Today’s world can often feel cruel, chaotic, and morally adrift. When you see millions at risk of losing health insurance for no justifiable reason, or watch women denied essential care because of political malfeasance, despair feels like a rational response. And yet, amid the noise and injustice, there are those who refuse to give in, people who continue, day after day, to build a more equitable, inclusive, and humane world. One of those people is Dr. Chelsea Clinton.
In a world consumed by so many crises, it’s always instructive to study how changemakers approach problems. I was struck by Chelsea’s service orientation and fearless optimism that things can be better. As vice chair of the Clinton Foundation, she has emerged as a leading health advocate, focusing on early childhood development, global health equity, and maternal mortality. In this edition of “Good Medicine,” we explore how Chelsea is applying the lessons from her unique life to the public health issues of our time. I spoke with her days after the Trump administration rescinded Biden-era EMTALA guidance, muddying federal protection for emergency abortion care. We ranged from her Good Friday Agreement thesis at Stanford to her motivations to enter public health to her kids’ current musical playlists. And perhaps most importantly, she told me why she believes optimism, powered by data and outcomes, is our way forward.
Her path to public health
As the daughter of a former president and Secretary of State, it’s quite obvious that policy always permeated Chelsea’s surroundings. But I was curious about what specifically got her interested in public health. I imagined beforehand perhaps a chance meeting with a CDC director or NIH leader, but it was a Nightly News story back in 1991. Her dad was running for president and she, all of eleven years old, was stuffing envelopes in the Little Rock campaign office. As she turned her attention to the TV, the news of Magic Johnson’s HIV diagnosis was being broadcast by Tom Brokaw. As I’m sure you remember, this was monumental news at the time. People living with HIV/AIDS suffered from intense societal ostracization, and Magic’s announcement was disorienting for many. Chelsea remembers being “curious why the broadcaster had framed this story initially in courage. Why was there something about Magic Johnson’s health that required him to be brave? It was intellectual and also an emotional reaction. So I got really interested, although I couldn’t have articulated it using this vernacular at the time, in stigma and also in HIV and AIDS and in what we were doing to try to help people, [but also asking] what was treatment? What was prevention? Those types of questions formed the through lines to the work that I’m privileged to be part of every day across the Clinton Foundation and the Clinton Health Access Initiative.”
Fast forward to her time in college at Stanford, she read the legendary Paul Farmer’s book “Infections and Inequalities,” a seminal text on global health inequities. (For those interested, I highly encourage you to learn more about Paul Farmer and his work through Partners in Health, as it is deeply inspiring.)
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She wrote to him after reading that book and he soon became a close mentor, thus deepening her interest in public health and health equity. This came in handy when her dad asked her what he should do in his post-presidential life, to which she replied that much more work needed to be done on HIV/AIDS and that he should speak with Paul Farmer. Thus began the Clinton HIV AIDS initiative, which has subsequently transformed into the Clinton Health Access Initiative, a program that has helped countless lives around the world.
Confronting the maternal mortality crisis
When it comes to her big focus on maternal health, the five-alarm fire that is our maternal mortality statistics prompted her to get involved. She often cites a shocking number that should give everyone pause: A mother today is 50 percent more likely to die in childbirth than a generation ago. And these deaths are largely preventable. Racial disparities compound this problem; for example, a Black woman is three times more likely to die during childbirth than a White woman. And in New York City, a place with such an immense concentration of wealth, power, infrastructure, and human capital, it’s nine times. Determined to change this, Clinton has become a core partner in New York City’s Birth Equity initiative, convened by the mayor and health departments. Her foundation is helping bring together a coalition of hospitals, community groups, and government agencies to tackle the social determinants of health that undergird these troubling statistics.
Lessons from the Good Friday Accords
I happened to unearth an old thesis Chelsea wrote while at Stanford on the Good Friday Accords, the landmark agreement that brokered peace in Northern Ireland. (And thanks to Chelsea for being a good sport here, as I would have struggled to remember my college thesis with any clarity.) The Good Friday Accords represented a painstaking multi-party negotiation, and I was curious what she took from that research that we might apply to our fractious political climate. As she reflected, she first highlighted the adage that “you don’t make peace with your friends,” which underscores how any negotiation must understand how the perspectives of the involved groups are shaped by history, grievance, personalities, and more. Her big takeaway though was the “fierce focus on the future, which I found quite profound and is something that I think about often these days. And one of the things I’ve always learned from my parents is the belief that tomorrow really can be better, and that’s not just something on a Hallmark card, but this deep sense of the moral choice of optimism in action.” I found this reframing of optimism, as a deliberate moral choice, profoundly moving. We often warp it to mean sunny thinking, yet true optimism is something deeper, a fierce act of hope, a quiet defiance against despair. It’s also maybe the essential ingredient to tackling humanity’s hardest challenges.
The new EMTALA confusion
Just before our conversation, the Trump administration had injected fresh confusion around the care of pregnant patients that show up in need of emergency medical care. To back up, CMS under the Biden administration had offered guidance that if a pregnant woman was experiencing an emergency, an abortion as a stabilizing treatment could and should be offered. This had been the standard for decades but really did not need affirmation until states like Texas began to ban abortions after six weeks of pregnancy. The Trump administration decided to rescind this guidance, thus creating widespread panic and unease among health care providers. Chelsea, though, urged us to remember that “EMTALA is the rule of the land. It is the law. So despite the Trump administration rescinding the Biden-era guidance, federal law protects emergency room doctors and other emergency room providers to be able to provide the necessary urgent care that anyone would need who walks in the door. But [for women who need abortion care] for whatever kind of reason of medical distress, providers are protected, legally protected and actually legally required to provide that care. And whatever the Trump administration may say, it doesn’t change what the original EMTALA, the Emergency Medical Treatment and Labor Act, has maintained for many, many years.”
She’s of course right. But the administration has succeeded at making providers in certain states think twice before providing emergency reproductive care. “This administration is very good at confusion. They’re very good at the constant injection of different rules or executive orders or interpretations, different ‘alternative facts’ to bring back a term of art from the first Trump administration. And that confusion is done with real clarity and harmful intent to create the chaos of needing to constantly absorb the information and sort out what is true and is not true. So I certainly have enormous sympathy for anyone who’s trying to navigate through that.” She believes that part of the solution is communication. “I think everyone who understands [the law], particularly the lawyers, need to be speaking with their megaphones to reassure hospitals, doctors, nurses, that the law of the land hasn’t changed and that not only are they still able to provide the care that they know patients need, but they are mandated by law to provide that care in emergency rooms.”
Real-world consequences: the Zurawski case
When I asked her about the real-life repercussions of state and federal restrictions on women’s health care, she reminded me about the case of Zurawski v. Texas. Amanda Zurawski is the lead plaintiff suing Texas for failure to provide timely, medically indicated abortion care.
“In Amanda’s instance, she was multiple days into sepsis before doctors felt like she was at the brink of death. And then they finally were legally protected under Texas law to intervene and save her life. Her experience, though, compromised her fertility. How could anyone claim that that was a pro-life stance in practice?” Amanda’s experience in Texas mirrors others in Georgia who “were told that they needed to wait until they were sick enough such that the providers felt like they had legal protection to intervene and just practice medicine.” Some of the women even died in these cases.
As if that weren’t bad enough, she added: “We also now know from Texas and Georgia that data around maternal health and mortality is either no longer being collected or no longer being shared. And so it will be harder to have public scrutiny. We are not able to see how many women are being harmed and possibly losing their lives because of these deeply draconian, unscientific, non-medical-based, ideologically-driven laws that are, despite what the lawmakers tell you, with exceptions to save a mother’s life, are not adequately saving mothers’ lives. And we now have painfully a death toll that attests to that.”
When I asked how we could support frontline physicians facing these circumstances, she told me about the amazing power of support from communities. “There are lots of people in these states who are providing just the solidarity of community. I’ve heard from providers how much it means to them when they hear from patients, but also when they just hear from the people they might see in the grocery checkout line, or at church, or at a soccer match, that their fellow community members know that it’s really hard.” Chelsea also mentioned opportunities to support legal defense funds. For example, the “Center for Reproductive Rights is doing a lot to challenge these laws and also prepare to defend providers. And then there are also many state level efforts to help provide legal resources to providers.” She also encouraged doctors to get involved with their state medical societies and boards to advocate for better legislation. For example, doctors can help “provide clarity around what exceptions should be, must be, given all that we now have learned about how ineffective they are in actually protecting women, protecting patients and protecting providers.”
On the threats to health research and public health
Like many in public health, Chelsea has been taken aback by the scale of cuts in our health infrastructure that have been implemented by the Trump administration (the proposed 2026 budget has a shocking 40 percent reduction in NIH spending). She went on to laud the incredible scientists at the NIH and their current predicament. “The brave NIH scientists recently published a letter criticizing the administration’s cuts in public health research and also made it clear that for all of the narrative around free speech and not being able to like speak your mind, that is not the way they feel within the NIH when trying to reach leadership either at the NIH or the HHS level, especially when they try to explain to Trump administration appointees the real value of their work and the real academic rigor and intellectual integrity behind how grants are assessed and then ultimately funded.” (This is a topic I discussed with Bobby Mukkamala of the AMA recently as well.)
While we can all hope these will all be reversed eventually, Chelsea reminded me that “even if all the funding came back, the months of research loss that we’ve already incurred will have effects for years to come. For example, the work that was stopped on studying the different ways in which Alzheimer’s expresses in women versus men, it will be very hard to restart that work and certainly will take years to get it back to where it was when the funding was halted. This all equates to money that won’t be going into frontier cancer research, that won’t be going into neurology, HIV/AIDS, cardio-metabolic health, etc.” On top of this, this activity will hurt the supportive architecture that is fundamental to our research ecosystem. “And it’s not only about what we’re not discovering to help make us healthier [but think about] all the companies and jobs that could be created out of that research. And of course, the medicines and the therapies and yes, also the vaccines that could be created. When I think about any of that and then when I think about what all of that can mean for our future, it certainly seems to me that we are actively depreciating our future and undermining what historically I would argue has helped make America great.”
“And I really worry about all of this being catastrophic broadly, but particularly harmful to women and women’s health research. Because we know that women’s health research has already been disproportionately frozen through the various kinds of stop-work orders. We know that the Trump administration is looking to get rid of multiple offices, some of which have existed for generations that are specifically oriented to understanding women’s health and women’s lives, whether it’s the Women’s Bureau in the U.S. Department of Labor or the more recent Women’s Health Initiative constituted under the Biden administration. So things that literally existed for more than one hundred years or even a few years, but all of which clearly had very clear purpose and logic to help us understand the health and wellbeing of women. We’re squandering all of that.”
Medicaid is another casualty in the Big, Beautiful Bill as well. (In a sad alchemy of chutzpah and moral cowardice, some of the same senators who voted for this bill want to now reclaim some of the lost Medicaid funding.) Estimates indicate 10 million people are likely to lose insurance (1.5 million in New York alone) as a result of this bill. And as Chelsea mentioned, these cuts will have “a catastrophic impact on rural hospitals” and any hospital that serves disproportionately low-income populations, who will have to eliminate certain services or close altogether. And it’s not just loss of Medicaid revenue; it’s also increased costs. Uninsured people still get sick, even if the Trump administration wants to pretend otherwise, and so their treatments are provided as uncompensated care that must be morally and legally provided by emergency rooms. As a brain tumor surgeon, I have seen firsthand the positive effects that Medicaid expansion has had on people who would otherwise be uninsured. For example, cancer care is a multi-disciplinary, diagnostically and therapeutically intensive journey that requires active and continuous surveillance; it simply cannot be provided in emergency settings alone. Medicaid has been crucial to ensuring that people receive the care they rightly need and deserve. When it comes to maternal health, Chelsea agrees that Medicaid has an important role to play in helping to reduce maternal mortality. For example, she would recommend that all pregnant women be presumptively eligible for Medicaid so they can easily and quickly get all their pregnancy and perinatal care, without insurance hassles getting in the way.
As we closed our conversation spanning maternal mortality, reproductive rights, and the gutting of public health infrastructure, I kept thinking of Paul Farmer’s words: “The idea that some lives matter less is the root of all that’s wrong with the world.” It’s a truth that reverberates through every statistic and every story she shared. And in Chelsea’s work, you see the antidote: a fierce insistence that every life, everywhere, deserves dignity and care.
One of my biggest takeaways though was Chelsea’s reframing of optimism, not as a mood or mindset, but as a moral choice. Real optimism is neither naive nor passive; it’s a deliberate stance that fuels action and drives change. Whether through advocacy, community solidarity, or simply refusing to cede the truth, each of us has a role in shaping a more just future. Optimism, then, isn’t a slogan, it’s the oxygen of change. And if we deliberately choose it together, tomorrow really can be better than today. Thank you, Chelsea, for that lesson.
Quick hits
Her magic policy wand to improve maternal mortality rates in America
“Restore, with stronger protections, full reproductive health access and choice in this country because we know there’s a very clear correlation between non-evidence-based policies that restrict a woman’s right to choose and a provider’s ability to provide care and rising rates of maternal mortality and morbidity.
So if I could choose one wand, I would choose that one. But if I have a few others, I would certainly ensure that every pregnant woman has a presumptive eligibility for Medicaid, which is currently not true, so that anyone who’s pregnant doesn’t have to worry about insurance coverage. I think we don’t do a good enough job, actually, of helping women understand the importance of prenatal visits. I think we need to really do a better job of that. And we need to make it easier for women who often do understand what they should be doing to be healthy in their pregnancies to make those healthy choices. Access to clean air, access to healthy food, access to paid leave, right? We’re ignominiously one of fewer than ten countries where that’s not true. So I think there’s a lot again that we know that works to protect pregnant women, some of which we talk about a lot these days, ensuring women have the right to choose and doctors have the ability to provide care. And some of which I don’t think we talk enough about, like actually ensuring that women who are thinking about getting pregnant or who may be newly pregnant understand the importance of going to see our providers, midwives, doctors during the course of our pregnancy.”
Most impactful mentor
Paul Farmer.
Book recommendations
Mystery novels. She recommends authors Barbara Nadel and David Housewright.
Intro music if there was a documentary about her
“All three of my children are obsessed with music in a wonderful way. They all play instruments. They all sing. My youngest son wants to be a rock star. Everything we listen to now is really led by them, and they have very eclectic taste. I have to get back and try to find that space as a parent where I can both appreciate all their tastes and rediscover what my taste is. Because right now my five-year-old who wants to be a rock star is obsessed with Beethoven and Bob Marley. And my eight-year-old is very fascinated by rock bands of every era. And then my daughter, probably like most ten-year-old girls, thinks the most important people in America are Taylor Swift and Beyonce. And so right now I think the intro music would need to be a mashup of all of that because that’s sort of the soundtrack to my life right now.”
Rohan Ramakrishna is a neurosurgeon.
