“I told him we could probably eat the same apples for the next 20 years and be OK, but we wouldn’t be OK if he didn’t continue his potential groundbreaking work,” Milken, 76, said. “Then we funded him.”

Driven by a family history of disease and his own experience with prostate cancer, Milken, the onetime junk-bond wizard whose spectacular downfall on securities charges led to a 22-month prison term in the 1990s, has spent the last three decades trying to advance medical science so that people “can find cures to life-threatening diseases within their own lifetimes.”

In “Faster Cures,” a book that is part memoir and part medical history, the financier-turned-philanthropist argues for applying business principles to foster quicker medical breakthroughs: more collaboration and information-sharing among researchers, a more streamlined path through government regulations, and more public and private funding to keep the best and brightest working in the field. The book was written with Geoffrey Evans Moore, a longtime associate of Milken’s.

Milken, whose net worth is estimated at $6 billion, has donated $1.2 billion to medical research and public health causes and raised another $1 billion for them from donors, according to a spokesperson. Much of that money is distributed through the Santa Monica-based Milken Institute, which funds organizations around the world that support research and education.

This interview has been edited for length and clarity.

Q: Was it difficult to write about your father’s death from cancer and your own diagnosis of advanced prostate cancer in 1993, which was thought at the time to be terminal?

Life-threatening diseases are not separated by wealth or anything else. One in 2 men are going to get diagnosed with cancer in their lifetime; for women, it’s 1 in 3. In the hospital room or in surgery, we’re all equal. That’s why I wanted to personalize it because my family is no different. In the 1970s, science could not move fast enough to save my father’s life.

Q: Is the U.S. too slow in reaching cures?

A train today in Europe or Asia can travel at 200 miles an hour, but the average train in the U.S. travels at the same speed as 100 years ago because you can’t put faster trains on tracks that aren’t more modern. Science is this train that’s moving fast, but the tracks are 20th-century tracks. As science moves quickly — sequencing your genome and your microbiome, for example — many of the ways we deal with our health system still relate to what it was in the 1900s, not in this century.

Q: What are those outdated practices?

One is collaboration. Thirty years ago, after my diagnosis, I attended a prostate cancer conference at MD Anderson Cancer Center in Houston, and I noticed that no one from Memorial Sloan Kettering [in New York City] was presenting, and they were the other recognized top experts in the field. When I asked why, I was told by MD Anderson’s people that they felt Sloan Kettering was a competitor. I said, “They’re not a competitor to patients.” We’ve done a huge amount of work in that area to get researchers and scientists sharing information and working together.

Q: Are cancer patients getting into clinical trials at earlier stages?

Yes, but there’s another element here relating to health equity. The demographics of America have changed considerably. Sixty years ago, 75% of everyone living in the U.S. who was not born here came from Europe. Today, more than 70% of everybody living here who wasn’t born here came from Latin America or Asia, but our clinical trials are still largely Caucasian. We’re not including people who will someday make up the majority of people in this country.

Q: You also spend a lot of time writing about prevention, especially as it pertains to diet. Why?

If you went to medical school in China 30 or 40 years ago, you wouldn’t have even studied diabetes because it was so rare there. Today, because of changes in the food chain and what they’re eating — meat-based and fat-based diets — China has the most people with diabetes of any country in the world. That’s what thousands of McDonald’s and KFC and other franchises will do. We also know that eating certain foods can slow the growth of certain kinds of cancers, or that changing your diet can accelerate the growth. The CEO of one of the largest medical research companies in the world told me, “The next great drug is going to be prevention.”

Q: But isn’t the medical industry oriented toward selling treatment and not prevention?

When we proposed the idea to the medical community in the ’90s that you are what you eat, they said, “Prove it.” And we didn’t sequence the genome until 2003, so prior to that the evidence was mostly anecdotal, but there was plenty of it. The notion is mainstream today, but teaching doctors that nutrition makes a difference is still a minor, minor part of medical school. It should be at the forefront. We often refer to the produce section of the grocery store as the pharmacy of the 21st century.

Q: Your financial theories revolved around finding lower-graded bonds that produced great returns — essentially, identifying an undervalued segment of the market. Is there an undervalued equivalent in medicine or science?

It’s about the democratization of capital. In medicine and science, access to financial capital serves as a multiplier effect, but the largest asset is human capital. I’ve spent considerable time trying to identify the future Ted Turners or [telecommunications giant] John Malones of the world of medicine, then convincing them to go into research and funding them.

Q: How do you provide financing to the most talented people in the field?

That includes private and public funding. In 1998, we organized a march on Washington, and a few months later President Clinton signed into law a massive increase in the NIH [National Institutes of Health] budget. Since then, there’s been an incremental half a trillion dollars invested into the NIH, and that has made all the difference for so many organizations working on specific diseases or types of cancer.

Q: Why do you fund medical research?

My interest in medicine and science started when I was 8 years old. It accelerated in the ’70s when my wife’s mother was diagnosed with breast cancer and my father’s melanoma returned. That began a search for medical solutions that I brought into my existing philanthropy in 1982. Who a person is and what they believe in — there has always been a lot of misinformation out there, and it’s only going to get worse with artificial intelligence chat. It’s not just related to me. But I think the thousands of companies that we financed, and the millions of jobs created, are evidence that the ideas I put forth are today in the mainstream. All of the facts are there for one to see.

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Luckily, she’s got the ear of President Joe Biden’s health secretary.

Reyes, 64, is married to Health and Human Services Secretary Xavier Becerra, who is championing the administration’s initiative to require all states to provide Medicaid coverage to mothers for a year after giving birth. In March, the Centers for Disease Control and Prevention released data showing a 40% increase in U.S. maternal deaths from 2020 to 2021. The mortality rate among Black women was 2.6 times that of white women, no matter their economic status.

Over the years, Becerra has spoken highly of his wife’s expertise, but she downplays her influence, saying her husband of nearly 35 years “had it in him to begin with” to improve health care for women and to demand fewer pregnancy-related deaths. She, too, describes the nation’s high maternal mortality rate as unacceptable and preventable.

Reyes, a Latina who grew up as one of eight children in California’s agricultural heartland, now practices perinatology at the University of California-Davis. She is a member of a California Department of Public Health panel that reviews cases of maternal deaths and recommends improvements. And she chairs the board of the California Health Care Foundation, a nonprofit that works to increase health care access. (California Healthline is an editorially independent service of the California Health Care Foundation.)

Her work has been a blend of medicine and advocacy, and she worries recent federal court rulings will erode hard-fought victories regarding the safety of pregnant women and their babies. She discussed the nation’s maternal health crisis and health care disparities with California Healthline senior correspondent Samantha Young. The interview has been edited for length and clarity.

Q: When did you first realize there are disparities in the health care system?

When I was in high school in the Fresno Unified School District, we were under a consent decree to desegregate. And I was, at the time, student body president at Roosevelt High School. I was asked to be on this unified school district desegregation task force, where the district had to come up with a plan.

It was a time when I really had incredible exposure to how policies are made at a larger level, societal level, that really determine where people live, where they can seek health care, where they go to school. That experience had a tremendous impact on my life in terms of what I wanted to do in a career and how to give back.

Q: The U.S. has one of the best health care systems in the world, yet the maternal mortality rate is high compared with other developed countries. Why do think that is?

What we know by the CDC and maternal mortality review committees is that about 60% of maternal deaths are considered preventable. And that’s really been a lot of what I’ve tried to focus on: What can we do to reduce the severity of disease? Or what can we do within the role that we play in maternal health that can reduce that?

We know that there are societal issues absolutely that increase women’s risks and there are public health issues. But there’s a role that hospitals play in helping reduce that risk. Ten years ago, I was on the maternal mortality review committee for the state of California when we started reviewing cases of women who died within hospital systems to see, “Is there a role that we can play in a hospital system to reduce that risk?”

We recognized that sometimes there were conditions that were not recognized early enough so that there was a delay in the care. Sometimes there was a misdiagnosis. Or in some hospital systems, especially rural systems where there aren’t as many resources, sometimes there was the lack of specialists available. So, we’ve identified these risks and said, “We can do something about them.”

Q: You served on a federal panel 20 years ago that published a groundbreaking report identifying racism in health care. It seems as if we could be much further along.

The purpose of that committee was to really answer the question: Do patients receive a different level of care based on race? Looking back, we knew there was something there, but we really didn’t know. And it took months for the committee to come to that agreement, that there was a difference. I mean, that was honestly monumental, because we just didn’t have that level of consensus before. And so just to say “That treatment is unequal and it’s unacceptable” was really profound.

We thought that the 700-page report was going to be a time period where there was going to be tremendous movement, and I think I’ve learned over 20 years that change doesn’t happen quickly, especially when providers and health systems don’t see that they play a role. It’s like … “OK, so maybe it exists, but not for me.”

We all saw George Floyd and how he was treated. And during covid we saw a tremendous difference in who was dying, right? Underrepresented minorities — certainly much higher. It was that culmination that made us realize the elephant in the room. We can’t ignore that this does exist, that there is a difference in how people are treated, even in our health care system.

Q: When addressing racism in health care, you talk about diversifying not just the health care workforce, but also the boardrooms of hospitals and health systems. Why is that important?

At the board level, change is hard. But we all play a role because leadership really helps determine much of what’s carried out. So, to have a leadership that is understanding and representative of the communities they serve, I think it has been demonstrated that we do make a difference.

Q: As a health care provider, do you have a wish list of policies you’d like the government to take up?

There was tremendous effort around offering preventive health services as a part of what was covered under the Affordable Care Act. And individuals exhaled, finally thinking this is a tremendous win, especially for women in pregnancy. Because we fought for preventive health services to help them have access so they can prepare for their pregnancy. So, for women, this was huge. But now with the Texas federal court ruling that the U.S. Preventive Services Task Force didn’t have any authority, it is a tremendous step backward.

We have culturally, linguistically appropriate standards in place, but it’s a matter in terms of how they’re carried out by state and by individual hospital systems. My wish list is that we really do listen to our patients, speak to them in a language of their choice, and provide them written materials in the language of their choice. We don’t fully do that.

Q: You mentioned one Texas ruling on the ACA. What’s your take on the ruling by another Texas judge suspending the abortion pill? And the U.S. Supreme Court’s overturning of Roe v. Wade?

As a maternal-fetal medicine specialist who tries to help women plan for pregnancies, those rulings are a tremendous setback.

Q: And what about women of color? Will they find access to abortion services more difficult?

Oh, absolutely. When we speak of underrepresented minorities or those with less resources, they have less resources to then seek the appropriate care. Some women may have the opportunity to go to a different state or seek care elsewhere if their state doesn’t provide it. Many women just don’t have those resources to devote to them and don’t have a choice. So, we will see that disparity widen.

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Bonta, the first Filipino American to serve as the state’s top prosecutor, asked 30 hospital CEOs in August for a list of the commercial software programs their facilities use to support clinical decisions, schedule operating rooms, and guide billing practices. In exchange, he offered them confidentiality. His goal, Bonta told KHN, is to identify algorithms that may direct more attention and resources to white patients than to minorities, widening racial disparities in health care access, quality, and outcomes.

“Unequal access to our health care system needs to be combated and reversed, not carried forward and propagated, and algorithms have the power to do either,” Bonta said.

It’s too early to know what Bonta will find, and his office will not name the hospitals involved. The California Hospital Association said in a statement that such bias “has absolutely no place in medical treatment provided to any patient in any care setting” and declined to comment further.

Advocates have high hopes for what Bonta will find — and for the next four years. “We expect to see a lot more from him in this full term,” said Ron Coleman Baeza, managing director of policy for the California Pan-Ethnic Health Network. “There is much more work to do.”

Last year, Gov. Gavin Newsom appointed Bonta as attorney general after Xavier Becerra left the position to join the Biden administration as secretary of the U.S. Department of Health and Human Services. In the Nov. 8 election, which won him his first full term, Bonta faced Republican challenger Nathan Hochman, a former federal prosecutor who campaigned on prosecuting violent criminals and pulling the deadly synthetic opioid fentanyl off the streets. In contrast, Bonta advocated for gun control and decriminalizing lower-level drug offenses, and in January advised law enforcement officials not to prosecute women for murder when a fetus dies, even if their drug use contributed to the death.

In unofficial results, Bonta had about 59% of the statewide vote, compared with 41% for Hochman.

Bonta, formerly a state legislator representing the East Bay, will be eligible to run for a second full term, which could allow him to serve for nearly 10 years.

His wife, Democratic state Assembly member Mia Bonta, was among the public officials who discussed their abortion experiences after a leaked draft of a U.S. Supreme Court opinion that was published in May revealed the justices would likely repeal Roe v. Wade. After they did, the attorney general threatened legal action against local jurisdictions that tried to adopt abortion bans.

Bonta called health care a right for all Californians and said he wanted to help people of color and low-income communities get more access to doctors and treatments, as well as better care. “It’s something I’ve been actively working on as an elected official my entire career, and even before that,” said Bonta, whose father helped organize health clinics for Central Valley farmworkers.

But health equity remains an elusive goal, even as it has become a catchphrase among advocates, researchers, politicians, and health care executives. And as with most aspects of the state’s mammoth health care system, progress comes slowly.

The Newsom administration, for example, will require managed-care plans that sign new Medicaid contracts to hire a chief equity officer and pledge to reduce health disparities, including in pediatric and maternal care. The state’s Medicaid program, known as Medi-Cal, serves nearly 15 million people — most of whom are people of color. But those changes won’t come until 2024, at the earliest.

State lawmakers are also trying to minimize racial discrimination through legislation. In 2019, for example, they passed a law that mandates implicit bias training for health care providers serving pregnant women. Black women are three times as likely to die from having a baby as white women.

In recent years, researchers started warning that racial discrimination was baked into the diagnostic algorithms that doctors use to guide their treatment decisions. One model predicted a lower rate of success for vaginal births among Black and Hispanic women who previously had a cesarean delivery than among white women, but failed to take into account patients’ marital status and insurance type, both of which can affect the success rate of a vaginal birth. Another, used by urologists, assigned Black patients coming into emergency rooms with “flank pain” a lower likelihood of having kidney stones than non-Black patients — even though the software’s developers failed to explain why.

Some researchers likened such medical algorithms to risk assessment tools used in the criminal justice system, which can lead to higher bail amounts and longer prison sentences for Black defendants. “If the underlying data reflect racist social structures, then their use in predictive tools cements racism into practice and policy,” they wrote in the New England Journal of Medicine in 2020.

Bonta is seeking the hospital industry’s cooperation in his algorithm investigation by framing racial and ethnic disparities as injustices that require intervention. He said he believes that his inquiry is the first of its kind and that it falls under the California Department of Justice’s responsibility to protect civil rights and consumers. “We have a lot of depth,” he said of his 4,500-employee agency.

Coleman Baeza and other advocates for health care consumers said the attorney general should also monitor nonprofit hospital mergers to ensure that health care facilities don’t reduce beds in underserved communities and crack down on predatory medical lending, particularly in dental care.

“They violate existing consumer protections, and that falls squarely within the AG’s jurisdiction,” said Linda Nguy, a senior policy advocate for the Western Center on Law and Poverty.

Nguy urged Bonta to go after underperforming health plans when they fail to contract with enough providers so patients can get timely appointments, even though the California Department of Managed Health Care is the state’s main health insurance regulator.

“During covid, the health plans were essentially given a pause on reporting of their timely access. But that pause is over, and the plans have to meet these requirements,” Nguy said. “He can ask for that utilization data.”

Bonta remains circumspect on a particular issue related to race.

His office has been facilitating California’s reparations task force, which issued a nearly 500-page preliminary report this year that noted that Black Californians had shorter life expectancies and poorer health outcomes than other groups. In surveys of hospitals across the country, Black patients with heart disease “receive older, cheaper, and more conservative treatments” than white patients, the report said.

The task force could recommend cash compensation for Black Californians who can establish ties to enslaved ancestors, but Bonta hasn’t endorsed that plan. The final report is due in July.

“If we can move the needle, then we should,” Bonta said. “There are a whole set of different possible solutions, pathways to get there.”

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It was a turning point for Clarke. “I realized, ‘Oh my God, I’m nearer the end than the beginning,’” she said. Soon, she was seized by a desire to examine what she looked like at that time — and to document the results.

Clarke, a professional photographer decades before, picked up a camera and began capturing images of her face, hair, eyes, arms, legs, feet, hands, and torso. In many, she was undressed. “I was exploring the physical part of being older,” she told me.

It was a radical act: Older women are largely invisible in our culture, and honest and unsentimental portraits of their bodies are almost never seen.

Before long, Clarke, who lives in Inverness, California, turned her lens on her partner, Igor Sazevich, a painter and architect 11 years her senior, and began recording scenes of their life together. Eventually, she realized they were growing visibly older in these photographs. And she understood she was creating a multiyear portrait of aging.

The collection that resulted, which she titled “Time As We Know It,” this year won a LensCulture Critics’ Choice Award, given to 40 photographers on five continents. “There is a universality and humility in seeing these images which remind us of the power of love and the fragility of life,” wrote Rhea Combs of the Smithsonian Institution’s National Portrait Gallery, one of the judges.

Early on, some people were offended by the images Clarke displayed at galleries in the San Francisco Bay Area, near her home. “I found out there’s a taboo about showing older adults’ bodies — some people were just aghast,” she told me in a phone conversation.

But many people in their 50s, 60s, 70s, and 80s expressed gratitude. “I learned that older people are dying for some kind of recognition and acceptance and that they want to feel seen — to feel that they’re not invisible,” Clarke said.

Art has many benefits in later life, both for creators and for those who enjoy their work. It can improve health by expanding well-being, cultivating a sense of purpose, and countering beliefs such as the assumption that older age is defined almost exclusively by deterioration and decline, Dr. Gene Cohen wrote in “The Creative Age: Awakening Human Potential in the Second Half of Life,” published in 2000.

Cohen, a psychiatrist, was the first director of the Center for Aging, Health and Humanities at George Washington University and acting director of the National Institute on Aging from 1991 to 1993.

In 2006, Cohen published findings from the Creativity and Aging Study, conducted in San Francisco; Brooklyn, New York; and the Washington, D.C., area. Two groups of older adults were studied: those who participated weekly in arts programs led by professionals and people who went about their usual business. Those in the first group saw doctors less often, used less medication, were more active, and had better physical and mental health overall, the study found.

For Clarke, “perspective” and “acceptance of my body as it is” have been benefits of her 12-year project. As a young and middle-aged woman, she said, she was “obsessed” with and anxious about her appearance. “Now, I think there’s a beauty that comes out of people when they accept who they are,” she told me. “It’s altered how I look at myself and how I see others.”

Shortly after our first conversation, in early August, Clarke, now 82, found herself at another turning point with the death of Sazevich, 93, who had lymphoma and refused chemotherapy. The couple had been together since 2003 but hadn’t married.

Sazevich had fallen three times in the months before, broken his hip, contracted pneumonia in the hospital, and returned home on hospice. As he lay in bed on his final day, receiving morphine and surrounded by family, two dogs belonging to one of his daughters came close, checking on him every hour. At the moment of his death, they growled, probably because “they felt a change in the energy,” Clarke said.

“It was amazing — I have never been through an experience like that in my life,” she said about Sazevich’s death. “There was so much love in that room, you could cut it with a knife. I think it’s changed me. It’s given me a glimpse of what’s possible with humans.”

Everywhere she goes in Inverness, Clarke runs into people who tell her how sorry they are for her loss and ask if they can help. “I am overwhelmed by the care pouring over me from my friends and family,” she told me. “It’s like a huge embrace.”

It takes a community to comfort an older adult coping with loss, just as it takes a community to raise a child. Clarke said she is still “up and down emotionally … questioning what death is” as she processes her loss.

Eventually, Clarke said, she wants to restart work on “Time As We Know It.” “Because it’s about aging me,” she said. “My aging. And that’s what I’m committed to. It’s given me a purpose. And when you’re growing old, you need to have something you love and makes you feel alive.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit kffhealthnews.org/columnists to submit your requests or tips.

This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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In 2015, one of those warehouses was built right in front of her old house, blocking her view of her suburban neighborhood. Soon thereafter, her son battled bronchitis and pneumonia. “It got so bad that I ended up taking him to the ER about three to four times a year,” she said. Her son, now 16, like so many others in the region developed asthma due to air pollution. She grew concerned that state policies were overlooking predominantly Hispanic and low-income residents in her community.

Gonzalez, 35, has evolved from a concerned parent into an environmental advocate. Her years as an educator specializing in bilingual and special education, along with a bout of homelessness, fuel her passion for advocating for marginalized communities. Today, she serves as executive director of the Center for Community Action and Environmental Justice, which works on air quality and environmental justice issues on behalf of the region.

Gonzalez and the organization have endorsed Proposition 30 on the November ballot. Funded primarily by the ride-hailing company Lyft, it would impose an additional 1.75% tax on what Californians earn above $2 million per year to fund zero-emission vehicle purchases, electric charging stations, and wildfire prevention programs.

While the initiative would provide subsidies for low-income consumers, it would also subsidize businesses, such as Lyft and other ride-hailing companies, by helping them add clean cars to their fleet. Lyft and other ride-hailing companies are under a mandate to make at least 90% of their vehicle fleets electric by 2030.

The once-popular measure has slipped into toss-up territory. A September poll by the Public Policy Institute of California found 55% of likely voters back the measure, down from 63% in April. And it has divided environmentalists and Democrats.

The measure would generate an estimated $3.5 billion to $5 billion a year, growing over time, according to the nonpartisan Legislative Analyst’s Office. Of that, 45% would primarily subsidize zero-emission vehicles and 35% would boost construction of residential and public charging stations, with at least half of each category directed to low-income households and communities. The remaining 20% would fund wildfire suppression and prevention.

The state Democratic Party and the American Lung Association endorsed Proposition 30, calling it an innovative measure that will expand access to electric vehicle chargers for every Californian, regardless of where they live or work.

But opponents include the California Teachers Association and Democratic Gov. Gavin Newsom, who recently called the measure “a Trojan horse that puts corporate welfare above the fiscal welfare of our entire state.”

California is a leader in pushing — and paying for — clean energy, but the state has been criticized for failing to distribute California’s clean-car subsidies equitably. For example, a 2020 study found wealthier communities in Los Angeles County had more electric and plug-in hybrid vehicles than its disadvantaged communities. And state Assembly member Jim Cooper, a Black Democrat from Elk Grove who will become Sacramento County sheriff next year, has said the state’s push for electric vehicles fuels “environmental racism.”

Gonzalez points to studies, such as a report by Earthjustice, showing how people who live close to warehouses are more likely to be low-income and at higher risk of asthma due to the air pollution generated by diesel trucks.

KHN reporter Heidi de Marco met with Gonzalez at her new home, where a development is proposed behind her property, to discuss why she and her organization endorsed Proposition 30. Gonzalez said she has not been paid by Lyft. The interview has been edited for length and clarity.

Q: Why is Proposition 30 important for your community?