changes your beliefs. 

The more people do that, the more systems can change. 

Pershard Owens: We got to look in the mirror and say, “Am I doing what I can to try and change the dynamic of Sikeston, even if it does hurt?” 

Cara Anthony: Pershard says he’s going to keep putting himself out there. He ran for City Council in 2021. And even though he lost, he says he doesn’t regret it. 

Pershard Owens: When you’re dealing with a place like Sikeston, it’s not going to change overnight. 

Cara Anthony: And he’s glad he worked with PACT. Even if the community dialogue has fizzled for now, he’s pleased with the new relationship he built with Chief McMillen. And all of this has broadened his view of what kind of change is possible. 

[Slow instrumental music ends.] 

Pershard Owens: If you want something that has never been done, you have to go places that you’ve never been. 

[“Silence in Sikeston” theme music plays.] 

Cara Anthony: Places that you’ve never been … stories that you’ve never told out loud … maybe all of that helps build a Sikeston where Black residents can feel safer. Where Black people can live healthier lives. 

A world you might not be able to imagine yet, but one that could exist for the next generation. 

[“Silence in Sikeston” theme music ends.] 

[Upbeat instrumental music plays.] 

Cara Anthony: Thanks for listening to “Silence in Sikeston.” 

Next, go watch the documentary — it’s a joint production from Retro Report and KFF Health News, presented in partnership with WORLD. 

Subscribe to WORLD Channel on YouTube. That’s where you can find the film “Silence in Sikeston,” a Local, USA special. 

If you made it this far, thank you. Let me know how you’re feeling. 

I’d love to hear more about the conversations this podcast has sparked in your life. Leave us a voicemail at (202) 654-1366. 

And thanks to everyone in Sikeston for sharing your stories with us. 

This podcast is a co-production of WORLD Channel and KFF Health News and distributed by PRX. 

It was produced with support from PRX and made possible in part by a grant from the John S. and James L. Knight Foundation. 

This audio series was reported and hosted by me, Cara Anthony. 

Audio production by me, Zach Dyer. And me, Taylor Cook. 

Editing by me, Simone Popperl. 

And me, managing editor Taunya English. 

Sound design, mixing, and original music by me, Lonnie Ro. 

Podcast art design by Colin Mahoney and Tania Castro-Daunais. 

Tarena Lofton and Hannah Norman are engagement and social media producers for the show. 

Oona Zenda and Lydia Zuraw are the landing page designers. 

Lynne Shallcross is the photo editor, with photography from Michael B. Thomas. 

Thank you to vocal coach Viki Merrick. 

And thank you to my parents for all their support over the four years of this project. 

Music in this episode is from Epidemic Sound and Blue Dot Sessions. 

Some of the audio you heard across the podcast is also in the film. 

For that, special thanks to Adam Zletz, Matt Gettemeier, Roger Herr, and Philip Geyelin. 

Kyra Darnton is executive producer at Retro Report. 

I was a producer on the film. 

Jill Rosenbaum directed the documentary. 

Kytja Weir is national editor at KFF Health News. 

WORLD Channel’s editor-in-chief and executive producer is Chris Hastings. 

Help us get the word out about “Silence in Sikeston.” Write a review or give us a quick rating wherever you listen to this podcast. 

Thank you! It makes a difference. 

Oh yeah! And tell your friends in real life too!  

[Upbeat instrumental music ends.] 

Credits

Taunya English
Managing editor

@TaunyaEnglish

Taunya is deputy managing editor for broadcast at KFF Health News, where she leads enterprise audio projects.

Simone Popperl
Line editor

@simoneppprl

Simone is broadcast editor at KFF Health News, where she shapes stories that air on Marketplace, NPR, and CBS News Radio, and she co-manages a national reporting collaborative.

Zach Dyer
Senior producer

@zkdyer

Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production.

Taylor Cook
Associate producer

@taylormcook7

Taylor is an independent producer who does research, books guests, contributes writing, and fact-checks episodes for several KFF Health News podcasts.

Lonnie Ro
Sound designer

@lonnielibrary

Lonnie Ro is an audio engineer and a composer who brings audio stories to life through original music and expert sound design for platforms like Spotify, Audible, and KFF Health News.

Additional Newsroom Support

Lynne Shallcross, photo editorOona Zenda, illustrator and web producerLydia Zuraw, web producerTarena Lofton, audience engagement producer Hannah Norman, video producer and visual reporter Chaseedaw Giles, audience engagement editor and digital strategistKytja Weir, national editor Mary Agnes Carey, managing editor Alex Wayne, executive editorDavid Rousseau, publisher Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chief Tammie Smith, communications officer 

The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.

Watch the accompanying documentary from WORLD, Retro Report, and KFF here.

To hear other KFF Health News podcasts, click here.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).

The integration of AI into mental healthcare is more advanced than many realize because it’s not always obvious; frequently, it’s providing support to free up clinicians to spend more time with their patients or to get more patients into treatment. 

The post How AI Humanizes Mental Healthcare appeared first on MedCity News.

SIKESTON, Mo. — In 1942, Mable Cook was a teenager. She was standing on her front porch when she witnessed the lynching of Cleo Wright.

In the aftermath, Cook received advice from her father that was intended to keep her safe.

“He didn’t want us talking about it,” Cook said. “He told us to forget it.”

More than 80 years later, residents of Sikeston still find it difficult to talk about the lynching.

Conversations with Cook, one of the few remaining witnesses of the lynching, launch a discussion of the health consequences of racism and violence in the United States. Host Cara Anthony speaks with historian Eddie R. Cole and racial equity scholar Keisha Bentley-Edwards about the physical, mental, and emotional burdens on Sikeston residents and Black Americans in general.

“Oftentimes, people who experience racial trauma are forced to not acknowledge it,” Bentley-Edwards said. “They’re forced to question whether or not it happened in the first place.”

Host

Cara Anthony
Midwest correspondent, KFF Health News

@CaraRAnthony

Read Cara's stories

Cara is an Edward R. Murrow and National Association of Black Journalists award-winning reporter from East St. Louis, Illinois. Her work has appeared in The New York Times, Time magazine, NPR, and other outlets nationwide. Her reporting trip to the Missouri Bootheel in August 2020 launched the “Silence in Sikeston” project. She is a producer on the documentary and the podcast’s host.

In Conversation With …

Eddie R. Cole
Professor of education and history, UCLA

Keisha Bentley-Edwards
Associate professor of medicine, Division of General Internal Medicine at Duke University

Carol Anderson
Professor of African American studies, Emory University

click to open the transcript

Transcript: Racism Can Make You Sick

“Silence in Sikeston,” Episode 1: “Racism Can Make You Sick” Transcript 

Editor’s note: If you are able, we encourage you to listen to the audio of “Silence in Sikeston,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast. 

Cara Anthony: Sikeston sits in the Missouri Bootheel. That’s the lower corner of the state, with the Mississippi River on one side, Arkansas on the other. Lots of people say it’s where the South meets the Midwest. 

Picture cotton, soybeans, rice. It’s hot, green, and flat. If you’ve ever heard of Sikeston before, it’s probably because of this: 

Ryan Skinner: Hot rolls! 

Cara Anthony: Lambert’s Café. Home of the “Throwed Rolls.” 

Server: Yeah, they’ll say, uh, “Hot rolls!” And people will hold their hands up and they’ll toss it to you. 

Cara Anthony: The servers walk around with carts and throw these big dinner rolls at diners. 

Ryan Skinner: Oh, it’s fun. You get to nail people in the head and not get in trouble for it. 

Cara Anthony: There’s the rodeo. The cotton carnival. 

But I came to see Rhonda Council. 

Rhonda Council: My name is Rhonda Council. I was born and raised here in Sikeston. 

Cara Anthony: Rhonda is the town’s first Black city clerk. 

She became my guide. I met her when I came here to make a film about the little-known history of racial violence in Sikeston. 

I’m Cara Anthony. I’m a health reporter. I cover the ways racism — including violence — affects health. 

Rhonda grew up in the shadow of that violence — in a part of town where nearly everyone was Black. It’s called Sunset. 

Rhonda Council: Sunset was a happy place. I remember just being, as a kid, we could walk down to the store, we could just go get candy. 

Cara Anthony: There were churches and a school there. 

Rhonda Council: We knew everybody in the community. If we did something wrong, you can best believe your parents was going to find out about it before you got home. 

Cara Anthony: Back in the day, these were dirt roads. 

Cara Anthony: OK, so we’re getting ready to go on a tour of Sunset, which used to be known as the Sunset Addition, right? 

Rhonda Council: Mm-hmm, yes. Mm-hmm. 

Cara Anthony: We got into her car, along with Rhonda’s mother and her grandmother, Mable Cook. 

Rhonda Council: This street was known as The Bottom. Everything Black-owned. They had clubs, they had stores, they even had houses that people stayed in. I think it was shotgun houses back then? 

Mable Cook: Uh-huh. 

Cara Anthony: That’s Rhonda’s grandmother, Ms. Mable, right there. She was a teenager here in the 1940s. Her memory of the place seems to get stronger with each uh-huh and mm-hmm. 

Rhonda Council: And this was just the place where people went on the weekend to, you know, have a good time and party. … And this area was kind of known as “the corner” because they used to have a club here. And they would … they would gamble a lot down here. They would throw dice. Everything down here on the corner. 

Mable Cook: That’s right. Sure did. Mm-hmm. 

Rhonda Council: You remember this street, Grandma? 

Mable Cook: Yeah, I’m trying to see where the store used to be. 

Rhonda Council: OK. 

Mable Cook: I think it was close to Smith Chapel. 

Rhonda Council: OK. 

Cara Anthony: Rhonda’s grandmother, Ms. Mable, was 97 then. 

Rhonda Council: She is a petite lady, to me, thin-framed. I describe her eyes as like a grayish-color eyes. And I don’t know if it’s because of old age, but I think they’re so beautiful. And she just has a pretty smile, and she’s just a fantastic lady. 

Cara Anthony: Ms. Mable was born in Indianola, Mississippi. When she was 14, her father moved to Sikeston looking for work. 

Rhonda Council: And so she came up here to, um, to be with her father. But she said when she came to Sikeston, she said it was an unusual experience because they were not allowed to go to stores. They were not allowed to, basically, be with the white people. And that’s not what she knew down in Mississippi. And in her mind, she couldn’t understand why Missouri, why Sikeston was like that in treating Black people that way. 

And not too long after that, the lynching of Cleo Wright occurred. 

[BEAT]  

Cara Anthony: It was 1942. While the United States was at war marching to stop fascism, a white mob here went unchecked and lynched a man named Cleo Wright. 

The lynching of a Black man in America was not uncommon. And often barely documented. 

But in the case of Cleo Wright — perhaps because the death challenged what the nation said it was fighting for — the killing in this small town made national news. 

The case generated enough attention that the FBI conducted the first federal investigation into a lynching. That investigation ultimately amounted to nothing. 

Meanwhile — here in Sikeston — the response to the brutal death was mostly silence. 

Eight decades later, another Black man was killed in Sikeston. This time by police. 

Local media outlets, like KFVS, covered it as a crime story: 

KFVS report: The Missouri State Highway Patrol says troopers must piece together exactly what led to the shooting death of 22-year-old Denzel Marshall Taylor. 

Cara Anthony: I think the killings of Denzel Taylor and Cleo Wright are a public health story. 

Our film “Silence in Sikeston” is grounded in my reporting about Cleo and Denzel. Part of the record of the community’s trauma and silence is captured in the film. This podcast extends that conversation. 

We’re exploring what it means to live with that stress — of racism, of violence. And we’re going to talk about the toll that it takes on our health as Black Americans, especially as we try to stay safe. 

In each episode, we’ll hear a story from my reporting. Then, a guest and I will talk about it. 

The history … 

Carol Anderson: The power of lynching is to terrorize the Black community, and one of the ways the community deals with that terror is the silence of it. […] And when you don’t deal with the wound, it creates all kinds of damage. 

Cara Anthony: And health … 

Aiesha Lee: It’s almost like every time we’re silent, it’s like a little pinprick. […] And after so long, those little pinpricks turn up as heart disease, as cancer, as all these other ailments. 

Cara Anthony: I’m hoping this journalism, and these stories, will spark a conversation that you’ve been meaning to have. 

This is an invitation. 

From WORLD Channel and KFF Health News and distributed by PRX, this is “Silence in Sikeston,” the podcast.  

Episode 1: “Racism Can Make You Sick” 

[BEAT] 

Cara Anthony: Ms. Mable was a witness to the lynching of Cleo Wright. The 25-year-old was about to become a father. 

Rhonda’s uncle says Cleo was … 

Harry Howard: Young, handsome, an athlete, and very well known in the community. 

Cara Anthony: That’s Harry Howard. He didn’t know Cleo. Harry wasn’t even born yet. But his uncle knew Cleo. 

Harry Howard: They were friends. They would shoot pool together and were known to be at the little corner store, the Scott’s Grocery. 

Cara Anthony: Harry’s family passed down the story of what happened. 

Harry Howard: So everything I’m reporting is the way it was told by people I trust. 

Cara Anthony: Black families mostly talked about it in whispers. 

Eddie R. Cole: And that sounds like this is one of those situations where that community would rather just leave this alone and try to move on with the life that you do have instead of losing more life. 

Cara Anthony: That’s my friend Eddie Cole. He’s a professor of history and education at UCLA. 

We were in college together at Tennessee State and worked on the school newspaper.  

I called up Eddie because I wanted to get his take as a historian. What happens when we keep quiet about a story like Cleo’s? 

Eddie R. Cole: Yeah, I’m Eddie Cole. … So here we go. 

Cara Anthony: Thousands of Black people were lynched before Cleo Wright was. But this was the first time the feds said, “Hey, we should go to Sikeston and investigate lynching as a federal crime.” 

This story though, seriously, like it just disappeared off the face of the map. Like, it’s, it’s scary to me. So many of the witnesses that I interviewed, they’ve passed away, Eddie, since we started this journey. And it’s frightening to me to think that their stories … that these stories can literally just go away. 

[BEAT]  

Eddie R. Cole: Lynching stories disappear but don’t disappear, right? So, the people who committed the crime, they committed it and went on with their day, which is twisted within itself, even to think about that. 

But on the other side, when you think about Black Americans, there was no need to talk a lot about it, right? Because you talk too much about some things and that same sort of militia justice might come to your front door in the middle of the night, right? Stories like this are known but not recorded. 

Cara Anthony: The hush that surrounded Cleo’s story back then was for Black people’s safety. But I’m conflicted. Should Cleo’s story be off the table? Or … could we be missing an opportunity for healing? 

On the phone with Eddie, I could feel this anxiety building up in me. I was almost afraid to bring it up, even though it was the reason why I called. 

[BEAT]  

Cara Anthony: And I will be honest with you, I think of you the same way I think of my brother, my father, like, I’ve almost wanted to protect the Black men in my life from that story because I know how hard it is to hear. 

Cara Anthony: It was January 1942. Cleo was accused of assaulting a white woman. A police officer arrested him; there was a fight. Cleo was beaten and shot. Covered in blood, he was eventually taken to jail. White residents of Sikeston mobbed the jail to get to Cleo. 

Cara Anthony: I do want to play a clip for you, just so you can hear a little bit, if you are up for that, because it’s a lot. How are you feeling about that today? 

Eddie R. Cole: No, I want to hear. I mean, I gotta know more now. You just told me there’s a story that just disappeared, but now you’re bringing it back to life. So let’s play the clip. 

Cara Anthony: All right. Let’s do it. 

Harry Howard: They took him out of the jail and drug him from downtown on Center Street through the Black area of Sunset. 

Obviously, it was a big commotion, and they were saying, “What’s going on?” And the man driving the station wagon told them, “Get out of the street,” and, of course, used the N-word. “There’s a lynching coming.” 

Cara Anthony: Historian Carol Anderson is a professor of African American studies at Emory University. She takes it from there. 

Carol Anderson: They hook him to the bumper of the car and decide to make an example of him in the Black community. 

The mob douses his body with five gallons of gasoline and set it on fire. People are going, “Oh my God, they are burning a Black man. They are burning a Black man. They have lynched a Black man.” 

Cara Anthony: I always need to take a deep breath after hearing that story. So, I check in with Eddie. 

Cara Anthony: OK. How you doing? You OK? 

Eddie R. Cole: Yeah, yeah, um, that was tough. 

Cara Anthony: I’ve grappled a lot with the question of why, like, why now? Why this story? Am I crazy for doing this? 

Eddie R. Cole: Yeah, I mean, this story is really an entry point to talk about society at large. Imagine the people who like the world that we’re in. A world where Black people are oppressed. Right? And so not telling stories like what happens in Sikeston is an easier way to just keep the status quo. And what you’re doing is pushing back on it and saying, ah, we must remember, because the remnants of this period still shape this town today. 

[BEAT]  

Cara Anthony: On the tour of Sikeston with Rhonda, I see that. 

Rhonda Council: We’re going to go in front of the church where Cleo Wright was burned. 

When we get down here to the right, you’ll see Smith Chapel Church. And wasn’t it over here in this way where he got burnt, Grandma? 

Mable Cook: Uh-huh, yep. 

Rhonda Council: OK. From what I hear, it happened right along in this area right here. 

Cara Anthony: It’s a small brick church with a steeple on top. The road is paved now, not gravel as before. It all looks so … normal. 

You’d think that kind of violence, so much hate, would leave a mark on the Earth. But on the day we visited, there was nothing to see. Just the church and the road. 

Ms. Mable is quiet. I wonder what she’s thinking. 

Mable Cook: I just remember them dragging him. They drove him from, uh, the police station out to Sunset Addition. But they took him around all the streets so everybody could see. 

Cara Anthony: Back at Rhonda’s home, we talked more about what Ms. Mable remembered. 

Rhonda Council: Did that affect you in any way when you saw that happening? 

Mable Cook: Yeah, it hurt because I never had seen anything like that. Mm-hmm. And it kind of got me. I was just surprised or something. I don’t know. Mm-hmm. 

Cara Anthony: Remember Ms. Mable had been a child in Mississippi in the ’30s — and it wasn’t until she moved north to Sikeston that she came face to face with a lynching. 

Rhonda Council: Did it stick in your mind after that for a long time? 

Mable Cook: Yeah, it did. It did stick because I just wondered why they wanted to do that to him. You know, they could have just taken him and put him in jail or something and not do all that to him. 

I just never had seen anything like it. I had heard people talking about it, but I had never seen anything like that. 

Cara Anthony: When it happened, a lot of Black families in Sikeston scattered, fled town to places that felt safer. Mable’s family returned to Mississippi for a week. 

But when they got back, she says, Sikeston went on like nothing had ever happened.  

Here’s Rhonda with Ms. Mable again. 

Rhonda Council: After you all saw the lynching that happened, did you and your friends talk about that? 

Mable Cook: No, we didn’t have none … we didn’t talk about it. My daddy told us not to have nothing be said about it, uh-uh. 

Rhonda Council: Oh, because your dad said that. 

Mable Cook: That’s right. He told us not to worry about it, not talk about it. Uh-huh. And he said it’ll go away if you not talk about it, you know, uh-huh. 

Rhonda Council: So over the years, did you ever want to get it out? Did you ever want to talk about it? 

Mable Cook: Yeah, I did want to. Uh-huh. I wanted to. Uh-huh. 

Rhonda Council: But you just couldn’t do it. 

Mable Cook: No. No. Uh-uh. No, he didn’t want us talking about it. He told us to forget it. 

Cara Anthony: Forget it. Don’t talk about it. It’ll go away. 

And, in a way, it did. 

No one was charged. No one went to prison. Cleo’s name faded from the news. 

[BEAT]   

Cara Anthony: But decades later, Ms. Mable, the witness; Rhonda, her granddaughter; and me, the journalist, we talked about it a lot. 

We turned the story over and over, and as I listened to Ms. Mable, there was a distance between the almost matter-of-fact way she described the lynching and what I expected her feelings would be. 

I asked her if she was ever depressed … or if she had sleepless nights, anxiety. As a health reporter, I was on the lookout for symptoms of post-traumatic stress disorder. 

But Ms. Mable said no. 

That surprised me. And Rhonda, too. 

Cara Anthony: If we were to roll back the clock, go in a time machine, it’s 1942. All of a sudden, you see Cleo Wright’s body on the back of a car. How do you, can you even imagine that? 

Rhonda Council: I could not imagine. And even when talking to her about it, and she had such a vivid memory of it. And you ask her, did it haunt her, and she said no, she, it didn’t bother her, but I know deep down inside it had to because there’s no way that you could see something like that — someone dragged through the streets, basically naked going over rocks and the body just being dragged. 

I, I don’t know how I could have handled it because that’s just very, you just can’t treat a human being like that. 

Cara Anthony: That’s what’s so hard about these stories. And the research shows that seeing that kind of brutal, racial violence has health effects. But how do we recognize them? And what happens if we don’t? 

Those are some of the questions I asked Keisha Bentley-Edwards. 

Keisha Bentley-Edwards: Oftentimes, people who experience racial trauma are forced to not acknowledge it as such, or they’re forced to question whether or not it happened in the first place. 

Cara Anthony: Keisha is an associate professor in medicine at Duke University. She studies structural racism and chronic health conditions and knows a lot about what happens after a lynching. 

Keisha Bentley-Edwards: It’s difficult to talk about racism. And part of it is that you’re talking about power, who has it, who doesn’t have it. 

It’s not fun to talk about constantly being in a state where someone else can control your life with little recourse. 

Cara Anthony: That’s even more complicated in a place like Sikeston. 

Keisha Bentley-Edwards: When you’re in a smaller city, there is no way to turn away from the people who were the perpetrators of a race-based crime. And that, in and of itself, is a trauma. To know that someone has victimized your family member and you still have to say hello, you still have to say, “Good morning, ma’am.” And you have to just swallow your trauma in order to make the person who committed that trauma comfortable so that you don’t put your own family members at risk. 

Cara Anthony: Keisha says part of the stress comes from being Black and always being aware — alert — that the everyday ways you move through the world can be perceived as a threat to other people. 

Keisha Bentley-Edwards: Your life as a Black person is precarious. And I think that is what’s so hard about lynchings and these types of racist incidents is that so much of it is about, “I turned left when I could have turned right.” 

You know, “If I had just turned right or if I had stayed at home for another 10 minutes, this wouldn’t have happened.” 

Cara Anthony: That’s as true today as it was when Cleo Wright was alive. 

Keisha Bentley-Edwards: So, you don’t have to know the history of lynching to be affected by it. And so if you want to dismantle the legacy of the histories, you actually have to know it. So that you can address it and actually have some type of reconciliation and to move forward. 

Cara Anthony: I don’t know how you move on from something like the lynching of Cleo Wright. But breaking the silence is a step. 

And at 97, Ms. Mable did just that. 

She spoke to me. She trusted me enough to talk about it. Afterward, she said she felt lighter. 

Mable Cook: That’s right. Mm-hmm. So, it makes me feel much better after getting it out. 

[BEAT]  

Cara Anthony: A couple of years after we took the tour of Sikeston together, Ms. Mable died. 

When they lowered her casket into the ground, Ms. Mable’s family played a hymn she loved. 

It was a song she had sung for me … the day she invited me to visit her church. We sat in the pews. It was the middle of the week, but she was in her Sunday best. 

As we talked about Cleo Wright and Ms. Mable’s life in Sikeston, she told me she came back to that hymn over and over. 

Mable Cook: “Glory, Glory.” That’s what it was. [SINGING] Glory, glory, hallelujah. Since I laid my burden down. Glory, glory, hallelujah. Since I laid my burdens down […] 

Cara Anthony: I grew up singing that song. But before that moment, it was just another hymn in church. When Ms. Mable sang, it became something else. It sounded more like … an anthem. A call to acknowledge what we’ve been carrying with us in our bodies and minds. And to know it’s possible to talk about it … and maybe feel lighter. 

Mable Cook: [SINGING] … Every route go high and higher since I laid my burden down. Every route go high and higher since I laid my burden down […] 

Cara Anthony: Racism is heavy and it’s making Black people sick. Hives, high blood pressure, heart disease, inflammation, and struggles with mental health. 

To lay those burdens down, we have to name them first. 

That’s what I want this series to be: a podcast about finding the words to say the things that go unsaid. 

Across four episodes, we’re exploring the silence around violence and racism. And, maybe, we’ll get some redemption, too. 

I’m glad you’re here. There’s a lot more to talk about. 

Next time on “Silence in Sikeston,” the podcast … 

Meet my Aunt B and hear about our family’s hidden history. 

Cara Anthony: I told you what the three R’s of history are, right? 

Aunt B: No, tell me. 

Cara Anthony: So the three R’s of history are, you have to recognize something in order to repair it, in order to have days of redemption. So, Recognize, Repair, Redeem. And that’s what we’re doing. 

Aunt B: Man, how deep is that? 

Cara Anthony: That’s what we’re doing. 

Aunt B: Wow. 

CREDITS 

Cara Anthony: Thanks for listening to “Silence in Sikeston.” 

Next, go watch the documentary — it’s a joint production from Retro Report and KFF Health News, presented in partnership with WORLD. 

Subscribe to WORLD Channel on YouTube. That’s where you can find the film “Silence in Sikeston,” a Local, USA special. 

This podcast is a co-production of WORLD Channel and KFF Health News and distributed by PRX. 

It was produced with support from PRX and made possible in part by a grant from the John S. and James L. Knight Foundation. 

The audio series was reported and hosted by me, Cara Anthony. 

Zach Dyer and Taylor Cook are the producers. 

Editing by Simone Popperl. 

Taunya English is managing editor of the podcast. 

Sound design, mixing, and original music by Lonnie Ro. 

Podcast art design by Colin Mahoney and Tania Castro-Daunais. 

Oona Zenda was the lead on the landing page design. 

Julio Ricardo Varela consulted on the script. 

Sending a shoutout to my vocal coach, Viki Merrick, for helping me tap into my voice. 

Music in this episode is from BlueDot Sessions and Epidemic Sound. 

Additional audio from KFVS News in Sikeston, Missouri. 

Some of the audio you’ll hear across the podcast is also in the film. 

For that, special thanks to Adam Zletz, Matt Gettemeier, Roger Herr, and Philip Geyelin, who worked with us and colleagues from Retro Report. 

Kyra Darnton is executive producer at Retro Report. 

I was a producer on the film. 

Jill Rosenbaum directed the documentary. 

Kytja Weir is national editor at KFF Health News. 

WORLD Channel’s editor-in-chief and executive producer is Chris Hastings. 

If “Silence in Sikeston” has been meaningful to you, help us get the word out! 

Write a review or give us a quick rating on Apple, Spotify, Amazon Music, iHeart, or wherever you listen to this podcast. It shows the powers that be that this is the kind of journalism you want. 

Thank you. It makes a difference. 

Oh yeah … and tell your friends in real life, too! 

Credits

Taunya English
Managing editor

@TaunyaEnglish

Taunya is deputy managing editor for broadcast at KFF Health News, where she leads enterprise audio projects.

Simone Popperl
Line editor

@simoneppprl

Simone is broadcast editor at KFF Health News, where she shapes and edits stories that air on Marketplace and NPR, manages a reporting collaborative with local NPR member stations across the country, and edits the KFF Health News Minute.

Zach Dyer
Senior producer

@zkdyer

Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production.

Taylor Cook
Associate producer

@taylormcook7

Taylor is an independent producer who does research, books guests, contributes writing, and fact-checks episodes for several KFF Health News podcasts.

Additional Newsroom Support

Lynne Shallcross, photo editorOona Zenda, illustrator and web producerLydia Zuraw, web producerTarena Lofton, audience engagement producer Hannah Norman, visual producer and visual reporter Chaseedaw Giles, audience engagement editor and digital strategistKytja Weir, national editor Mary Agnes Carey, managing editor Alex Wayne, executive editorDavid Rousseau, publisher Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chief Tammie Smith, communications officer 

The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.

Watch the accompanying documentary from WORLD, Retro Report, and KFF starting Sept. 16, here.

To hear other KFF Health News podcasts, click here.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Enfrenta los desafíos de ser una estudiante de primer año de secundaria, aunque también está emocionada de reencontrarse con sus amigos y volver a bailar y a jugar voleibol. Incluso podría unirse al equipo de lucha libre para ganarse el respeto en la escuela.

Pero el pasado sigue presente.

En una reunión del 4 de julio, un amigo de la familia llevó auriculares que amortiguan el ruido, por si los fuegos artificiales eran demasiado para ella. A principios del verano, Gabriella tuvo dificultades para ver la colección de armas de un pariente, especialmente las pistolas. Y comenzó a hiperventilar cuando vio la herida en el dedo de un amigo de la familia que se había cortado accidentalmente: la vista de la sangre le recordó a Lisa Lopez-Galván, quien murió por una herida de bala afuera de Union Station, la única fatalidad ese día.

Su madre, Bridget Barton, dijo que Gabriella ha tenido una actitud más dura desde el desfile. “Ha perdido algo de suavidad, algo de dulzura”, observó.

Los niños son particularmente vulnerables al estrés de la violencia con armas de fuego, y 10 de las 24 que sufrieron heridas de bala en el desfile del 14 de febrero tenían menos de 18 años. Muchos más niños como Gabriella experimentaron el trauma de primera mano. Enfrentan miedo, ira, problemas de sueño e hipersensibilidad a las multitudes y los ruidos.

Una adolescente de 15 años que recibió disparos en la mandíbula y el hombro prácticamente dejó la escuela por un tiempo, y los ataques de pánico diarios también le impidieron asistir a la escuela de verano.

Un niño de 11 años que recibió un disparo describió sentirse enojado en la escuela por razones que no podía explicar. Una niña de 5 años que estaba sobre los hombros de su padre cuando le dispararon entra en pánico cada vez que su papá se siente enfermo, temiendo que le hayan disparado de nuevo.

“No es la misma niña. Quiero decir, definitivamente no lo es”, dijo Erika Nelson, madre de Mireya, de 15 años, quien tiene cicatrices en la mandíbula y la cara. “Nunca sabes cuándo va a estallar. Nunca sabes. Podrías decir algo o alguien podría mencionar algo que le recuerde ese día”.

En 2020, las armas superaron a los accidentes automovilísticos como la principal causa de muerte de niños, pero un número mucho mayor sufren heridas de balas y sobreviven. La investigación sugiere que los niños sufren lesiones por armas de fuego no fatales entre dos y cuatro veces más a menudo de lo que son asesinados con armas.

Científicos dicen que los efectos a largo plazo de la violencia armada en los niños se investigan poco y son mal comprendidos. Pero el daño es generalizado. Investigadores de Harvard y del Hospital General de Massachusetts encontraron que durante el primer año después de una lesión por arma de fuego, los sobrevivientes infantiles experimentaron un aumento del 117% en trastornos del dolor, del 68% en afecciones psiquiátricas y del 144% en adicciones. Los efectos en la salud mental se extienden a madres, padres y hermanos.

Para muchos afectados por el tiroteo en Kansas City, Missouri, los desencadenantes comenzaron de inmediato.

“Me enojo fácilmente”

A solo 10 días que Samuel Arellano fuera baleado en el desfile, fue a otro gran evento deportivo.

Samuel fue invitado a un partido de baloncesto masculino de la Universidad de Kansas en el Allen Fieldhouse en Lawrence. Durante un descanso del partido, con una cámara de video apuntando a Samuel y a sus padres, Jalen Wilson, ex estrella de KU, apareció en la pantalla y se dirigió a él directamente.

“Escuché tu historia”, dijo Wilson, que ahora juega en la NBA, desde la pantalla gigante. “Estoy muy agradecido de que estés aquí hoy, y es una bendición que podamos tenerte para brindarte el amor y apoyo que realmente mereces”.

Wilson pidió a los 16,000 fans presentes que se pusieran de pie y aplaudieran a Samuel. Mientras la multitud aplaudía y un locutor exclamaba que era un “joven valiente”, Samuel miró a sus padres, luego al suelo, sonriendo tímidamente.

Pero minutos después, cuando el partido se reanudó, Samuel comenzó a llorar y tuvo que salir del auditorio con su madre, Abigail.

“Cuando se puso bastante ruidoso, fue cuando comenzó a desmoronarse de nuevo”, dijo su padre, Antonio. “Así que ella tuvo que salir con él por un momento. Así que cualquier lugar ruidoso, si es demasiado fuerte, lo afecta”.

Samuel, que cumplió 11 años en marzo, fue baleado a la altura de las costillas en su lado derecho. Ahora, la cicatriz en su espalda es apenas perceptible, pero los efectos persistentes del tiroteo son evidentes. Está viendo a un terapeuta, al igual que su padre, aunque a Abigail le ha resultado difícil encontrar uno que hable español y aún no ha tenido una cita.

En las primeras semanas luego del tiroteo, Samuel tuvo problemas para dormir y a menudo se metía en la cama con su madre y su padre. Solía tener buenas notas, pero eso se volvió más difícil, dijo Abigail. Su personalidad ha cambiado, algo que a veces se ha manifestado en la escuela.

“Me enojo fácilmente”, dijo Samuel. “Nunca he sido así antes, pero si me dicen que me siente, me enojo. No sé por qué”.

Los niños traumatizados a menudo tienen dificultades para expresar emociones y pueden tener arrebatos de ira, según Michelle Johnson-Motoyama, profesora de trabajo social en la Universidad Estatal de Ohio.

“Estoy segura que para ese niño hay una sensación de tremenda injusticia por lo que sucedió”, dijo Johnson-Motoyama.

Especialmente justo después del tiroteo, Samuel tenía ataques de pánico y comenzaba a sudar, contó Antonio. Los terapeutas les dijeron que eso era normal. Pero los padres también lo mantuvieron alejado de su teléfono por un tiempo: había demasiado sobre el tiroteo en las noticias y en internet.

Abigail, que trabaja en un concesionaria de automóviles con Antonio, está ansiosa por ver a su hijo cambiar, por su sufrimiento y tristeza. También está preocupada por sus tres hijas, una de 16 años y gemelas de 13. Su padre, Victor Salas, que estaba con Samuel en el desfile, también estaba devastado después de los hechos.

“Estoy llorando y llorando y llorando por lo que pasó”, dijo Salas en español cuatro días después del desfile. “Porque fue un caos. Eso no significa que las familias no amen a su familia, pero todos huyeron para salvar sus propias vidas. Salvé la vida de mis nietos, pero ¿qué pasa con el resto de la gente? No estamos preparados”.

En el lado positivo, Samuel se sintió muy apoyado por la comunidad en Kansas City, Kansas. Muchas personas de su escuela se acercaron en los primeros días para visitarlo, amigos e incluso un ex conductor de autobús, que estaba llorando. Tiene una “habitación llena de dulces”, dijo Abigail, en su mayoría Skittles, su favorito.

En su cumpleaños, recibió una pelota de fútbol americano autografiada por Patrick Mahomes, mariscal de campo de los Kansas City Chiefs. Lo hizo llorar, algo que ocurre con bastante frecuencia, dijo su padre.

“Hay días buenos y malos, días más normales y fáciles, y luego hay días en los que la familia tiene que estar un poco más atenta y apoyarlo”, dijo Abigail en español. “Siempre ha sido extrovertido y hablador como su madre, pero eso ha cambiado desde el desfile”.

El 4 de julio, disparador de una semana

El 4 de julio fue particularmente angustiante para muchos de los jóvenes sobrevivientes y para sus familias. ¿Deberían comprar fuegos artificiales? ¿Querrían celebrar? ¿Por qué todos los petardos que explotan en el vecindario suenan como disparos?

Este año, Gabriella, de 14 años, necesitó la ayuda de su padrastro, Jason Barton, para encender sus fuegos artificiales, algo que normalmente hace con entusiasmo. En el desfile, como muchas personas, la familia Barton primero confundió el sonido de los disparos con fuegos artificiales.

Y Erika Nelson, madre soltera de Belton, Missouri, temía incluso mencionar la celebración a Mireya, quien siempre ha amado el Día de la Independencia. Eventualmente, Mireya dijo que no quería fuegos artificiales grandes este año y que solo quería que su madre los encendiera.

“Cualquier pequeño desencadenante, quiero decir, podría ser un ligero chasquido, y ella se tensaba”, dijo Erika Nelson.

Patty Davis, gerente de programas para el cuidado informado sobre el trauma en el hospital Children’s Mercy en Kansas City, dijo que incluso clientes suyos que estuvieron en el desfile pero no resultaron heridos todavía se estremecen ante los sonidos de sirenas u otros ruidos fuertes. Es una respuesta poderosa a la violencia armada en general, no solo al desfile.

“No es una respuesta exagerada”, dijo Davis. “De hecho, es muy natural para los jóvenes, y no tan jóvenes, que han experimentado algo similar o han presenciado violencia con armas de fuego”.

“No se trata de un trauma accidental, sino de un trauma perpetrado con fines violentos, que puede provocar un mayor nivel de ansiedad en las personas que lo viven, que se preguntan si volverá a suceder. ¿Y qué tan seguras están?”, agregó.

Reviviendo el instante

Los ruidos extraños, las luces brillantes y las multitudes pueden tomar desprevenidos a los niños y a sus padres.

En junio, Mireya Nelson estaba esperando a su hermana mayor después de un recital, con la esperanza de ver a un muchacho. Su madre quería ir, pero Mireya la hizo callar. “De repente, se escuchó un estruendo muy fuerte”, dijo Erika. “Se agachó y luego se levantó de un salto. Dijo: ‘¡Dios mío, me estaban disparando otra vez!’”. Mireya lo dijo tan fuerte que la gente se quedó mirando, así que fue el turno de Erika de hacerla callar y tratar de calmarla. “Le dije: ‘Mireya, está bien. Estás bien. Se les cayó una mesa. Solo están sacando cosas. Fue un accidente’”, explicó Erika.

Pasaron unos minutos hasta que el shock se disipó y más tarde Mireya se rió de la situación, pero Erika siempre está atenta.

La tristeza inicial de su hija (que veía películas durante horas y lloraba todo el tiempo) se ha transformado en descaro. Medio año después, Mireya bromea sobre el tiroteo, lo que destroza a su madre. Pero tal vez eso sea parte del proceso de sanación, dijo Erika.

Antes del 4 de julio, Mireya fue a Worlds of Fun, un gran parque de diversiones, y la pasó bien. Se sintió bien porque había guardias de seguridad por todas partes. También disfrutó de una visita a la oficina local del FBI con una amiga que estaba con ella el día del tiroteo.

Pero cuando alguien le sugirió ir al ballet, Mireya lo descartó rápidamente: está cerca de Union Station, el lugar del tiroteo. Ya no quiere ir al centro. Erika dijo que ha habido muchas citas médicas y dificultades económicas, y que su mayor frustración como madre es no poder arreglar las cosas para su hija.

“Tienen que seguir su propio camino, su propio proceso de curación. No puedo sacudirla, como diciéndole: ‘Vuelve a ser tú misma’”, dijo Erika. “Podría llevar meses, años. ¿Quién sabe? Podría ser el resto de su vida. Pero espero que pueda superarlo un poco”.

Piel de gallina en medio del calor sofocante

James Lemons notó un cambio en su hija de 5 años, Kensley, que estaba sobre sus hombros cuando le dispararon en el desfile.

Antes del tiroteo, Kensley era extrovertida y comprometida, dijo James, pero ahora está retraída, como si estuviera dentro de una burbuja y se hubiera desconectado de la gente.

A Kensley, las grandes multitudes y los policías le recuerdan al desfile. Ambos estuvieron presentes en una graduación de secundaria a la que asistió la familia este verano, y Kensley solo quería irse. James la llevó a un campo de fútbol vacío, donde, dijo, se le puso la piel de gallina y se quejó de tener frío a pesar del calor sofocante.

La hora de dormir es un problema particular para la familia Lemons. Kensley ha estado durmiendo con sus padres. Otro hijo, Jaxson, de 10 años, ha tenido pesadillas. Una noche, soñó que el tirador se acercaba a su padre y lo hacía tropezar, dijo Brandie Lemons, la madrastra de Jaxson.

Los niños más pequeños como Kensley expuestos a la violencia con armas de fuego tienen más probabilidades de desarrollar un trastorno de estrés postraumático que los niños mayores, según Johnson-Motoyama, de la Universidad Estatal de Ohio.

Davis, del Children’s Mercy en Kansas City, dijo que los niños cuyos cerebros no están completamente desarrollados pueden tener dificultades para dormir y comprender que están seguros en sus hogares por la noche.

James le compró a la familia un nuevo cachorro, un bulldog americano que ya pesa 32 libras, para ayudarlos a sentirse protegidos. “Busqué el pedigrí”, dijo, “Son muy protectores. Muy cariñosos”.

En busca de una salida

Para desahogarse después del tiroteo, Gabriella comenzó a boxear. Su madre, Bridget, dijo que le devolvió algo de la confianza y el control que había bajado después del desfile. “Me gusta golpear a la gente, no de una manera mala, lo juro”, dijo Gabriella en abril mientras moldeaba un protector bucal a sus dientes antes de irse a entrenar.

Sin embargo, desde entonces ha dejado de boxear, por lo que el dinero puede destinarse a un viaje a Puerto Rico con su clase de español. Están pagando $153 al mes durante 21 meses para cubrir el viaje. Las clases de boxeo costaban $60 al mes.

Bridget pensaba que el boxeo era una buena salida para la ira que le quedaba, pero a finales de julio Gabriella no estaba segura de si todavía tenía el impulso para contraatacar de esa manera. “El pasado es el pasado, pero todos vamos a pasar por cosas. ¿Tiene sentido?”, preguntó Gabriella.

“Estás bien en general, pero todavía tienes desencadenantes. ¿Es eso lo que quieres decir?”, preguntó su madre. “Sí”, respondió.

Después del tiroteo, Mireya Nelson probó las clases en línea, que no funcionaron bien. Los primeros días de la escuela de verano, Mireya tenía un ataque de pánico todos los días en el auto y su madre la llevaba de vuelta a casa.

Mireya quiere regresar a la escuela secundaria este otoño, y Erika es cautelosa. “Sabes, si vuelvo a la escuela, existe la posibilidad de que me disparen, porque en la mayoría de las escuelas hoy en día hay tiroteos”, recordó Erika que dijo su hija. “Y yo digo: ‘Bueno, no podemos pensar así. Nunca se sabe lo que va a pasar’”.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Six months after Gabriella Magers-Darger’s legs were burned by sparks from a ricocheted bullet at the Kansas City Chiefs Super Bowl parade in February, the 14-year-old is ready to leave the past behind.

She is dreading the pitfalls of being a high school freshman, even as she looks forward to being back with friends and at color guard, dance, and volleyball. She might even join the wrestling team to get some respect at school.

But the past remains ever present.

At a July Fourth gathering, a family friend brought noise-canceling headphones in case the fireworks became too much. Earlier in the summer Gabriella had a hard time viewing a relative’s gun collection, the handguns in particular. And she hyperventilated when she saw a family friend’s finger after it was sliced by accident — the sight of blood reminds her of seeing a fatally wounded Lisa Lopez-Galvan minutes after she was shot outside Union Station, the only person killed that day.

Her mom, Bridget Barton, said Gabriella has had a chip on her shoulder since the parade.

“She’s lost some softness to her, some gentleness to her,” Barton said.

Children are particularly vulnerable to the stresses of gun violence, and 10 of 24 people injured by bullets at the Feb. 14 parade were under 18 years old. Countless more children like Gabriella experienced the trauma firsthand. They’ve endured fear, anger, sleep problems, and hypersensitivity to crowds and noises.

A 15-year-old girl who was shot through the jaw and shoulder effectively dropped out of school for a time and daily panic attacks kept her from summer school, too. An 11-year-old boy shot in the side described feeling angry at school for reasons he couldn’t explain. A 5-year-old girl who was on her father’s shoulders when he was hit by gunfire panics each time her dad feels sick, fearing he has been shot again.

“She’s not the same kid. I mean, she’s definitely not,” said Erika Nelson, mother of the 15-year-old, Mireya, who has scars on her jaw and face. “You never know when she’s going to snap. You never know. You might say something or someone might bring up something that reminds her of that day.”

Guns overtook motor vehicle accidents as the leading cause of death for children in 2020, but a far higher number of kids are hit by gunfire and survive. Research suggests that kids sustain nonfatal firearm injuries anywhere from two to four times more often than they are killed by guns.

Scientists say the long-term effects of gun violence on kids are little researched and poorly understood. But the harm is pervasive. Harvard and Massachusetts General Hospital researchers found that during the first year after a firearm injury, child survivors experienced a 117% increase in pain disorders, a 68% increase in psychiatric disorders, and a 144% increase in substance use disorders. The mental health effects spill over — to mothers, fathers, siblings.

For many affected by the shooting in Kansas City, Missouri, the triggers began right away.

‘I Get Mad Easily’

Just 10 days after Samuel Arellano was shot at the parade, he attended another big sporting event.

Samuel was invited to attend a University of Kansas men’s basketball game at Allen Fieldhouse in Lawrence. During a break in the game, with a video camera pointed at Samuel and his parents, former KU star Jalen Wilson appeared on the scoreboard and addressed him directly.

“I heard about your story,” Wilson, who now plays in the NBA, said on the big screen. “I’m so very thankful that you are here today and it is a blessing that we can have you to give you the love and support you truly deserve.”

Wilson asked the 16,000 fans in attendance to stand and give Samuel a round of applause. As the crowd clapped and an announcer bellowed about him being a “brave young man,” Samuel looked at his parents, then down at his feet, smiling shyly.

But minutes later when the game resumed, Samuel started to cry and had to leave the auditorium with his mom, Abigail.

“When it got pretty loud, that’s when he started breaking up again,” his dad, Antonio, said. “So she had to step out with him for a minute. So any loud places, if it’s too loud, it’s affecting him.”

Samuel, who turned 11 in March, was shot in the ribs on his right side. The scar on his back is barely noticeable now, but lingering effects from the parade shooting are obvious. He is seeing a therapist — as is his father, though Abigail has had a tough time finding a Spanish-speaking one and still hasn’t had an appointment.

Samuel had trouble sleeping in the first weeks after the shooting and often crawled in bed with his mom and dad. He used to get good grades, but that became more difficult, Abigail said. His personality has changed, which sometimes has shown up at school.

“I get mad easily,” Samuel said. “I [have] never been like this before but like, if they tell me to sit down, I get mad. I don’t know why.”

Traumatized children often have difficulty expressing emotions and may be given to outbursts of anger, according to Michelle Johnson-Motoyama, a professor of social work at Ohio State University.

“I’m sure for that child there is a sense of tremendous injustice about what happened,” Johnson-Motoyama said.

Especially right after the shooting, Samuel had panic attacks, Antonio said, and he’d break out in a sweat. Therapists told them that was normal. But the parents also kept him off his phone for a while, as there was so much about the shooting on the news and online.

Abigail, who works at a car dealership with Antonio, is anxious about seeing her son change, his suffering and sadness. She is also concerned for her three daughters, a 16-year-old and 13-year-old twins. Her father, Victor Salas, who was with Samuel at the parade, was also reeling in its aftermath.

“I’m crying and crying and crying about what happened,” Salas said in Spanish four days after the parade. “Because it was chaos. It doesn’t mean that families don’t love their family, but everyone took off to save their own lives. I saved my grandchildren’s lives, but what happens to the rest of the people? We’re not prepared.”

On the good side, Samuel felt very supported by the community in Kansas City, Kansas. Many people from his school stopped by in the first few days to visit, including friends and even a former bus driver, who was in tears. He has a “room full of candy,” Abigail said, mostly Skittles, his favorite.

An autographed football from Kansas City Chiefs quarterback Patrick Mahomes arrived on his birthday. It made him cry, his father said, which happens pretty often.

“There are good and bad days, days that are more normal and easier, and then there are days where the family has to be a little bit more aware and supportive,” Abigail said in Spanish. “He’s always been outgoing and talkative like his mom, but that has changed since the parade.”

Fourth of July a Weeklong Trigger

The Fourth of July was particularly harrowing for many of the young survivors and their families. Should they buy fireworks? Will they want to celebrate? And why do all the firecrackers going off in the neighborhood sound like gunshots?

Fourteen-year-old Gabriella needed help from her stepfather, Jason Barton, to light her fireworks this year, something she is ordinarily enthusiastic about doing herself. At the parade, like many people, the Barton family initially mistook the sound of gunfire for fireworks.

And Erika Nelson, a single mom in Belton, Missouri, feared even bringing up the holiday with Mireya, who has always loved Independence Day. Eventually Mireya said she didn’t want any big fireworks this year and wanted only her mom to set theirs off.

“Just any little trigger — I mean, it could be a light crackle — and she just clenched,” Erika Nelson said.

Patty Davis, a program manager for trauma-informed care at Children’s Mercy hospital in Kansas City, said even her clients who were at the parade but were not injured still flinch at the sounds of sirens or other loud noises. It’s a powerful response to gun violence, she said.

“So not just an accidental trauma,” she said, “but a trauma that was perpetrated for violent purposes, which can cause an increased level of anxiety for persons around that to wonder if it’s going to happen again. And how safe are they?”

Reliving Getting Shot

Random sounds, bright lights, and crowds can catch the kids and their parents off guard. In June, Mireya Nelson was waiting for her older sister after a dance recital, hoping to see a boy she knew give a flower to a girl everyone said he had a crush on. Her mom wanted to go, but Mireya shushed her.

“Then all of a sudden, there was a loud boom,” Erika said. “She dropped low to the ground. And then she jumped back up. She goes, ‘Oh my God, I was getting shot again!’”

Mireya said it so loudly people were staring, so it was Erika’s turn to shush her and try to soothe her.

“I was like, ‘Mireya, it’s OK. You’re all right. They dropped a table. They’re just moving stuff out. It was an accident,’” Erika said.

It took a few minutes for the shock to wear off and Mireya later giggled about it, but Erika is always on watch.

Her daughter’s early sadness — she watched movies for hours, crying throughout — has since changed to a cheekiness. Half a year later, Mireya will joke about the shooting, which tears her mother up. But maybe that is part of the healing process, Erika says.

Before the Fourth of July, Mireya went to Worlds of Fun, a large amusement park, and had a good time. She felt OK because there were security guards everywhere. She also enjoyed a visit to the local FBI office with a friend who was with her the day of the shooting. But when someone suggested a trip to the ballet, Mireya squashed it quickly — it’s near Union Station, the site of the shooting. She doesn’t want to go downtown anymore.

Erika said the doctor appointments and financial strains have been a lot to juggle and that her biggest frustration as a parent is that she’s not able to fix things for her daughter.

“They have to go their own way, their own process of healing. I can’t shake her, like, ‘Get back to yourself,’” Erika said. “It could take months, years. Who knows? It could be the rest of her life. But I hope that she can overcome a little bit of it.”

Goose Bumps in the Sweltering Heat

James Lemons noticed a change in his 5-year-old daughter, Kensley, who was on his shoulders when he was shot at the parade. Before the shooting Kensley was outgoing and engaged, James said, but now she is withdrawn, like she has closed off her bubble and disconnected from people.

Large crowds and police officers remind Kensley of the parade. Both were present at a high school graduation the family attended this summer, prompting Kensley to ask repeatedly to leave. James took her to an empty football field, where, he said, she broke out in goose bumps and complained of being cold despite the sweltering heat.

Bedtime is a particular problem for the Lemons family. Kensley has been sleeping with her parents. Another child, 10-year-old Jaxson, has had bad dreams. One night, he dreamt that the shooter was coming near his dad and he tripped him, said Brandie Lemons, Jaxson’s stepmom.

Younger children like Kensley exposed to gun violence are more likely to develop post-traumatic stress disorder than older children, according to Ohio State’s Johnson-Motoyama.

Davis, of Children’s Mercy in Kansas City, said children whose brains are not fully developed can have a hard time sleeping and understanding that they are safe in their homes at night.

James got the family a new puppy — an American bulldog that already weighs 32 pounds — to help them feel protected.

“I looked up the pedigree,” he said, “They’re real protective. They’re real loving.”

Searching for an Outlet to Let Off Steam

Gabriella took up boxing after the shooting. Her mother, Bridget, said it restored some of her confidence and control that dimmed after the parade.

“I like beating people up — not in a mean way, I swear,” Gabriella said in April as she molded a mouthguard to her teeth before leaving for training.

She has since stopped boxing, however, so the money can instead go toward a trip to Puerto Rico with her Spanish class. They’re paying $153 a month for 21 months to cover the trip. Boxing classes were $60 a month.

Bridget thought boxing was a good outlet for leftover anger, but by the end of July Gabriella wasn’t sure if she still had the drive to fight back that way.

“The past is the past but we’re still gonna all, like, go through stuff. Does that make sense?” Gabriella asked.

“You’re mostly OK but you still have triggers. Is that what you mean?” her mother asked.

“Yeah,” she replied.

After the shooting, Mireya Nelson tried online classes, which didn’t work well. The first few days of summer school, Mireya had a panic attack every day in the car and her mother took her home.

Mireya wants to return to high school this fall, and Erika is wary.

“You know, if I do go back to school, there’s a chance at school of being shot, because most schools nowadays get shot up,” Erika recalled her daughter saying. “And I’m like, ‘Well, we can’t think like that. You never know what’s gonna happen.’”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The Host

Julie Rovner
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Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

In what will certainly be remembered as a landmark decision, the Supreme Court’s conservative majority this week overruled a 40-year-old legal precedent that required judges in most cases to yield to the expertise of federal agencies. It is unclear how the elimination of what’s known as the “Chevron deference” will affect the day-to-day business of the federal government, but the decision is already sending shockwaves through the policymaking community. Administrative experts say it will dramatically change the way key health agencies, such as the FDA and the Centers for Medicare & Medicaid Services, do business.

The Supreme Court also this week decided not to decide a case out of Idaho that centered on whether a federal health law that requires hospitals to provide emergency care overrides the state’s near-total ban on abortion.

This week’s panelists are Julie Rovner of KFF Health News, Joanne Kenen of the Johns Hopkins schools of public health and nursing and Politico Magazine, Victoria Knight of Axios, and Alice Miranda Ollstein of Politico.

Panelists

Joanne Kenen
Johns Hopkins University and Politico

@JoanneKenen

Read Joanne's articles.

Victoria Knight
Axios

@victoriaregisk

Read Victoria's stories.

Alice Miranda Ollstein
Politico

@AliceOllstein

Read Alice's stories.

Among the takeaways from this week’s episode:

• In 1984, the Supreme Court ruled broadly that courts should defer to the decision-making of federal agencies when an ambiguous law is challenged. On Friday, the Supreme Court ruled that the courts, not federal agencies, should have the final say. The ruling will make it more difficult to implement federal laws — and draws attention to the fact that Congress, frequently and pointedly, leaves federal agencies much of the job of turning written laws into reality.
• That was hardly the only Supreme Court decision with major health implications this week: On Thursday, the court temporarily restored access to emergency abortions in Idaho. But as with its abortion-pill decision, it ruled on a technicality, with other, similar cases in the wings — like one challenging Texas’ abortion ban.
• In separate rulings, the court struck down a major opioid settlement agreement, and it effectively allowed the federal government to petition social media companies to remove falsehoods. Plus, the court agreed to hear a case next term on transgender health care for minors.
• The first general-election debate of the 2024 presidential cycle left abortion activists frustrated with their standard-bearers — on both sides of the aisle. Opponents didn’t like that former President Donald Trump doubled down on his stance that abortion should be left to the states. And abortion rights supporters felt President Joe Biden failed to forcefully rebut Trump’s outlandish falsehoods about abortion — and also failed to take a strong enough position on abortion rights himself.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: The Washington Post’s “Masks Are Going From Mandated to Criminalized in Some States,” by Fenit Nirappil.  

Victoria Knight: The New York Times’ “The Opaque Industry Secretly Inflating Prices for Prescription Drugs,” by Rebecca Robbins and Reed Abelson. 

Joanne Kenen: The Washington Post’s “Social Security To Drop Obsolete Jobs Used To Deny Disability Benefits,” by Lisa Rein.  

Alice Miranda Ollstein: Politico’s “Opioid Deaths Rose 50 Percent During the Pandemic. in These Places, They Fell,” by Ruth Reader.  

Also mentioned in this week’s podcast:

• Politico’s “Inside the $100 Million Plan To Restore Abortion Rights in America,” by Alice Miranda Ollstein.
• JAMA Network Open’s “Use of Oral and Emergency Contraceptives After the US Supreme Court’s Dobbs Decision,” by Dima M. Qato, Rebecca Myerson, Andrew Shooshtari, et al.
• JAMA Health Forum’s “Changes in Permanent Contraception Procedures Among Young Adults Following the Dobbs Decision,” by Jacqueline E. Ellison, Brittany L. Brown-Podgorski, and Jake R. Morgan.
• JAMA Pediatrics’ “Infant Deaths After Texas’ 2021 Ban on Abortion in Early Pregnancy,” by Alison Gemmill, Claire E. Margerison, Elizabeth A. Stuart, et al.

click to open the transcript

SCOTUS Ruling Strips Power From Federal Health Agencies

KFF Health News’ ‘What the Health?’Episode Title: ‘SCOTUS Ruling Strips Power From Federal Health Agencies’Episode Number: 353Published: June 28, 2024

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Mila Atmos: The future of America is in your hands. This is not a movie trailer, and it’s not a political ad, but it is a call to action. I’m Mila Atmos and I’m passionate about unlocking the power of everyday citizens. On our podcast, “Future Hindsight,” we take big ideas about civic life and democracy and turn them into action items for you and me. Every Thursday, we talk to bold activists and civic innovators to help you understand your power and your power to change the status quo. Find us at futurehindsight.com or wherever you listen to podcasts.

Julie Rovner: Hello, and welcome back to “What the Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Friday, June 28, at 10:30 a.m. As always, news happens fast and things might’ve changed by the time you hear this, so here we go.

We are joined today via video conference by Alice Miranda Ollstein of Politico.

Alice Miranda Ollstein: Hello.

Rovner: Victoria Knight of Axios News.

Victoria Knight: Hello, everyone.

Rovner: And Joanne Kenen of the Johns Hopkins Schools of Nursing and Public Health and Politico Magazine.

Joanne Kenen: Hi, everybody.

Rovner: I hope you enjoyed last week’s episode from Aspen Ideas: Health. This week we’re back in Washington with tons of breaking news, so let’s get right to it. We’re going to start at the Supreme Court, which is nearing, but not actually at, the end of its term, which we now know will stretch into next week. We have breaking news, literally breaking as in just the last few minutes: The court has indeed overruled the Chevron Doctrine. That’s a 1984 ruling that basically allowed experts at federal agencies to, you know, expert. Now it says that the court will get to decide what Congress meant when it wrote a law. We’re obviously going to hear a lot more about this ruling in the hours and days to come, but does somebody have a really quick impression of what this could mean?

Ollstein: So this could prevent or make it harder for health agencies, and all the federal agencies that touch on health care, to both create new policies based on laws that Congress pass and update old ones. Things need to be updated; new drugs are invented. There’s been all these updates to what Obamacare does and doesn’t have to cover. That could be a lot harder going forward based on this decision. It really takes away a lot of the leeway federal agencies had to interpret the laws that Congress passed and implement them.

I think kicking things back to courts and Congress could really slow things down a lot, and a lot of conservatives see that as a good thing. They think that federal agencies have been too untouchable and not have the same accountability mechanisms because they’re career civil servants who are not elected. But this has health policy experts … Honestly, we interviewed members of previous Republican administrations and Democratic administrations and they’re both worried about this.

Rovner: Yeah, going forward, if Donald Trump gets back into the presidency, this could also hinder the ability of his Department of Health and Human Services to make changes administratively.

Knight: These agencies are stacked with experts. This is what they work on. This is what they really are primed to do. And Congress does not have that same type of staffing. Congress is very different. It’s very young. There’s a lot of turnover. There are experienced staffers, but usually when they’re writing these laws, they leave so much up to interpretation of the agency because they are experts.

So I think pushing things back on Congress would really have to change how Congress works right now. When I talked to experts, we would need staffers who are way more experienced. We would need them to write laws that are way more specific. And Congress is already so slow doing anything. This would slow things down even more. So that’s a really important congressional aspect I think to note.

Rovner: I think when we look back at this term, this is probably going to be the biggest decision. Joanne, you want to add something before we move on?

Kenen: We’re recording. We don’t know if immunity just dropped, which is all still going to be, not a health care decision but an important decision of the country. I’ve got SCOTUSblog on my other screen. Here’s a quote from [Justice Elena] Kagan’s dissent. She says, because it’s very unfocused for what we do on this podcast, “Chevron has become part of the warp and woof of modern government, supporting regulatory efforts of all kinds, to name a few, keeping air and water clean, food and drugs safe and financial markets honest.” So two of the three of us. Financial markets affect the health industry as well.

Rovner: Oh, yeah.

Kenen: But I think that what the public doesn’t always understand is how much regulatory stuff there is in Washington. Congress can write a 1,000-page law like the ACA [Affordable Care Act]. I’ve never counted how many pages of regulation because I don’t think I can count that high. It’s probably tens of thousands.

Rovner: At least hundreds of thousands.

Kenen: Right. And that every one of those, there’s a lobbying fight and often a legal fight. It’s like the coloring book when we were kids. Congress drew the outline and then we all tried to scribble within the lines. And when you go out of the lines, you have a legal case. So the amount of stuff, regulatory activity is something that the public doesn’t really see. None of us have read every reg pertaining to health care. You can’t possibly do it in a lifetime. Methuselah couldn’t have done it. And Congress cannot hire all the expert staff and all the federal agencies and put them in; they won’t fit in the Capitol. That’s not going to happen. So how do they come to grips with how specific are they going to have to be? What kind of legal language can they delegate some of this to agency experts. We’re in really uncharted territory.

Rovner: I think you can tell from the tones of all of our voices that this is a very big deal, with a whole lot of blanks to be filled in. But for the moment …

Kenen: Maybe they’ll just let AI do it.

Rovner: Yeah, for the moment, let’s move on because, until just now, the biggest story of the week for us was on Thursday. We finally got a decision in that case about whether Idaho’s near-total ban on abortion can override a federal law called EMTALA, the Emergency Medical Treatment and Active Labor Act, which requires doctors in emergency rooms to protect a pregnant woman’s health, not just her life. And much like the decision earlier this month to send the abortion pill case back to the lower courts because the plaintiffs lacked legal standing, the court once again didn’t reach the merits here. So Alice, what did they do?

Ollstein: So like you said, both on abortion pills and on EMTALA, the court punted on procedural issues. So it was standing on the one and it was ripeness on the other one. This one was a lot more surprising. I think based on the oral arguments in the mifepristone case, we could see the standing-based decision coming. That was a big focus of the arguments. This was more of a surprise. This was a majority of justices saying, “Whoops, we shouldn’t have taken this case in the first place. We shouldn’t have swooped in before the 9th Circuit even had a chance to hear it. And not only take the case, but allow Idaho to fully enforce its law even in ways that people feel violate EMTALA in the meantime.” And so what this does temporarily is restore emergency abortion access in Idaho. It restores a lower-court order that made that the case, but it’s not over.

Rovner: Right. It had stayed Idaho’s ban to the extent that it conflicted with EMTALA.

Ollstein: So this goes back to lower courts and it’s almost certain to come back to the Supreme Court as early as next year, if not at another time. Because this isn’t even the only major federal EMTALA case that’s in the works right now. There’s also a case on Texas’ abortion ban and its enforcement in emergency situations like this. And so I think the main reaction from the abortion rights movement was temporary relief, but a lot of fear for the future.

Rovner: And I saw a lot of people reminding everybody that this Texas ruling in Idaho, now the federal law is taking precedence, but there’s a stay of the federal law in the 5th Circuit. So in Texas, the Texas ban does overrule the federal law that requires abortions in emergency circumstances to protect a woman’s health. That’s what the dispute is basically about. And of course, you see a lot of legal experts saying, “This is a constitutional law 101 case that federal law overrides state law,” and yet we could tell by some of the add-on discussion in this case, as they’re sending it back to the lower court, that some of the conservatives are ready to say, “We don’t think so. Maybe the federal law will have to yield to some of these state bans.” So you can kind of see the writing on the wall here?

Ollstein: It’s really hard to say. I think that you have some justices who are clearly ready to say that states can fully enforce their abortion bans regardless of what the federal government’s federal protections are for patients. I think they put that out there. I think the case is almost certain to come back to them, and there was clearly not a majority ready to fully side with the Biden administration on this one.

Rovner: And clearly not a majority ready to fully side with Idaho on this one. I think everything that I saw suggested that they were split 3-3-3. And with no majority, the path of least resistance was to say, “Our bad. You take this back lower court. We’ll see when it comes back.”

Ollstein: It was a very unusual move, but some of the justification made sense to me in that they cited that Idaho state officials’ position on what their abortion ban did and didn’t do has wavered over time and changed. And what they initially said when they petitioned to the court is not necessarily exactly what they said in oral arguments, and it’s not exactly what they have said since. And so at the heart here is you have some people saying there’s a clear conflict between the patient protections under EMTALA — which says you have to stabilize anyone that comes to you at a hospital that takes Medicare — and these abortion bans, which only allow an abortion when there’s imminent life-threatening situation. And so you have people, including the attorney general of Idaho, saying, “There is no conflict. Our law does allow these emergency abortions and the doctors are just wrong and it’s just propaganda trying to smear us. And they just want to turn hospitals into free-for-all abortion facilities.” This is what they’re arguing. And then you have people say …

Rovner: [inaudible 00:11:12] … in the meanwhile, we know that women are being airlifted out of Idaho when they need emergency abortions because doctors are worried about actually performing abortions …

Ollstein: Correct.

Rovner: And possibly being charged with criminal charges for violating Idaho’s abortion ban.

Ollstein: Sure, but I’m saying even amongst conservatives, there are those who are saying, “There’s no conflict between these two policies. The doctors are just wrong either intentionally or unintentionally.” And then there’s those who say there is a conflict between EMTALA and state bans, and it should be fine for the state to violate EMTALA.

Rovner: No. Obviously this one will continue as the abortion pill case is likely to continue. Well, also in this end-of-term Supreme Court decision dump, an oddly split court with liberals and conservatives on both sides, struck down the bankruptcy deal reached with Purdue Pharma that would’ve paid states and families of opioid overdose victims around $6 billion, but would also have shielded the company’s owners, the Sackler family, from further legal liability. What are we to make of this? This was clearly a difficult issue. There were a lot of people even who were involved in this settlement who said the idea of letting the Sackler family, which has hidden billions of dollars from the bankruptcy settlement anyway, and clearly acted very badly, basically giving them immunity in exchange for actually getting money. This could not have been an easy… obviously was not an easy decision even for the Supreme Court.

Kenen: No, it wasn’t theoretical. The ones who opposed blowing up the agreement were very much, “This is going to add delay any kind of justice for the families and the plaintiffs.” It was not at all abstract. It was like there are a lot of people who aren’t going to get help. At least the help will be delayed if this money doesn’t start flowing. So I was struck by how practical, relating to the families who have lost people because of the actions of Purdue. But the other side was, also that was much more a clear-cut legal issue, that people didn’t give up their right to sue. It was cutting off the right to sue was imposed on potential plaintiffs by the settlement. So that was a much more legalistic argument versus, it was a little bit more real world, but they need the help now. And including some of the conservatives. This is an interesting thing to read. This was painstaking. This is a huge settlement. It took so long. It had many, many moving parts. And I don’t know how you go back and put it together again.

Rovner: But that’s where we are.

Kenen: Yes.

Rovner: They have to basically start from scratch?

Kenen: I don’t know if they have to start entirely from scratch. You’d have to be nuts to get the Sacklers to say, “OK, we’ll be sued,” which they’re obviously you’re not going to. Is somebody going to come up with a “Split the difference, let’s get this moving and we won’t sue anymore?” I don’t know. But I don’t know that you have to start 100% from scratch, but you’re surely not anywhere near a finish line anymore.

Rovner: That’s big Supreme Court case No. 3 for this week. Now let’s get to big Supreme Court case No. 4. Earlier this week, the court turned back a challenge that the government had wrongly interfered with free speech by urging social media organizations to take down covid misinformation. But again, as with the abortion pill case, the court did not get to the merits. But instead, they ruled that the states and individuals who sued did not have standing. So we still don’t know what the court thinks of the role of government in trying to ensure that health information is correct. Right?

Knight: Right. And I thought it was interesting. Basically the White House was like, “Well, we talked to the tech companies, but it was their decision to do this. So we weren’t really mandating them do this.” I think they’re just being like, “OK, we’ve left it up to the tech companies. We haven’t really interfered. We’re just trying to say these things are harmful.” So I guess we’ll have to see. Like you said, they didn’t take it up on standing, but overall, conservatives that were saying, “This was infringing on free speech.” It was particularly some scientists, I think, that promoted the herd immunity theory, things like that.

So I think they’re obviously going to be upset in some way because their posts were depromoted on social media. But I think it just leaves things the way they are, the same way. But it would be interesting, I guess, if Trump does go to the White House, how that might play out differently?

Rovner: This court has been a lot of the court deciding not to decide cases, or not to decide issues. Sorry, Alice, go ahead.

Ollstein: Yeah, so I think it is pretty similar to the abortion pill case in one key way, which is that it’s the court saying, “Look, the connection between the harm you think you suffered and the entity you are accusing of causing that suffering, that connection is way too tenuous. You can’t prove that the Biden administration voicing concerns to these social media companies directly led to you getting shadow-banned or actual banned,” or whatever it is. And the same in the abortion pill case, the connection between the FDA [Food and Drug Administration] approving the drug and regulating the drug and these individual doctors’ experiences is way too tenuous. And so that’s something to keep in mind for future cases that, we’re seeing a pattern here.

Rovner: Yes, and I’m not suggesting that the court is directly trying to duck these issues. These are legitimate standing cases and important legal precedents for who can sue in what circumstance. That is the requirement of constitutional review that first you have to make sure that there’s both standing in a live controversy and there’s all kinds of things that the court has to go through before they get to the merits. So more often than not, they don’t get there.

Well, meanwhile, we have our first hot-button, Supreme Court case slotted in for next term. On Monday, the court granted “certiorari” [writ by which a higher court reviews a decision of a lower court] to a case out of Tennessee where the Biden administration is challenging the state’s ban on transgender care for minors. It was inevitable that one of these cases was going to get to the high court sooner or later, right?

Kenen: Yeah, I think it’s not a surprise, the politics of it and the techniques or tools used by the forces that are against the treatment for minors. It’s very similar to the politics and patterns of the abortion case, of turning something into an argument that it’s to protect somebody. A lot of the abortion requirements and fights were about to protect the woman. Ostensibly, that was the political argument. And now we’re seeing we have to protect the children so that it’s the courts, as opposed to families and doctors, who are, “protecting the children.”

There’s a lot of misunderstanding about what these treatments do and who gets them and at what age;  that they’re often described as mutilation and irreversible. For the younger kids, for preteen, middle school age-ish, early teens, nothing is irreversible. It’s drugs that if you stop them, the impact goes away. But it has become this enormous lightning rod for the intersection of health and politics. And I think we all have a pretty good guess as to where the Supreme Court’s going to end up on this. But you’re sometimes surprised. And also, there could be some …

Rovner: Maybe they don’t have standing.

Kenen: There could be some kind of moderation, too. It could be a certain … they don’t have to say all … it depends on how clinical they want to get. Maybe they’ll rule on certain treatments that are more less-reversible than a puberty blocker, which is very reversible, and some kind of safeguards. We don’t know the details. We’re not surprised that it ended up … and we know going in, you could have a gut feeling of where it’s likely to turn out without knowing the full parameters and caveats and details. They haven’t even argued it yet.

Rovner: This is a decision that we’ll be waiting for next June.

Kenen: Right. Well, could not. Maybe it’s so clear-cut, it’ll be May. Who knows, right?

Rovner: Yeah, exactly. All right, well, moving on. There was a presidential debate last night. I think it was fair to say that it didn’t go very well for either candidate, nor for anybody interested in what President Biden or former President Trump thinks about health issues. What did we learn, if anything?

Ollstein: Well, I was mainly listening for a discussion of abortion and, boy was it all over the place. What I thought was interesting was that both candidates pissed off their activist supporters with what they said. I was texting with a lot of folks on both sides and conservatives were upset that Trump doubled down on his position that this should be entirely left to states, and they disagree. They want him to push for federal restrictions if elected.

And on the left, there was a lot of consternation about Biden’s weird, meandering answer about Roe v. Wade. He was asked about abortions later in pregnancy. One, neither he nor the moderators pushed back on what Trump’s very inflammatory claims about babies being murdered and stuff. There was no fact-checking of that whatsoever. But then Biden gave a confusing answer, basically saying he supports going to the Roe standard but not further, which is what I took out of it. And that upset a lot of progressives who say Roe was never good enough. For a lot of people, when Roe v. Wade was still in place, abortion was a right in name only. It was not actually accessible. States could impose lots of restrictions that kept it out of reach for a lot of people. And in this moment, why should we go back to a standard that was never good enough? We should go further. So just a lot of anxiety on both sides of this.

Rovner: Yeah. Meanwhile, Trump seemed to say that he would leave the abortion pill alone, which jumped out at me.

Kenen: But that was a completely … CNN made a decision not to push back. They were going to have online fact-checking. Everybody else had online fact. … And they didn’t challenge. And I guess they assumed that the candidates would challenge each other, and Biden had a different kind of challenging night. Trump actually said that the previous Supreme Court had upheld the use of the abortion drug and that it’s over, it’s done. That was not a true statement. The Supreme Court rejected that case, as Alice just explained, on standing. It’s going to be back. It may be back in multiple forms, multiple times. It is not decided. It is not over, which is what Trump said, “Oh, don’t worry about the abortion drug. The Supreme Court OK’d it.” That’s not what the Supreme Court did, and Biden didn’t counter that in any way.

And then Biden, in addition to the political aspect that Alice just talked about, he also didn’t describe Roe, the framework of Roe, particularly accurately. And, as Alice just pointed out, the things that Trump said were over-the-top even for Trump, and that they went unchallenged by either the moderators or President Biden.

Rovner: I was a little bit surprised that there wasn’t anything else on health care or there wasn’t much else.

Knight: Biden tried to hit his health care talking points and did a very terrible job. Alice had a really good tweet getting the right. … He initially said wrong numbers for the insulin cap, for the cap on out-of-pocket for Medicare beneficiaries, how much they can spend on prescription drugs. He got both of those wrong. I think he got insulin right later in the night. And then the very notably, “We will beat Medicare.” That was just unclear what he even meant by that. Maybe it was about drug price negotiations, I’m sure. So he was trying, but just could not get the facts right and I don’t think it came across effective in any way. And health care does do really well for Democrats. Abortion does really well for Democrats. So he was not effective in putting those messages.

I also noticed the moderators asked a question about opioids, addressing the opioid epidemic. Trump did not answer at all, pivoted to I think border or something like that. I don’t think Biden really answered either, honestly. So that was an opportunity for them to also talk about addressing that, which I think is something they could both probably talk about in a winning way for both. But I thought it was mentioned more than I expected a little bit. I thought they may want to talk about it at all. So it was still not much substantive policy discussion on health care.

Kenen: Biden tried to get across some of the Democratic policies on drug prices and polls have shown that the public doesn’t really understand that is actually the law in going forward. So if any attempt to message that in front of a very large audience was completely muddled. Nobody listening to that debate would’ve come out — unless they knew going in — they would’ve not have come out knowing what was in the law about Medicare price negotiations. They would’ve gotten four different answers of what happened with insulin, although they probably figured something good, helpful happened. And a big opportunity to push a Democratic achievement that has some bipartisan popularity was completely evaporated.

Rovner: I think Biden did the classic over-prepare and stuff too many talking points into his head and then couldn’t sort them all out in the moment. That seemed pretty clear. He was trying to retrieve the talking point and they got a little bit jumbled in his attempt to bring them out. Well, back to abortion: Alice, you got a cool scoop this week about abortion rights groups banding together with a $100 million campaign to overturn the overturn of Roe. Tell us about that?

Ollstein: Yeah, so it’s notable because there’s been so much focus on the state level battles and fighting this out state by state, and the ballot initiatives that have passed at the state level and restored or protected access have been this glimmer of hope for the abortion rights movement. But I think there was a real crystallization of the understanding that that strategy alone would leave tens of millions of people out in the cold because a lot of states don’t have the ability to do a ballot initiative. And also, if there were to be some sort of federal restrictions imposed under a Trump presidency or whatever, those state level protections wouldn’t necessarily hold. So I think this effort of groups coming together to really spend big and say that they want to restore federal protections is really notable.

I also think it’s notable that they are not committing to a specific bill or plan or law they want to see. They are keeping on the, “This is our vision, this is our broad goal.” But they’re not saying, “We want to restore Roe specifically, we want to go further,” et cetera. And that’s creating some consternation within the movement. I’ve also, since publishing the story, heard a lot of anxiety about the level of spending going to this when people feel that that should be going to direct support for people who are suffering on the ground and struggling to access abortion. Right now you have abortion funds screaming that they’re being stretched to the breaking point and cannot help everyone who needs to travel out of state right now. So, of course, infighting on the left is a perennial, but I think it’s particularly interesting in this case.

Rovner: Well, meanwhile, we have a trio this week of examples of what I think it’s safe to call unintended consequences of the Supreme Court’s overturn of Roe. First, a study in the medical journal JAMA Pediatrics this week, found that in the first year abortion was dramatically restricted in Texas — remember, that was before the overturn of Roe — infant deaths rose fairly dramatically. In particular, deaths from congenital problems rose, suggesting that women carrying doomed fetuses gave birth instead of having abortions. What’s the takeaway from seeing this big spike in infant mortality?

Ollstein: So I’ve seen a lot of anti-abortion groups trying to spin this and push back really hard on it. Specifically picking up on what you just said, which is that a lot of these are fatal fetal anomalies. And so they were saying, “Were abortion still legal, those pregnancies could have been terminated before birth.” And so they’re saying, “There’s no difference really, because we consider that an infant death already. So now it’s an infant death after birth. Nothing to see here.”

Rovner: When everybody has suffered more, basically.

Ollstein: Yeah, that is the response I’m seeing on the right. On the left, I am seeing arguments that anyone who labels themselves pro-life should think twice about the impact of these policies that are playing out. And like you said, we’re only just beginning to get glimmers of this data. In part because Texas was out in front of everybody else, and so I think there’s a lot more to come.

The other pushback I’ve seen from anti-abortion groups is that infant mortality also rose in states where abortion remains legal. So I think that’s worth exploring, too. Obviously, correlation is not always causation, but I think it’s hard when you’re getting the data in little dribs and drabs instead of a full complete picture that we can really analyze.

Rovner: Well, in another JAMA study, this one in JAMA Network Open, they found that the use of Plan B, the morning-after birth control pill, fell by 60% in states that implemented abortion bans after the Dobbs [v. Jackson Women’s Health Organization] decision. Now, for the millionth time, Plan B is not the same as the abortion pill. It’s a high-dose contraceptive. But apparently, a combination of the closure of family planning clinics in states that impose bans, which are an important source of pills for people with low incomes who can’t afford over-the-counter versions, and misinformation about the continuing legality of the morning-after pill, which continues to be legal, contributed to the decline. At least that’s what the authors theorize. This is one of many ironies in the wake of Dobbs; that states with abortion bans may well be ending up with more unintended pregnancies rather than fewer.

Ollstein: Well, one trends that could be feeding this is that some of the clinics where people used to go to to access contraception, also provided abortion and have not been able to keep their doors open in a post-Roe environment. We’ve seen clinics shutting down across the South. I went to Alabama last year to cover this, and there are clinics there that used to get most of their revenue from abortion, and they’re trying to hang on and provide nonabortion gynecological services, including contraception, and the math just ain’t mathing, and they’re really struggling to survive.

And so this goes back to the finger-pointing within the movement about where money should be going right now. And I know that red state clinics that are trying to survive feel very left behind and feel that this erosion of access is a result of that.

Kenen: Julie, and also to put in, even before Dobbs, it was not easy in many parts of the country for low-income women to get free contraception. There are states in which clinics were few and far between. Federal spending on Title X has not risen in many years.

Rovner: Title X is a federal [indecipherable].

Kenen: Right. Alice knows this, and maybe I’ve said on the podcast, I once just pretty randomly with me and my cursor plunked my cursor down on a map of Texas and said, “OK, if I live here, how far is the nearest clinic?” And I looked at the map of the clinics and it was far, it was something like 95 miles, the nearest one. So we had abortion deserts. We’ve also had family planning deserts, and that has only gotten worse, but it wasn’t good in the first place.

Rovner: Well, finally, and for those who really want to make sure they don’t have unintended pregnancies, according to a study in a third AMA journal, JAMA Health Forum, the number of young women aged 18 to 30 who were getting sterilized doubled in the 15 months after Roe was overturned. Men are part of this trend, too. Vasectomies tripled over that same period. Are we looking at a generation that’s so scared, they’re going to end up just not having kids at all?

Kenen: Well, there are a lot of kids in this generation who are saying they don’t want to have kids for a variety of reasons: economic, climate, all sorts of things. I think that I was a little surprised to see that study because there are safe long-acting contraceptives. You can get an IUD that lasts seven to nine years, I think it is. I was a little surprised that people were choosing something irreversible because.. I do know young people who… You’re young, you go through lots of changes in life, and there is an alternative that’s multiyear. So I was a little surprised by that. But that’s apparently what’s happening. And it’s for… This generation is not as… What are they, Gen[eration] Z? They’re not as baby-oriented as their older brothers and sisters even.

Knight: Well, that age range is millennial and Gen Z. But I don’t know. I’m a millennial. I think a lot of my friends were not baby-oriented. So I think that’s probably a fair statement to say. But it is interesting that they wouldn’t choose an IUD or something like that instead. But I do think people are scared. We’ve seen the stories of people moving out of states that have really strict abortion bans because they are so concerned on what kind of medical care they could have, even if they think they want to get pregnant. And sometimes you don’t have a healthy pregnancy and then need to get an abortion. So I’m sure it has something to do with that but…

Rovner: Yeah, it’s one of those trends to keep an eye out for. Well, moving on, U.S. Surgeon General Vivek Murthy has been busy these past couple of weeks. First, he published an op-ed in The New York Times calling for a warning label for social media that’s similar to the one that’s already on tobacco products, warning that social media has not been proven safe for children and teenagers. Of course, he doesn’t have his own authority to do that. Congress would have to pass a law. Any chance of that? I know Congress is definitely into the “What are we going to do about social media” realm.

Kenen: But talking about it and doing something or thinking, it’s a long way. Is this as, compared to his other topic of the week, which was gun safety? He’s got a lot more bipartisan …

Rovner: We’re getting to that.

Kenen: … He’s got a lot more bipartisan support for the concern about health of young people and what social media is. What is social media? Social media is mixed. There are good things and bad things, and what is that balance? There is a bipartisan concern. I don’t know that that means you get to the labeling point. But the labeling point is one thing. That the larger concept of concern about it, and recognition about it, and what do we do about it, is bipartisan up to a point. How do you even label? What do you label? Your phone? Your computer? I’m not sure where the label goes. Your eyelids? [inaudible 00:33:07]

Knight: Right. Well, tech bills in Congress in general are like… Even though TikTok was surprisingly able to get done in the House. But TikTok lobby was big. But there would be a big social media lobby, I’m sure, against that. I guess there is bipartisan support. I don’t know. It’s not something I’ve asked members about, but I think that would be pretty far off from a reality actually happening.

Rovner: Well, also this week, as Joanne mentioned, the surgeon general issued a Surgeon General’s Advisory, declaring gun violence a public health crisis, calling for more research funding on gun injuries and deaths, universal background checks for gun buyers, and bans on assault weapons and high-capacity ammunition magazines. I feel like the NRA [National Rifle Association] has lost some of its legendary clout on Capitol Hill over the past few years, thanks to a series of scandals, but maybe not enough for some of these things. I feel like I’ve heard these suggestions before, like over the last 25 or 30 years.

Kenen: I think one of the interesting things about Vivek Murthy is he came to public prominence on gun safety and guns in public health before people were really talking about guns in public health. I forgot what year it was — 2016, 2017, whenever Obama first nominated him. Because remember, this is his second run as surgeon general. It was an issue that he had spoken about and had made a signature issue, and as he became a more public figure before the nomination. And then he went silent on it. He had trouble getting confirmed. He didn’t do anything about it. We never really heard … as far as I can recollect, we never even heard him talk about it once. Maybe there was a phrase or two here or there. He certainly didn’t push it or make it a signature issue.

Right now, he’s at the end of the last year with the Biden administration. Some kind of arc is being completed. He’s a young man, there’ll be other arcs. But this arc is winding down and the president cares about gun violence. Congress actually did, not the full agenda, but they did something on it, which was unusual. And I think that this is his chance to use his bully pulpit while he still has it in this particular perch to remind people that we do have tools. We don’t have all the solutions to gun violence. We do not understand everything about it. We do not understand why some people go and shoot a movie theater or a school or a supermarket or whatever, and there are multiple reasons. There are different kinds of mass killers. But we do know that there are some public health tools that do work. That red flag laws do seem to help. That safe gun storage … There are things that are less controversial than a spectrum of things one can do.

Some of them have broader support, and I think he is using this time — not that he expects any of these things to become law in the final year of the Biden administration — but I think he’s using it. This is bully pulpit. This is saying, “Moving forward, let’s think about what we can come to agreement on and do what we can on certain evidence-based things.” Because there’s been a lot of work in the last decade or so on the public health, not just the criminal… Obviously, it’s a legal and criminal justice issue. It’s also a public health issue, and what are the public health tools? What can we do? How do we treat this as basically an epidemic? And how can we stop it?

Rovner: Finally this week, since we didn’t really do news last week, there have been a couple of notable stories we really ought to mention. One is a court case, Braidwood v. Becerra. This is the case where a group of Christian businesses are claiming that the Affordable Care Act’s preventive services provisions that require them to provide no cost-sharing access to products, including HIV preventive medication, violates their freedom of religion because it makes them complicit in homosexual behavior. Judge Reed O’Connor, district court judge — if that name is familiar, it’s because he’s the Texas judge who tried to strike down the entire ACA back in 2018. Judge O’Connor not only found for the plaintiffs, he tried to slap a nationwide injunction on all of the ACA’s preventive services, which even the very conservative 5th Circuit appeals court struck down. But meanwhile, the appeals court has come up with its ruling. Where does that leave us on the ACA preventive services?

Ollstein: It leaves us right where we were when the 5th Circuit took the case because they said that, “We’re going to allow the lower court ruling to be enforced just for the plaintiffs in the meantime, but we’re not going to allow the entire country’s preventive care coverage to be disrupted while this case moves forward.” And so that basically continues to be the case. Some of the arguments are getting sent back down to the lower court for further consideration. And we still don’t know whether either side will appeal the 5th Circuit’s ruling to the Supreme Court.

Rovner: But notably, the appeals court said that U.S. Preventive Services Task Force, which is appointed by the Department of Health and Human Services, is basically illegally constituted because it should be nominated by the president, approved by the Senate, which it is not. That could in the long run be kind of a big deal. This is a group of experts that supposedly shielded from politics.

Kenen: Yeah, I don’t think this story is over either. It is for now. Right now we’re at the status quo, except for this handful of people who brought recommendations on all sorts of health measures, including vaccination and cancer screenings and everything else. They stand. They’re not being contested at this moment. How that will evolve under the next administration and this court remains to be seen.

Rovner: Finally, finally, finally, to end on a bit of a frustrating note, the National Academies of Sciences, Engineering, and Medicine, has found that two decades after it first called out some of the most egregious inequities in U.S. health care, not that much has changed. Joanne, this has been a very high-profile issue. What went wrong?

Kenen: Well, I think this report got very little attention probably because it’s like, oh, reports aren’t necessarily news stories. And it was like nothing changed, so why do we report it? But I think when I read the report — and I did not get through all 375 pages yet, but I did read a significant amount of it and I listened to a webinar on it — I think what really struck me is how we’re not any better than we really were 20 years ago. And what really was jarring is the report said, “And we actually know how to fix this and we’re not doing it. And we have the scientific and public health and sociological knowledge. We know if we wanted to fix it, we could, and we haven’t. Some of that is needing money and some of it is needing will.” So I thought the bottom line of it was really quite grim. If we didn’t know how bad it was, if the general public didn’t know how bad it was, the pandemic really should have taught them that because of the enormous disparities, and we’re back on this glide path toward nothing.

Rovner: I do think at very least, it is more talked about. It’s a little higher profile than it was, but obviously you’re right.

Kenen: They didn’t say no gains in any… I mean, the ACA helped. There are people who have coverage, including minorities, who didn’t have it before. That was one of the bright spots. But there’s still 10 states where it hasn’t been fully implemented. It was a pretty discouraging report.

Rovner: All right, well, that is this week’s news. Now it is time for our extra-credit segment. That’s when we each recommend a story we read this week we think you should read, too. As always, don’t worry if you miss it. We will post the links on the podcast page at kffhealthnews.org and in our show notes on your phone or other mobile device. Victoria, why don’t you go first this week?

Knight: Sure. So I was reading a story in The New York Times about PBMs [pharmacy benefit managers]. It was called “The Opaque Industry Secretly Inflating Prices for Prescription Drugs.” It’s by Rebecca Robbins and Reed Abelson. And so it kind of is basically an investigation into PBM practices. It was interesting for me because I cover health care in Congress, and so it’s always the different industries are fighting each other. And right now, one of the biggest fights is about PBMs. And for those that don’t know, PBMs negotiate with drug companies, they’re supposed to pay pharmacies, they help patients get their medications. And so they’re this middleman in between everyone. And so people don’t really know they exist, but they’re a big monopoly. There’s only three of them, really big ones in the U.S. that make up 80% of the market. And so they have a lot of control over things.

Pharma blames them for high drug prices and the PBMs blame pharma. So that’s always a fun thing to watch. There actually is quite a bit of traction in Congress right now for cracking down on PBM practices. Basically, The Times reporters interviewed a bunch of people and they came away with saying that PBMs …

Rovner: They interviewed like 300 people, right?

Knight: Yes, it said 300.

Rovner: A large bunch.

Knight: Yeah, and they came away with a conclusion that PBMs are causing higher drug prices and they’re pushing patients towards higher drugs. They’re charging employers of government more money than they should be. But it was interesting for me to watch this play out on Twitter because the PBM lobby was, of course, very upset by the story. They were slamming it and they put out a whole press release saying that it’s anecdotal and they don’t have actual data. So it was interesting, but I think it’s another piece in the policy puzzle of how do we reduce drug prices? And Congress thinks at least cracking on PBMs is one way to do it, and it has bipartisan support.

Rovner: And apparently this story is the first in a series, so there’s more to come.

Knight: Yes, I saw that. Yeah, more to come, so it’ll be fun. I also just noticed as I was just pulling it up on my phone and they had closed the comment section. It was causing some robust debate.

Rovner: Yes, indeed. Joanne?

Kenen: I should just say that after I read that story in The Times that same day, I think I got a phone call from a relative, a copay that had been something like $60 for 30 days is now $1,000. And this relative walked away without getting the drug because that’s not OK. So anyway, my extra credit [“Social Security To Drop Obsolete Jobs Used To Deny Disability Benefits,”] is from The Washington Post. Lisa Rein posted an investigation a couple of years ago, and this was the coda of the Social Security Administration finally followed through on what that investigation revealed. And Lisa wrote about the move, how it’s being addressed. That to get disability benefits, you have to be unemployable basically. And the Social Security Administration had a list of … it’s called the Dictionary of Occupational Titles. It had not been updated in 47 years. So disabled people were being denied Social Security disability benefits because they were being told, well, they could do jobs like being a nut sorter or a pneumatic tube operator or a microfilm something or other. And these jobs stopped existing decades ago.

So the Social Security Administration got rid of these obsolete jobs. You’re no longer being told, literally, to go store nuts. If you are, in fact, legitimately disabled, you’ll now be able to get the Social Security disability benefits that you are, in fact, qualified for. So thousands of people will be affected.

Rovner: No one can see this, but I’m wearing my America Needs Journalists T-shirt today. Alice?

Ollstein: I chose a piece [“Opioid Deaths Rose 50 Percent During the Pandemic. in These Places, They Fell”] by my colleague Ruth Reader, about a county in Ohio that, with some federal funds, implemented all of these policies to reduce opioid overdoses and deaths, and they had a lot of success. Overdoses went down 20% there, even as they went up by a lot in most of the country. But bureaucracy and expiring funding means that those programs may not continue, even though they’re really successful. The federal funding has run out. It is not getting renewed, and the state may not pick up the slack.

So it’s just a really good example. We see this so often in public health where we invest in something, it works, it makes a difference, it helps people, and then we say, “Well, all right, we did it. We’re done.” And then the problems come roaring back. So hopefully that does not happen here.

Rovner: Alas. Well, my extra credit this week is from The Washington Post. It’s called “Masks Are Going From Mandated to Criminalized in Some States.” It’s by Fenit Nirappil. I hope I’m pronouncing that right. In some ways, it’s a response to criminals who have obviously long used masks, and also to protesters, particularly those protesting the war in Gaza. But it’s also a mark of just how intolerant we’ve become as a society that people who are immunocompromised or just worried about their own health can’t go out masked in public without getting harassed. The irony, of course, is that this is all coming just as covid is having what appears to be now its annual summer surge, and the big fight of the moment is in North Carolina where the Democratic governor has vetoed a mask ban bill, that’s likely to be overridden by the Republican legislature. Even after covid is no longer front and center in our everyday lives, apparently a lot of the nastiness remains.

All right, that is our show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcast. We’d appreciate it if you left us a review. That helps other people find us, too. Special thanks as always to our technical guru, Francis Ying, and our editor, Emmarie Huetteman. As always, you can email us your comment or questions. We’re at whatthehealth@kff.org, or you can still find me at Twitter, which the Supreme Court has now decided it’s going to call Twitter. I’m @jrovner. Alice?

Ollstein: I’m @AliceOllstein on X.

Rovner: Victoria?

Knight: I’m @victoriaregisk.

Rovner: Joanne?

Kenen: I’m at Twitter, @JoanneKenen. And I’m on Threads @joannekenen1, and I occasionally decided I just have better things to do.

Rovner: It’s all good. We will be back in your feed next week. Until then, be healthy.

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