(lively music) - When Amy Nunn speaks, you can still hear more than a hint of her Little Rock, Arkansas roots.

But when it comes to promoting public health, there are few people who are more immersed in Rhode Island.

Nunn is a professor at Brown University's Medical School and Brown School of Public Health.

She leads an institute that wrestles with thorny healthcare issues and she's the CEO of Open Door Health, the state's first health clinic for the LGBTQ+ community.

Now there's a new threat to public health.

Advocates are wrestling with research cuts from the Trump administration and trying to decide how to respond to what they see as dangerous ideas from the Make America Healthy Again movement.

So how does Nunn see the way forward?

What would it take to truly make Americans healthier?

And is it even possible to diminish the influence of the pharmaceutical industry.

I'm Ian Donnis, and that's just some of what we talked about in this in-depth conversation.

(lively music ending) Amy Nunn, welcome to "One on One."

- Thank you.

- You wear a lot of hats related to public health.

Take us back to the beginning.

How did this become the focus of your life's work?

- My background in training around global health, and I was actually working overseas in Guatemala, working on some environmental issues, and I saw that what women really wanted was family planning.

Guatemala has some of the highest fertility rates in Latin America, and I had decided at that point that I wanted to go into public health to work on reproductive health for women.

I'm a big advocate for women's rights, and that's how I got my start in public health, and kind of a long meandering path.

But that was how I got here in the first place.

- As we talk here now, there's a fierce fight playing out over the future of public health in the the United States.

You've witnessed this personally with the cancellation and later reinstatement of a federal grant on a study to slow the spread of HIV.

Bring us up to speed.

How do things stand now on how the Trump administration is affecting public health here in Rhode Island?

- Well, I think we're all really concerned.

For example, right now the government shutdown has affected a lot of things in public health.

We're on the precipice of having really steep increases in premiums for people who buy their insurance on the exchange through the Affordable Care Act or as a result of the Affordable Care Act.

A lot of people are not sure whether or not they will receive their full SNAP benefits.

So there are a lot of things affecting public health right now.

I think also we're concerned about reimbursement rates for Medicaid and their future here and trying to get them on par with our neighboring states of Massachusetts and Connecticut.

That's another big public health challenge.

So I think there are a lot of things, the federal level that are affecting our healthcare climate here as well.

- What can advocates like yourself and state leaders do to try and counteract some of what you're talking about and to minimize the effect on Rhode Islanders?

- Well, I think I really admire what Judge McConnell has done and also the Attorney General.

- Judge McConnell's the federal judge who said that the federal government has an obligation to pay for the food assistance program known as SNAP.

- Correct, among many other cases.

He's also the judge who has been leading the way on some of the efforts to bring federal resources back after they were abruptly terminated.

And I think also our attorney general has been very outspoken locally and at the federal level about the catastrophic impacts on our healthcare system.

So I think those are a few leaders that I really admire and look up to right now.

One of the things that we try to do at the Public Health Institute is help educate people about what's happening to make some of these complex issues more readily understandable for the average person.

- And to follow up on what you're saying about making it understandable to the average person, how would you describe in human terms how you expect Rhode Islanders to be impacted by some of what you described?

- Well, I think the impacts of the SNAP assistance program will be nothing short of catastrophic.

People will be going hungry.

There's also the potential to really bankrupt our food banks and emergency support systems.

We're all really concerned about it.

And I think there are also some other things happening in the health system that probably will affect people's ability to get medical care, both in inpatient systems at the hospitals, as well as in primary care settings.

- Is this to the degree that people will be experiencing more disease or more deaths even if things play out the way they're headed?

- I think so.

I think we'll be relying on our emergency systems a lot more and that's something we're really concerned about.

So both morbidity, which is what we in public health refer to as, you know, people's disease, and then mortality or, you know, preventable deaths.

Those are things that we're really concerned about.

- If things are this dramatic less than a year into the second Trump administration, how do you expect the public health landscape to be different by the time President Trump completes his time in office?

- Well, I'm really nervous about that.

I think we may not be able to rely on the federal government at this time.

We can't go without the federal government, but it's a time for our state leaders to really lean in and step up to the plate to fill some of these gaps and also to demand accountability I believe from the federal government as well.

- Anti-vaxxers played a role in the rise of President Trump's Health and Human Services Secretary Robert Kennedy Jr., and the so-called Make America Healthy Again movement.

If vaccines are overwhelmingly safe and effective as people like you maintain, why did this significant group of Americans come about who don't believe that?

- Well, it's kind of alarming what's happening that there is a movement that is anti-science.

That is something that's pretty new.

And we have been shocked with how that has confused so many people.

They've been very effective at sowing seeds of doubt through the popular and conservative media.

And one of the reasons that I'm here today and that we've been really outspoken is to reassure people that a lot of the things that are grounded in generations of scientific evidence are in fact safe.

You know, we've been really outspoken about the importance of vaccines, particularly for children and older adults.

So a lot of this has been focused on children, but it's also really important for older adults to get vaccinated, for example, for shingles, pneumonia, a few other things as well.

And those are things that are real threats to health and wellbeing.

- Conservative critics say the federal government and state governments in blue states were way too heavy handed in responding to the pandemic with various mandates and dictates.

Do those governments bear any responsibility for the kind of skepticism and reactionarism we've seen in response to healthcare?

- Well, my personal belief is that it's not really productive to place blame.

I think what we can do is look back and learn.

And I was a vocal supporter of vaccine mandates myself.

What I've learned though is that turns off a lot of people.

And so rather than talk about mandates, I like to talk about what I would do.

The physicians that work at our clinic talk about what they would do, what they would counsel their patients to do and their families to do.

And that's probably a more effective way to communicate with people and that's something that we learned.

I think the other thing is we might have been a little bit too tough on some of our public health leaders at that time.

I think people were pretty critical about the COVID response at the federal level, but there were a lot of triumphs.

I mean, we've never brought a vaccine to market any quicker than that.

And the fact that we were able to bring vaccines to market in such record time is unprecedented in scientific history.

The community may have been a little too heavy handed with the criticisms, and if people knew how much time and money it usually takes to bring a vaccine to market, they might have been a little bit less critical.

Usually it takes at least a decade and sometimes longer to bring a vaccine to market.

So the fact that we were able to do that is pretty incredible, and to vaccinate most Americans that wanted to get vaccinated and really the world, that was a scientific triumph.

And I think that's one of the reasons why President Trump touts that as one of his greatest achievements.

Although he's walked that back a little bit, it was something that he used to tout as a big success.

- Do you agree that that was a significant achievement for President Trump?

- I do.

I think it was important to bring those vaccines to market.

It would've been better had it not been surrounded by such convoluted messaging about other things that weren't grounded in any scientific evidence.

But the fact that they were able to do that I think was a great thing.

- We talked a little earlier about vaccine skepticism and the anti-science movement.

We live in an age of social media.

There've always been conspiracy theories, but social media has put conspiracy theories on steroids.

How do people like you, who believe in science, counteract that in this day and age beyond doing interviews like this one?

- Well, we try to put our messages out in a variety of different ways.

For example, our communications team communicates differently with older adults than we do with younger folks.

We do put out a ton of messages on social media that are often a little more fun and playful that are really focused on people under the age of 35.

And when we want to reach older adults, we often put out our messages on television and through more traditional ways.

And that's because people consume media differently.

So you have to think about the audiences you're going to reach with the different messages and who needs what messages, and then pivot accordingly.

- You are the CEO of Open Door Health, which opened five years ago as Rhode Island's first health clinic for the gay, lesbian, transgender, queer+ community.

What difference has the presence of that clinic made for that community?

- Well, we serve about 7,000 patients and we're on the West Side.

I think that we provide affirming services.

I think that's more important now more than ever because the LGBTQ community has been paralyzed with fear as a result of all of the discriminatory messages that are in the media in this day and age, and all of the explicit discriminatory messages that people experience every day.

We have a new behavioral health services program that is focused on that community.

It has also received a lot of support from local foundations.

I think that has filled gaps that existed.

We also have a walk-in STD service that's one of the only ones in the state I think.

It's designed to eliminate barriers to care, like long lines.

So you can make an appointment, but you can also walk in, and that's open five days a week.

And STD rates are often higher among the people that we serve.

And we aim to make those services more accessible and friendly to that community.

We also have an HIV prevention program and an HIV care program.

One of the things that's happened in the last decade is that STD rates have skyrocketed, and there need to be services that make screening and treatment readily accessible that have few barriers.

You know, anyone who's tried to go to the doctor in 2025 knows that it's not as easy as it used to be because there is so much demand on the health system.

And we pride ourselves in making services accessible to all folks.

- On a related note, we saw how President Trump last year used transgender issues as a wedge issue against Kamala Harris.

I think it's not just hard right conservatives who have some anxiety about the idea of, you know, for example, their daughter being in a bathroom or competing in youth sports with a person who is born as a different gender.

Do Democrats need to find a different way of talking about this issue?

- Probably.

I think that this is a really kind of a non-issue that has been blown out of proportion.

The health risks associated with co-mingling with transgender people are zero.

And so I think that the real public health issue is the overwhelming amount of anxiety that stems from open discrimination towards people that I don't think that we've seen really since the Civil Rights Movement in the United States.

So that's something that we're really concerned about is that discrimination has been socially normalized.

And we believe that we have a moral obligation to protect the rights of all persons, including immigrants, people of color and LGBTQ persons.

There are no health risks associated with socializing or playing sports with transgender folks.

It's just ridiculous.

- I hear you calling this the politicization of a non-issue, but if it helps a candidate like Donald Trump to win an election, and that results in less financial support for the kind of healthcare practices that you champion, it seems like your side of the ledger has to figure out how to respond.

What do you say about that?

- Well, I think we will need community support by being here and talking about it openly.

I am sending a signal that we will affirm the dignity of all persons, including transgender persons, and we will stand by that.

We hope that if we experience funding cuts because of that, that we receive some support from the community for taking a bold stance in defending the civil rights of all persons.

And that's just, we've taken a line on that and we intend to stick with that.

- You had an opinion piece in The Boston Globe recently, you co-wrote with two colleagues about GLP-1s.

These are the products like Ozempic and Wegovy that some people are using to lose weight.

And you argue for using this as part of a larger strategy to help people fight obesity.

You're saying that Rhode Island should help to purchase these drugs in bulk and you're looking to the pharmaceutical industry to accept lower profit margins to make that happen.

It seems like pharma's probably pretty unlikely to go along with that.

Am I wrong about that?

- Well, I think if it were Rhode Island acting alone, probably, but if we were to band together with big states like California, Florida and Texas or New York, the heavyweights, I think that we could consider some bulk purchasing agreements.

There's precedent for this with a variety of different medications.

The Veterans Administration does it.

They bulk purchase their medications.

Also we've done it with hepatitis C medications.

We joined a consortium to bulk purchase hepatitis C medications for Medicaid patients.

So it's not unprecedented.

There are two things here.

One is the price of the medications, which are about $1,500 a month, between let's say 750 and $1,500 a month.

But the part that's so important, it's the number of people who need them.

So it's the scope of the problem.

I think we need to have honest and candid conversations about the impact of the medications on our health insurance premiums.

So whether or not you're on the medications or not, this is affecting the cost of your healthcare.

So we have to deal with this in order to deal with our primary care crisis.

We need to have bulk purchase agreements with both private insurers, as well as Medicaid.

And we have to have a conversation about it.

The conversation should not be that we're going to ration the medications.

The medications are very important to address obesity, but we need to kind of shift the conversation to talk about what is causing the problem, and to have solutions that address the cause of the problem.

The solution should not be rationing these medications because they're so effective, and so many millions of Americans need them.

- What does that tell us about healthcare in the United States?

That this is a product that, at least in the short term, is proving very effective for people with an important public health need, but the cost is a lot and that because of that, there is the possibility of rationing.

What does that tell us about how healthcare works in the United States or doesn't work?

- Well, I think that the pharmaceutical industry has too much control over drug prices.

In Europe, and in every other industrialized country of the world, there are policies to address this, bulk purchase agreements and also price controls.

Even our neighbors, you know, Canada.

And so we've got to change the conversation.

We do not have to accept exorbitant prices.

We need to declare a public health emergency.

There are also ways this could be addressed that have worked in global health.

For example, there were similar problems with the cost of HIV medications around the year 2000 and 2001, and by negotiating with pharmaceutical companies, several developing countries were able to get tremendous price reductions, and agreements called voluntary and compulsory licenses that allow third parties to produce the medications with or without the patent holder's consent.

So until we have conversations like that, these medications are gonna be holding the whole health system hostage.

So it's time for us to start thinking about these big problems in different ways, not just wringing our hands and lamenting their costs, but we've gotta really think nationally about how we're going to enhance access to these game-changing medications.

- As it stands, Amy Nunn, we see how US spending on healthcare tops about $6 trillion in 2023.

That's about $15,000 per capita.

I would imagine that you think we're not really getting a good bang for the buck for all that.

- Well, it depends on how you look at it.

I think a lot of people get extraordinary healthcare, but the access remains far too inequitable.

I think in Rhode Island, one thing that I'm really proud of as a Rhode Islander is that most people have insurance.

You know, I'm from the Deep South originally, I'm from Arkansas where a lot of people go bankrupt because they can't afford their healthcare or they go without important services.

And in Rhode Island, we have such fantastic insurance coverage.

So we're blessed here.

I think our local system has a lot of other crises, but at least most people do have health insurance.

- Another one of the issues here in Rhode Island is a lack of primary care doctors.

The state has started trying to come to terms with this a little bit.

A big part of the challenge is how reimbursement for insurance is less than in our neighboring states of Connecticut and Massachusetts.

But the legislature has been looking at the possible creation of a med school at the University of Rhode Island.

Do you think that's a good way of trying to get at this shortage of primary care doctors?

- I think there are a lot of things that we can and should do, and I think that's a great step.

I'm very supportive of educating more physicians.

We have a shortage and we need a state investment in training more physicians, but not just physicians, also physician's assistants and nurse practitioners could step in to fill the void.

And I think having a medical school that takes that on is an important part of the solution.

- Another big issue here in Rhode Island is troubled hospital finances.

There's a lot of uncertainty right now about the future of Roger Williams Medical Center in Providence and Our Lady of Fatima Hospital in North Providence.

The nonprofit foundation based in Atlanta that's trying to acquire them has struggled to close its financing.

Hence there's a lot of uncertainty.

Do you have any confidence that these hospitals will be able to continue operating into the future?

- I sure hope so because it has a huge impact on the rest of the health system.

First of all, I think there are about 50,000 emergency room visits to those hospitals.

They also have large number of behavioral health beds, I think the second largest in the state, some other really important subspecialty services, and they are part of the fabric of our community.

For those reasons alone, it's important.

But also, if those hospitals close, the patients that we're seeing there will need somewhere else to go.

So it will potentially clog up our entire system if we don't address this.

It will affect primary care, it will affect emergency rooms across the state, and they are too big to fail.

The public health consequences are too grave for us to ignore this.

So there needs to be, I believe, a candid conversation with state leaders about this.

This crisis has the potential to affect healthcare across the entire state, and we can't ignore it.

- As you said earlier, some people get great healthcare in the United States.

At the same time, there are other threats to public health, obesity, there's said to be a crisis of young men and how they are maturing.

How does the public health of Rhode Islanders compare now in 2025 to 20, 30, 40 years ago?

What's your sense of that?

- Well, we're certainly a lot fatter and we have a lot more inequity.

But if you look at where we fare nationally, we do pretty well.

We are more healthy than average.

We are less obese than a lot of other states.

So you know, we fare pretty well.

Areas where we have some big challenges are with pediatric obesity.

Believe it or not, our pediatric obesity rates are on par with that of the southern United States.

And that is because we have a crisis with pediatric obesity with our Hispanic kids, and that's something that I worry about a lot.

We also have higher rates of lead poisoning because of our housing stock and poor enforcement of our laws about lead paint remediation.

We also have very high rates of addiction.

And so those are some of the places where I think we need to lean in.

We've also got a primary care crisis.

So while we're healthier than average, I still think we have a lot of work to do and I think we need to shore up some of our challenges with access to primary care in Rhode Island.

- Amy Nunn, thank you so much for sitting down to talk.

- Thank you.

- Thanks for watching "One on One" with me, Ian Donnis.

You can find all of our past interviews on Ocean State Media's YouTube channel.

We'll see you next week.

(lively music) (lively music continues) (lively music continues)