Ten years after the release of “Being Mortal,” Atul Gawande’s seminal book on death and end-of-life care, the celebrated surgeon and author has shifted his focus beyond U.S. health care to global issues.
“Trust in public health agencies is built on trust in government. What we see is that there are enormously varying levels of trust that have declined in governments around the world,” said Gawande, speaking Thursday at the 2024 STAT Summit in Boston. “That is in many ways a bigger problem than health care.”
In the wake of the coronavirus pandemic, Gawande has urged public health leaders to stop juggling “one emergency after another” and invest in a long-term, global strategy. This recommendation stems from the last four years Gawande has spent lending his expertise on public health crises in countries outside of the U.S. as the assistant administrator for global health at the U.S. Agency for International Development.
During his first months on the job in 2022, Gawande said, he had to figure out how to supply Ukrainians with necessary medications after Russia invaded Kyiv and shut down the country’s pharmacies.
The conversation also turned to Gawande’s time as CEO of Haven, a health venture led by Amazon, JPMorgan Chase, and Berkshire Hathaway and launched in 2018 with the goal of curbing out-of-control costs and mediocre patient outcomes. Gawande stepped down as CEO in 2020, and the company folded in 2021.
“In the end, what’s crazy about health … is you are not rewarded for optimizing the outcome. You don’t financially win when you lower the costs,” said Gawande, explaining that public sector policy has an important role to play even in private efforts at health care reform.
While Gawande spends a lot of time now focused on addressing inequities in life expectancy around the world, the questions he is asking today are remarkably similar to those he posed a decade ago in his book about the end of life.
“When we are able to live, on average, an 80-plus-year life expectancy, we’re going to spend half our lives in the care of needing assistance along the way,” he said. That means it’s important to not just to extend people’s lives, but to understand their priorities.
“Whether it’s wearing a mask or taking cancer chemotherapy, the questions are the same,” he told the audience. “What are you willing to sacrifice? What are you not willing to sacrifice for the sake of more time?”
Correction: An earlier version of this story incorrectly implied that Russia invaded Ukraine in 2020. It was in 2022
