Episode 32: U.S. women spend more to get less from healthcare — Jo Lim of Babylon is using AI to change that

"Definitively Speaking" is a definitive healthcare podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us at definitivehc.com. Hello and welcome to another episode of "Definitively Speaking", the podcast where we have data-driven conversations on the current state of healthcare. I'm Justin Steinman, chief marketing officer here at Definitive Healthcare and your host for this podcast. AI is everywhere these days, you can't roll out a bed, pick up your iPad or turn on the TV without hearing somebody muse about the impact of ChatGPT or Google Bard or machine learning and how it's going to change the world. It's probably just a matter of time until Skynet takes over or we're all plugged into the Matrix. But not all AI is evil, particularly in healthcare and that's what our guest today on "Definitively Speaking" is here to talk about. AI has lots of amazing benefits for healthcare delivery, from reviewing standard radiology images that let radiologists practice at the top of their license to accelerating drug development to helping improve access to care. And it's that access that Jo Lim is here to talk with me about today. Jo Lim is the SVP of growth and engagement at Babylon Health. According to their website, Babylon Health has built the industry's leading AI-driven digital first primary service to manage population health at scale. Today, Babylon's technology and clinical services support a global patient network across 15 countries and its digital healthcare platform is capable of operating in 16 languages. Jo has been in healthcare for a long time across multiple continents, so she's got a unique global perspective on what's working and what's not in healthcare delivery. Before joining Babylon Health more than five years ago, she worked at Booz and Company where she consulted for large health systems and before that, she lived in England, where she worked inside the UK National Health Service Foundation Trust on a variety of topics. And somewhere in there, Jo got a master's degree in health policy and management at the Harvard TH Chan School of Public Health where she studied with my friend and colleague, Kate Shamsuddin Jensen, who's a chief product officer here at Definitive Healthcare, she's also on "Definitively Speaking" today. And so I'm happy to welcome both Jo and Kate to our latest episode, Jo, hello.

Hello.

Kate, hello.

Hello, thank you for the warm welcome.

We're happy to have you both here. All right, Jo, let's get started. What does it mean to manage population health at scale? I mean isn't population health at scale by definition.

Yes. I think population health by definition is already at scale. But what I would say at Babylon is that I think it's kind of greater than that, right? We can provide services to populations across the globe, you know, within the US for instance, we take, you know, we can take a population but say within a state, we could take anyone across the state. We're not kind of restricted by say the brick and mortar provider practice where you can reach say a radius of a certain distance of kind of people within that area. So I think we just have this level of scalability globally and kind of within a country or state.

Okay, so for our listeners out there, can you explain what population health is?

Right. So I would say population health is when you are taking care of a population of people and the way that you allocate your resources to support that population may be determined based on whoever might need it the most versus trying to provide care to everybody. So you're determining how you allocate resources in that way.

Got it and so, but then if you're working with population of 15 to 20,000 people, right, you really can't be selling to the independent physician practice, you've really gotta work with a large health systems, correct?

Well actually we're working with the payers.

Okay.

So what I'm saying is we take risk or financial risk for a population, so say, so I think what we do is we are a virtual primary care provider that essentially can be like any other provider practice, but it's all virtual, right? So think of a large IPA or provider practice. We will contract with the payer and take risk for a population.

Got it. That's helpful. But so virtual primary care is hot these days. I mean everybody and their mother, I feel like, starting a virtual primary care practice, from the old school Teladoc to my friends at Amwell, to my friends at CVS, what are you doing that's different?

So I think that what we're doing differently is that we have really integrated our primary care services. So we have primary care, we have urgent care, we have integrated behavioral health, we have kind of wraparound care management within that, we have, you know, CHW programs, et cetera. So those I would say are the services and underpinning all of that, we have this platform that we deliver it from and that can mean that we're able to consume lots of data, stratify the population and then be able to target, you know, who we're going to outreach, who we're going to care for and deliver the services virtually through the app or through the web.

So, but you have to have some brick and mortar component, right 'cause if I need urgent care, I can't necessarily get that virtually, right?

No, so we provide that virtually. So we provide urgent care virtually and of course if it is something that requires someone to go into brick and mortar, we will help them understand where they can go to to get urgent care.

Got it but I'm not gonna set my own broken arm.

No, you are not gonna say your broken arm.

I'm just checking, right? I mean maybe you have some new technology, I don't know.

No, that isn't gonna happen. But I think there is still a lot of components of care that can be provided virtually, yes, a broken arm is not a good example. That would have to be very much in person. But I think you can also help someone understand, you know, when you should go in person to the ED versus urgent care, versus you know, it can wait and go to a PCP.

Got it. So you have actually doctors who are employed by you?

Yes, that's correct.

And you're selling to big insurance plans, small insurance plans? And does it show up in front of the user or patient as Babylon Health, does it show up as like Aetna United? How does that think?

In some of the contracts that we have, we're just another provider in their network and so it is like Babylon as a provider, so you know, the same as any other provider. We did design a new virtual first product with a payer, which we launched early this year and that was a virtual first commercial exchange product and that is like, you know, the payer in partnership with Babylon. And so that, you know, we launched across six states at the beginning of this year.

Fascinating, I could talk all day long about virtual care. It's an area of passion, I, way back in my days at Aetna, I was helping to build the very first virtual primary care offering with Aetna and Teladoc and Kate knows I've talked to her about that for a long while. In fact, I think I told her that story when I was interviewing for a job here. So, but I wanna pivot because one of the reasons that I didn't want Kate to join us today was I know that a major area of personal interest for both of you is tackling disparities in care, right? Particularly in the areas of women's health. And so Kate, let's start with you. What do you see as some of the bigger areas of disparity of care in the US today?

Yeah, so I think that's a really good question. When we think about disparities in care and kind of just taking a step back, especially as we're considering women's health, one of the things that I think I'm most focused on is the notion that there's just actually not a ton of data and there's not a ton of research on women's health today. And I think that's really the genesis for a lot of the disparities that we're actually seeing. So you know, Jo and I were chatting before the podcast and one of the things that we were actually just talking about was the notion that a lot of what we see being studied for women's health is all about the actual treatment of an issue. You've gotten to the point we're actually sick. You need intervention, you need medical care. One of the things that's not necessarily studied as much is how we actually think about prevention. Like how do you actually take a major step back, start to really evaluate what women need from a healthcare and a health point of view and start to really understand how do you prevent illnesses from actually getting to a point where you need to have medical intervention? How do you make sure that you keep healthy women that are healthy going forward? And so as we think about kind of a bunch of the disparities that I think are really prevalent today, I think just really understanding that there's a lack of data, there's a lack of research that I think has really kind of kept that part of the medical field, quite frankly lagging behind some of the others.

Interesting. Well I'm gonna come back and talk about prevention in a second but you know, here on "Definitively Speaking" we do like ourselves a good piece of data and I actually did find a study, or actually our producer Jan found the study for, we'll give Jan a shout out here. She found a study from the Commonwealth Fund and some of the stats were just horrifying, for lack of a better phrase. This is just about US women. So according to the Commonwealth Fund, US women have the highest rate of avoidable death including pregnancy related deaths compared to other high income countries. US women face the highest maternal mortality rate compared to other high income countries. US women spend more out of pocket on healthcare compared with women in other high income countries. US women are significantly more likely to skip or delay needed care because of the cost. US women are more likely to have problems paying medical bills. Us women have the highest rate of multiple chronic conditions and the highest rate of mental health needs and yet, US is among the country's women are the least likely to report having a regular doctor or place to go for care. Wow. Please, what do we do here? Help us out. What's the answer?

I mean I think as we think about some of the stats that you just mentioned, this comes back a little bit and I'd love Jo's perspective on how you actually think about the virtual care model or how you actually think about community-based organizations to I think close, maybe not all, but at least some of the gaps that you just mentioned in the statistics, Justin. And so how do we actually identify kind of what are the major issues that we really need to be focusing on? How do we think about treatment strategies that are gonna help us bring healthcare into the communities where women are, as opposed to necessarily bringing women into healthcare settings, into primary doctors offices, et cetera. And so I think the notion of how do we use virtual care, how do we think about models like we've got with Babylon Health to really drive that? How do we also think about kind of technology that might be outside of virtual care remote monitoring as an example to be able to really kind of understand if that's the best way to really kind of track how somebody feels and how you can actually monitor kind of what their illnesses over time. Again, how do we get those treatments and how do we get those kind of strategies into the hands of the woman that, you know, are really where they're at versus kind of trying to force them into a healthcare office where they might not have the privilege of transportation, they might not have the privilege of having childcare services in order to support them.

Yeah, I think Kate, I'm kind of thinking about like backing up a little bit because yes, I think we're talking about, at the solution level, like how can we deliver care in a different way? But I would even go back and you know, talking about access and prevention, which, I think Justin you said you wanna come back to but I'm coming back to it now.

Go for it.

But you know, I think for women and and you know in some of the populations that we've been serving, which are Medicaid specific populations and looking at the, kind of what people can and can't access here in the US, I think is pretty kind of interesting, right? Like I think when you look at, and I'm starting to think about what I would consider just normal, natural things that happen in a woman's life. So pregnancy, you know, menopause and you know, or preventing pregnancy, things like this. I think for me coming from the UK, there's like, a huge kind of difference between I think how this is kind of thought about in the US versus the UK and I think those then have a lot of the kind of downstream effects on kind of what some of these stats I think are talking to.

Well I'm glad you brought up the UK 'cause you know, I know mentioned earlier there, our listeners may have heard the traces of a British accent when you've been speaking. So what is the UK doing that we're not doing here in the US and why is it so much better?

So I think specifically to women's healthcare, I would say that I think it is to me kind of the approach to maternal health in the UK, so I think first and foremost, I'd say kind of from an equity perspective, right? Everyone has access to care free at the point of delivery. You know, I think if you start thinking about access to things like contraception and safe contraception, it's universal in the UK, people age 16 and over can get a script for it, I think, you know, regulations over here are quite different state by state. Whose parents need to know the ages, all of those good things that are quite different. Plus people would have to have a provider appointment and then pay for a script. So I think it can also be cost prohibitive. And then if you are not helping people access contraception, you know, prior to the event, then you know for them when they get pregnant, if it's unwanted then we go into, you know, trouble accessing abortion. So I think we went backwards last June quite significantly, unfortunately here in the US. I think the other thing, moving to delivery, so that to me is kind of more around prevention, but moving to delivery of care. I would say the model in the UK for maternal, like, you know, I would say maternal health and you know having delivering babies et cetera, it's much more midwife driven, right? So you may not even see a provider throughout the whole of your pregnancy and delivery. So that I think is also very different. Whereas here I feel like the way things happen and are done, it's a lot more interventions by providers, more cesareans, less home births and things like that.

So I feel like we're pinning again like a bleak picture of the healthcare in the United States here. So Jo, you just listed a bunch of problems. I just made you supreme emperor of healthcare in the United States, how do we begin to fix them?

I mean, I'm not gonna say we should do what the UK's doing, but I definitely think that there are models from other parts of the world that we could look at to leverage a little bit more. Delivery of care really reflects how things are incentivized and paid for, right? So how do you really think about making those kinds of changes to then allow for innovation in different ways to deliver care? I think at Babylon that's something that I've spent a lot of time thinking about 'cause we want to serve the Medicaid population, reimbursement rates are terrible, you know, the RCHW program for instance, which we do provide to our value-based kind of populations has seen some really great results. But that in of itself is not a well reimbursed or even reimbursable service, right? So it's only value-based models and contracts that allow us to kind of deliver services that we know will benefit the population but maybe not kind of reimbursable in a classic fee-for-service way.

So I mean, all kidding aside, I mean, the US healthcare system is titanic and moves very slow and very glacially and it's complicated to change. So would you say a healthy first step, pun intended, would be start trying to work on incentives?

Yeah, I would say incentives and reimbursements. I mean I think CMS and payers have done a good job of, you know, of trying to move the needle but I think we just need to keep doing that more and more, so yeah.

Is it the incentives for the systems, the providers, the patients, which incentives?

So I suppose we were just talking about reimbursements. So I would say I was probably talking about specific to the kind of providers, right? Like how do we incentivize providers or delivery of care to change.

But I think you'd have to change also the payer's attitude as well, right? Because they're reimbursing specialists at higher rates than primary care providers and certainly higher than midwives, right? And so if you're an individual and you're trying to decide, you know, do I wanna go be a mid midwife or a, you know, obstetrician, you start to want a real cost benefit analysis for yourself, right? And so I think it's not only the providers, I think it's also looking at the payers.

Yes, yes of course. No I suppose I was saying the payments to the providers, which come from-

Right.

And CMS government.

And I would add that I think it's important to, as we think about kind of all the stakeholders, Justin, you obviously just mentioned a bunch of the bigger ones that are really important, the overall kind of healthcare delivery model is taking that step back and understanding what is the patient experience and what is the patient journey. So I think, you know, there are different incentives for various kind of stakeholders along that journey to help them understand and have I think a better kind of empathy and understanding of how you actually wanna, you know, treat women and think about women's health issues. But looking at that end-to-end journey and really, really starting to break that down I think is actually pretty fundamental to make sure that it's great to have incentives but are we actually incenting the right behavior? Are we doing it a way that is also considering improvement of health outcome and access to care. I think on one side of the spectrum, while also thinking about are we doing it really efficiently and are we doing it in a humane kind of driven way?

So where do you start?

It's a great question, I mean I think, you know, Jo brought up this point a little bit earlier in the podcast where understanding like, literally what is just like a day in the life of a woman is a really kind of fascinating concept, you know, where I think very kind of understudied or underutilized when it comes to topics like menopause and understanding what that means. So I would say like really just having some pretty good fundamental research around that women health experience is probably a great place to start and then really, really kind of advocating that key stakeholders need to be a pretty big part of that conversation and kind of drive the agenda around it.

So you've mentioned multiple times Kate, that we haven't done enough research into this space and yet in a country where I think women making either 51 or 52% of the population, why haven't we done this research?

I mean I think it revolves around why haven't we kind of studied women's issues in general in the same way that kind of women's healthcare obviously kind of fits neatly within that problem statement. Fun fact that I had learned is that actually in the US, women were actually not required to be in any clinical trials until the late 1980s. They weren't permitted to be in trials until the 1980s and it wasn't until 1993 that it actually became a part of the protocol that women needed to be a part of the overall studies depending on what the topic was at hand. So despite the fact that we might be leading by a small margin in terms of the overall population, I think that's a really, really strong and compelling example of, it wasn't so long ago that we started to make changes that helped us really, really kind of just get into the overall experience of what women are going through.

I never would've predicted that in like a million years.

Yep.

Wow.

Thought it was a kind of a fun illuminating stat.

That is a good stat.

Yeah, I'll file that one away. I mean, 1993 is not that long ago.

No, we're talking 30 years ago.

Yeah.

So.

So we've talked a lot about access to care and I think it's really an important topic, you know, you gotta go where people are 'cause they may not be able to go to the care themselves. And so it's something I think we as a country, as a healthcare industry really need to address. So again, I'll give you a couple interesting facts that we actually pulled from our definitive healthcare data, which is, you know, US women ages 18 to 49 in rural populations are 4% more likely to be diagnosed with a mental health condition. US women 18-49 in rural population are also slightly more likely to be diagnosed with multiple chronic conditions, about 16% of them versus 15% in rural versus urban conditions, locations. What's driving all of that and how do we begin to fix it? Who has that responsibility to fix it, is it the government? Is it private practice? Where do we start?

So I think in terms of kinda where we start, especially with the kind of access to care issue is fundamentally just being able to kind of understand the populations of people that are living in all of these different geographies and understanding obviously kind of what those difference in geographies really implicate us on in terms of kind of the overall health of a population, especially the health of women who tend to be obviously doing worse off than some of their counterparts. And so when we think about access, I think really kind of digging in and understanding the barriers and really having, I think people that are local within your community. Having I think kind of state-based leadership and how you actually think about kind of state-based government and then federal government really, really I think, you know, being a key part of trying to kind of narrow in on what the issue is, being able to really kind of diagnose what are the biggest barriers to accessing healthcare for that population is a pretty fundamental starting point for us to jump from. One of the things I think is really interesting about where we stand today in 2023 is that access to healthcare has always been an issue. Disparities in healthcare have always been an issue for us here in the United States. I think what we're actually seeing is a trend going in the opposite direction of what we really want to experience. I think those disparities are either getting larger, I think barriers and access are getting tougher and more challenging across the board and so being able to create kind of the right resource network, being able to kind of rely on how you actually think about being a part of a community to start to kind of drive and close some of those areas that are really challenging. I would say that's a really fundamental place for us to be able to at least jump off from.

Yeah, I think just as you were talking about all of that, I think one stat that I have, which is maybe not as good as the the '93 stat, that a third of Americans live in a designated primary care health professional shortage. So if you think about it, one in three of the population would have, you know, a struggle to really access I think some, you know, simple primary care services. So I think, not that I'm just trying to plug for Babylon, but for virtual kind of models, I do think there's a way that you can really bring care into the home for people, especially if they live in rural areas and as Kate was saying, you know, people who don't have the luxury of easy transport or other such things, it can make a real difference. I was actually putting some patient testimonials together and there was, you know, one of the women that we help in Missouri and she's a single mother of six and so she was just saying how kind of revolutionary it's been for her because she's able to get behavioral health services for her kids virtually now she can get her, you know, primary care services at home. So instead of like having to kind of get all of the kids in the car, go to an appointment, you know, do that and come back, I think she's just like, this has completely really kind of changed her life.

Yeah, I mean I have four kids and that's complicated coordinator healthcare, I can't think about two more, oh my god, Hair on my arms is standing up as you talk about that. So I think closely related to the concept of access to care is really social determinants of care and that is a very hot term. It gets thrown on a lot these days. Jo, how would you define that for our listeners?

So when I think about SDOH, I just kind of think about all of that like non-healthcare life stuff that we kind of need in our lives in order to be able to kind of live our daily lives healthily. So yeah, that's how I think about it.

Gimme an example.

So food, jobs, finances, housing.

And so those social determinants of care we think are really dragging down healthcare or how do they impact somebody's healthcare in this conversation that we've been having here?

You know, obviously I think we've determined that socioeconomic factors are a big driver of outcomes, right? So people who have a lack of resources and are not able to be able to access healthcare, not able to access food or if they do have some means, they're having to prioritize maybe how they're spending their money. So it may be I need to get food on the table for the kids versus spending it on a behavioral health appointment for my child if that's what they also need.

One of the things that I would add is just kind of generally the notion that, social determinants of health, at least from my perspective actually help us to understand the patient populations better. It provides richer information, it provides more detail about you know, who these individuals are and how they actually, you know, one might be associated kind of either through kind of correlation or causation with an outcome or potentially thinking about how they might be making like very micro decisions on a day-to-day basis. And so as we think about how SDOH can be impactful over time, to me it feels like it's another tool in our toolkit in terms of being able to stratify, how do we actually think about like who are the segments of people that we wanna be able to take care of. Based on the segment that you might find your yourself in or that swim lane, what's really kind of the right care model that you approached to? Should we be going to you virtually or is it potentially better to have you in a more specialized model? And so I think really starting to kinda leverage this type of data in a way that helps us just fundamentally try to get to know people a little bit better and how that actually impacts their healthcare and the outcomes of their healthcare, I think is actually kind of really cool to see where the market's going.

So let's kind of link some of that back together here, which is, we've talked a little bit about stratification of populations and we kicked this off Jo, by talking about population health. So how do some of the stratifications help improve population health?

That is a good question and something that obviously we spend a lot of time thinking about at Babylon. So I think at the beginning when you were asking me kind of what we do, I think something that we didn't quite get to was just about how we kind of underpin a lot of our platform and a lot of what we do with AI, which really I think is a great tool to manage population health at scale. So I think specifically talking about risk stratification, I think, you know, we believe in predicting to prevent, right? So taking a lot of data and then kind of using the data to kind of build models and then be able to really kind of identify who do we believe in a predictive way, not in just a kind of snapshot of the past way is going to really, as we call it, have kind of addressable costs, right? And so how we then allocate our resources to really manage those people with addressable costs, which are the right interventions, Kate, as you were saying that would best serve them and how we deliver the care. So that's kind of threaded through very fundamentally like, kind of our thesis of how we go about delivering care.

How's the thesis working out?

So I think the thing about value-based care is that it's a long game, right? Like I don't think anyone can say after a year you're really necessarily gonna know kind of how it's gonna go and which way it's gonna go. But I think it's definitely been very encouraging. A lot of our early indicators are saying, we actually started off taking risk for Medicaid populations and I think we've definitely seen some exciting stats about, you know, reducing the cost of care for some of those populations by several percentage points. So I think we'll just have to keep watching and seeing kind of what we're seeing.

Yeah, I think that time element is one that is really, one we don't discuss enough in healthcare and I think it shows up in a number of different areas. If I have Oreos for dinner every night, in the short term, it's not gonna cause any health issues, one week, two weeks, three weeks, I'm gonna be just fine. If I have Oreos every night for six months, it's gonna cause a health issue, right? And the same types of thing thinks about, you know, value-based care, you know, hospitals are operating particularly, you know, on quarterly operating margins and they're getting measured on how much revenue and how much profit did you generate this month. But the reality is if I'm going to invest money in a pre-diabetic to stop him from getting diabetes, I may not see a return on that investment for three years. Granted it might be a 10x return in three years, but I oftentimes feel like hospitals don't have those three years to get that return on investment and they're like, you know what, I'll just shoot them up with insulin today, deal with the diabetes tomorrow, pre-diabetics, you might not even be living here in three years. You're not my problem. Can we solve the time problem?

I think it's an interesting question and one that we definitely debate ourselves, right? And so, you know, if you talk to our clinical team, right, they're just all about the care. They just wanna give everyone the care that they need when they need it for whatever it is. Obviously when you are talking to our actuarial team and our contracting teams, it's a little bit different. And so kind of how do you really just, you know, kind of balance those pieces and obviously, what's ethically appropriate too. Another neat thing, what allows us to maybe think about this a little bit more real time and what AI allows us to do is that kind of ingestion of data. So if you have been eating those Oreos, then it's coming out and it's kind of being shown in, you know, HIE data that we get or ADT feeds or pharmacy data, then we can like, real time, you know, our predictive models are updating and that allows us to kind of trigger specific actions to intervene or kind of do things. So that's another kind of, I think, neat thing that AI's allowing us to do, which is I think pretty differentiated.

And if AI could create a calorie free Oreo, that would just be fantastic.

We'd all be having Oreos for dinner every night.

I eat one Oreo at day, Kate, after I eat a healthy dinner. Just so we're all clear.

That's why you're the host of the podcast.

Exactly, so we've covered a lot here. I got one kind of last big question for you and it's sort of related, but it's sorted not but it's something that is definitely, I want to raise up here. We've talked a lot about health equity for women and both of you are obviously women in positions of leadership in healthcare industry, which unfortunately puts you in a small minority. According to World Health Organization, women account for 67% of the global healthcare and social care workforce and yet according to the International Hospital Federation, women only account for 25% of the leadership roles in healthcare organizations globally. And a study from the Journal of American Medical Association reports that only 15% of health systems CEOs are women. So I wanna ask you both, how do we fix this problem? How do we get more women into leadership roles in healthcare?

It's a great question. I think we also come back to something that we talked about a little bit earlier in the conversation is, you know, how do we fix the understanding of women health issues when you've got underrepresentation that is obviously playing out, kind of in all facets of kind of the conversation we're having today, you can imagine that there's I think, some relatively strong headwinds that we still have to be able to kind of fight off and make sure that we can change at least, even moderately, some of the statistics that you just listed off there, Justin, so one of the things that I think about in terms of, you know, how do we really support women coming into more leadership roles. Whether that's in healthcare or whether that's just kind of across any industry in any kind of, you know, business that we might wanna be in, is really thinking about kind of one passion. Do you have a passion in that area? Is that a spot that you wanna be in and then two, finding really, really good mentors that you can partner up with and you can buddy with over time. It's pretty remarkable. I've had some pretty impactful mentors in my own kind of professional journey that have really, really helped me get to where I'm at today and I absolutely wanna be able to pay that forward to other people that have kind of a similar interest. And so, you know, as I think about kind of closing some of those gaps, it's find people that you really, really trust in your network, build the right connections and relationships, kind of share a little bit about where your passions are and figure out how we can all help each other a little bit. Because I feel like at the end of the day, there's a human connection and there's absolutely kind of a way for us to turn around what you suggested in terms of some of those other somewhat depressing statistics.

Not to be boring, but I think a lot of what Kate has said, you know, does resonate with me. I think not only having kind of the mentor that can help you professionally, but I think within an organization as well. I know you can't always really manage, like who you are managed by, but I do think that kind of finding someone who can champion you and you can build that relationship with like, that's really the psychological trust and kind of the way that someone can let you grow within an organization I think can be really impactful as well. I think I have a coworker who says to me, people don't leave a job, they need a manager. And I think that can be really, really true. So I think it also behooves us all, men and women, you know, to really look at nurturing the people that, you know, are spending their time kind of working for our businesses and us and making sure that they're able to kind of grow and develop.

Well you know, with two thirds of the workforce being women, there's certainly a lot of candidates for those leadership positions. I just think we all need to make a concerted effort to get them up and help figure how can we lift them all up because as you said multiple times, Kate, there is a lack of knowledge and awareness and I think it has to start from leadership on down to move that funding, to move that research, to move that investment. And I think that's how we have to start working through that challenge.

I agree.

It's interesting, I think that stat, that two thirds, what did you say, two thirds of women are.

Two thirds of the global health and social care workforce are women according to the World Health Organization.

Yeah and so, I mean obviously I can think there's probably a split when you think about frontline workers, right, versus maybe more administrative roles. But I think with that, how do we look after these people comes back to a little bit of what we were talking about before where, you know, when it comes to say kind of maternal health and like, maternity leave and paternity leave in this country, you know, how do we think about that and giving people the time right? With their families or with their newborns?

Well I think it's really interesting to your point, there's tons of talent. Two thirds of the workforce out there are women, obviously we've got lots of great candidates that are probably, you know, ready to chomp at the bit and take on their next opportunity. I think also what this conversation highlight is that we have tons of opportunity, like we are clearly far from being perfect and so there's a lot of work that we need to do and quite frankly a lot of hard work we need to do to really kind of go through a bunch of the topics that we explored here in today's conversation. So Justin, I really love your point about how do you actually kind of start this from the top down and from a leadership perspective. So if we know we have the talent and we know we have the opportunity, to me that indicates and signals that we've got a lot of things in our control to actually make the improvements that we wanna be able to see.

Excellent, well Jo, Kate, thanks for joining me today. This has been a fascinating conversation. I really appreciate your time.

Thank you for having us.

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