D

onna Shalala has kept a close watch on the state of American health care for decades.

Shalala, who served as secretary of health and human services for eight years during Bill Clinton’s presidency, now heads up the global Clinton Foundation. She’s come under fire in both posts — first, for her liberal takes on health care policy and, more recently, for the connections the nonprofit foundation might have to Hillary Clinton’s campaign.

Shalala sat down with STAT at Spotlight Health, part of the Aspen Ideas Festival, to talk about refugee health, how having a stroke gave her a new perspective on health care, and how she thinks the US is dealing with the opioid crisis.

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This conversation has been condensed and edited for clarity.

Are you happy with what’s become of the projects you worked on as secretary?

Oh, yes. Particularly, the focus on children — expanding Head Start, expanding child care, childhood immunizations, which were the highest in history. They went over 90 percent during our [time]. When we left office, children were healthier and wealthier, by any measure. So continuing to do that kind of work, both here and abroad, has always been very important to me.

What do you make of the anti-vaccine movement now in the US?

It’s very dangerous. I’m still concerned about it. But it’s a very tiny part of the population, and we’ve pretty much gotten every kid vaccinated. [Outbreaks caused by unvaccinated kids], that’s intolerable. Parents that do vaccinate their kids shouldn’t tolerate it in their communities.

What else stands out from your time as secretary? 

When we came to office, people were dying of AIDS. We had no way of stopping their death. It wasn’t just gay people. I spent a lot of time with hemophiliac children who had gotten it through blood transfusions.

You wanna break someone’s heart? I recently went to the annual convention of the hemophiliac society. [There were] a lot of parents whose kids had died during that period and a lot of parents whose kids had been saved because of the rules that we’d put in place. We cleaned up the blood supply in the United States. That was the one thing we could do to prevent [the spread of AIDS].

Another cause you’ve championed is reducing childhood obesity. How should we be tackling that?  

In an ideal world, every breakfast and every lunch in every school in America would be very healthy. And we would find a way to get healthy vegetables and fruits into some of the poorest areas of our country. And you would basically eliminate childhood hunger. We still have too many kids that don’t have access to the right foods or don’t have access to food. In this country, that’s unacceptable.

How do you feel we’re grappling with the health crisis among international refugees?

Jordan has been heroic. They’ve absorbed a million refugees. They’re overwhelmed. Turkey, Lebanon, and Jordan are just overwhelmed. Everybody’s focused on Europe, but those countries have really taken the brunt of it. … Their health care system is overwhelmed. Supplies are overwhelmed. These aren’t the richest countries on Earth. And they’re getting help from lots of private sectors, but it’s not enough. What they really need is peace.

There are a lot of doctors in the camps [who are also refugees]. There is a lot of talent in those camps that could be used. Many of them are working in clinics already, when they’re identified. Many of them would like to emigrate to places where they can practice medicine.

How did your stroke last year affect your views on health?

It gave me some insight into how the health care system works in emergencies. I happened to be standing practically next to an ambulance, so I got on the operating table right away and I completely recovered. But my energy took about six months to completely come back. It gave me insight into the emergency part of the health care system, and the high-tech part of the health care system as well. The operation they did on me wasn’t available five years ago.

You were a huge supporter of needle exchange programs in the ’90s. How have you seen that work play out in the opioid crisis?

Even in the most conservative places, like Indiana, governors have decided we really did need needle exchange. Needle exchange has gone through an evolution. Remember, from an AIDS point of view, most of the transmission now is not intravenous drug users but is sexual transmission. From a drug point of view, we are working on the opioid situation. We’ve made naloxone [which can reverse opioid overdoses] available to high schools, and a low-cost naloxone available to colleges across the country. Our piece has been working with the drug companies to make sure that naloxone is affordable and to work on trying to track the epidemic.

How would a Trump presidency change health care compared to a Clinton presidency?

I literally have turned myself off from the politics that are going on because my job is to keep the [foundation] out of the election.

How feasible is it to do that?

Easy. There’s no one in the foundation that’s working on the campaign, and we’re not talking about the campaign.

Have some people approached the foundation to lobby in any way?

Nope. Nope. Nope. No. Because if someone does, if someone comes up to me and says hey, I’d like to talk to you about the campaign, or hey, I’ve got a proposal for Hillary, I just say I can’t talk to you about that because that’s not the foundation’s business, and we have to keep the foundation separate from the campaign. And if they say can you connect me up with the campaign, the answer is no, I cannot connect you up with the campaign. We’ve been very disciplined about keeping ourselves out of the campaign.

But there are still lingering questions about the connection between the campaign and the foundation. 

We’ve put out very careful facts, and there have been fact-checkers. So when people make accusations about the foundation, the facts are there. We’re also very transparent. There isn’t another foundation in the country that discloses their donors quarterly.

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