Voices: Dr. Atul Gawande on USAID spending, Covid-19 Aftermath, and the Need for the US to Lead in Global Health.
Part 3 of the three-part series.
Here’s the link to Part 3 (of 3) of my interview with Dr. Atul Gawande, the best-selling author, public health researcher, surgeon, and current lead for global health at the United States Agency for International Development (USAID).
If you want to catch the first two segments—which were equally interesting—here is the link for Part 1 (“Atul Gawande on the Importance of Palliative Care”) and Part 2 (“AI and the Safe Surgery Checklist”).
Part 3 is entitled “Why Spend U.S. Dollars on Healthcare Abroad?”
Here are some key points from our discussion:
Role of USAID: Dr. Gawande highlighted the importance of USAID, stating that its efforts are not only for the benefit of international communities but also serve US national security interests. He emphasized the agency's ability to build capacity to address disease outbreaks globally, citing the example of recent Ebola outbreaks.
US Values and Global Health: USAID's work is a reflection of the United States' commitment to the principle of equal worth of all lives. Dr. Gawande stressed that while the US is not responsible for every life on earth, it still bears some responsibilities overseas. He cited the eradication of smallpox and the driving force in the Green Revolution in India as examples of the US successfully getting involved abroad.
Global Leadership: Dr. Gawande argued that the world looks to the US for leadership in global health. Following the pandemic, he believes that the US should lead efforts to get global life expectancies back to (and beyond) pre-pandemic levels.
Covid-19 Aftermath: Gawande mentioned that while the official Public Health Emergency is over, Covid-19 will continue to be a major disease that we must live with. He stressed the need to incorporate this into routine healthcare and emphasized the importance of concentrating resources on the 20% sickest and oldest in the world.
Damage to Healthcare Systems: The pandemic has significantly affected health systems worldwide, causing resource diversion, economic damage, and economic consequences. Dr. Gawande pointed out the need to protect primary care workers.
On a personal note, it was a joy to speak with Atul for this series and I hope we can bring him back. I’ll mention that it has been nice getting to know Atul a bit more over the years. When I first arrived at Harvard, we met for coffee to discuss my early career— or, more accurately, to discuss what I could learn from his. We’d occasionally chat in the pre-pandemic era, sharing pieces we’d written or found mutually interesting. Then during the pandemic, we spoke and emailed more often. But I don’t think we’d had a real chat (other than via text messages) in over a year, in large part because of his new role in the US government. So, this interview was a great way to catch up and learn more. He’s a fascinating thinker. I truly enjoyed it.
Special shoutout to Emily Hutto at MedPage Today for editing this wide-ranging conversation and streamlining it into three digestible episodes. I hope you found it as valuable as I did!
I have really appreciated your interviews with Dr. Gawande particularly because he touches on the gap in Western med as well as our society...reticence to address not just death but DYING, or more accurately, living a quality of life while seriously chronically ill and/or terminal no matter your age. I watched his Frontline doc, Being Mortal, and purchased his book of same title. My sister has Stage IV terminal Inflammatory Breast Cancer. Her "care" has been appalling (outside of some excellent palliative care nurses). At the Seattle Cancer Center when she had a blood clot from her ankle to thigh due to cancer and/or treatment, it took them 2 weeks to respond to her. She went months without an oncologist when her's left practice. All of them have been only interested in her if she opts to do radical treatments. Nobody wants to treat her if she opts out and wants to focus on what's left of her life. For me, I'm chronically seriously ill with Progressive MS, RA, CVID. The MS has now impacted my autonomic system (heart, blood pressure, etc.) and weakened my diaphragm in addition to motor skills, bowel and bladder. I'm in a wheelchair. Both my sister and I have still tried to live full lives but our med care has made us feel abandoned as we are "complex". It makes it very hard to make important decisions about our lives. I was so encouraged by the work of Dr. Gawande. The only sad and frustrating part is that his book is 8 years old and sadly his colleagues don't seem to be listening as not much has changed on this important subject. It is actually getting much worse . The work that you both are doing to bring these sort of topics to a broader audience is significant, but I wish we could find a way for patients like myself and my sister to advocate with insightful physicians like you. How we communicate together in the process of treating and healing should be based on the common realistic goal of how patients like us can live the best life in our circumstances not undue pressure on you to provide miraculous cures. And definitely should not be based on dictates from private annuities who do not share your expertise and compassion, nor the fact that the patient is the one who lives or dies with the consequences.
As a bedside RN and a mother with a kid who has long Covid I couldn’t agree more. Viral and post-viral complications aren’t something that we factor into acute or even routine medical care like we need to in a “post-covid” healthcare world.