Good evening. It’s a great honor to be here tonight with so many old friends, colleagues and mentors.
Victor, thank you for that warm introduction and the opportunity to speak tonight. And thank you for all you’ve done throughout your distinguished career to drive improvements in health care in the United States and around the world. Ever since I worked for and learned from you at Brigham and Women’s Hospital, you’ve been a tremendous mentor and friend.
Over the past 45 years, the work of the IOM -- now the National Academy of Medicine -- has had a profound impact on health care, providing rigorous evidence and being a clear voice of reason and wisdom when it’s been needed most.
During perhaps the greatest public health challenge of our time—the AIDS pandemic—the IOM helped shape our responses at home and abroad. In the mid-1980s, your advocacy and sharing of evidence of the then-newly defined epidemic increased public understanding and helped make AIDS a higher priority for federal research funding and public health activities.
In 1999, the IOM, with the leadership of another friend and mentor, Don Berwick, wrote the book on health care quality. With the publication of the seminal report To Err Is Human: Building a Safer Health System, we learned that health care was a decade or more behind other high-risk industries in its attention to basic safety. These data focused much-needed attention on quantifying and improving the quality of health services.
Today, the Academy continues to drive the quality agenda with its recent report, Improving Diagnosis in Health Care, which shows that many, if not most, patients will be harmed by wrong or delayed diagnoses at some point in their lives.
And these are just a few of the thousands of influential IOM studies.
So I’m pleased to be here to celebrate the Academy’s vast achievements over the past 45 years. In the basic and clinical sciences, in health policy and in so many other realms, the IOM and now NAM have made fundamental contributions. But I’m also here to issue a challenge: Don’t let your new name – the National Academy – define the horizons of your work, especially when it comes to the now enormous and rapidly growing field of global health.
With Victor Dzau in the lead, I know that there is little chance that the National Academy of Medicine will limit its focus to problems within our national boundaries -- because he has demonstrated throughout his own career that the health issues that need the greatest attention are global in nature, and they require an Academy with a truly global perspective and mandate. Also in keeping with Victor’s own convictions, I would add that the Academy should also have a particular focus on the poorest and most vulnerable populations, and a commitment to action. Indeed, my own career would not have taken the course it has without Victor’s insistence in the late 1990’s that I lead, along with my longtime colleagues and mentors Paul Farmer and Howard Hiatt, a division of Global Health Equity within his department of medicine at the Brigham and Women’s Hospital. Victor actually taxed the other divisions in the department to generously support us and I know I don’t have to explain to this audience the significance of that brilliant but also courageous decision.
I urge the NAM to increase its focus on global health for reasons that should give us all hope and inspiration. First, the interest in global health among students in the health sciences is enormous and growing. Second, we are seeing for thefirst time the possibility of what has been called a “grand convergence” in which health outcomes and life expectancy across the globe will begin to equalize. This won’t happen automatically but with entirely affordable investments over the next few decades, we can now envision a world in which lack of access to health care will NOT limit the potential achievements of any child born in any country in the world. Third, we now have clear evidence that investing in health is not only the right thing to do morally and ethically, it’s the SMART thing to do economically. Larry Summers has become one of our most important advocates and at a recent meeting at the World Bank Group, he said to the world’s finance ministers, if you don’t invest in better health outcomes for your people, you either don’t have a heart or you can’t count. In a seminal paper published a few years ago, Professor Summers and his colleagues argued that from 2000-2011, better health outcomes accounted for fully 24 percent of growth in “full income” in developing countries. I meet with nearly all of the world’s finance ministers twice a year, and I meet with the G20 finance ministers an additional two to three times a year, and believe me, I am sending this message loudly and clearly.
Going forward, let me suggest three areas where the Academy can have a profound and lasting impact on both national and global well-being and prosperity. These are: security, equity, and delivery.
First, security. We know from the recent Ebola crisis in West Africa that the world is sorely lacking in effective pandemic preparedness and response systems. In the 2010 report, Infectious Disease Movement in a Borderless World, the IOM was prescient on the challenges that emergent pandemic threats pose to U.S. and global security. As the Ebola, and more recently, the MERS outbreak in Korea have made clear, in today’s interconnected world even countries with advanced health systems put their health and economy at risk as long as there are countries, rich or poor, that are unable to deliver basic care or manage a serious outbreak.
I’m grateful to Victor and the Academy for taking on global health security with its forthcoming report on the lessons of Ebola. I am hopeful that your work will drive urgent global and national action to improve preparedness and response before we experience the next global health crisis – which we know is likely to be much more deadly and more costly. The most recent data we have suggests that an airborne pandemic today on the scale of the 1918 Spanish Flu could cost 33 million lives and at least $4 trillion dollars in lost income.
Second, equity. Take the example of child health. The last two decades have seen tremendous advances in lifesaving care for young children, and child deaths have been reduced by half since 1990. Yet today in sub-Saharan Africa, the rate of child mortality in developing countries is still 12 times higher than that in wealthy countries like ours.
Furthermore, a staggering one-quarter of all children in the developing world under the age of five are stunted. Because of poor nutrition and lack of appropriate stimulation, these children’s physical and cognitive development are permanently damaged. There is strong evidence – to which the Academy has contributed – showing that stunting leads to fewer neuronal connections and that in turn leads to poor schooling outcomes, lower adult earnings, higher incidence of chronic diseases, and other disadvantages. Those who are stunted will simply never have the same opportunity as their better-off peers to reach their potential.
It’s unconscionable that this disparity continues when the science and the solutions are startlingly clear. And as with security, ending stunting is not only a moral issue of helping the poorest and most disadvantaged children in faraway countries. It also has a major effect on global economic and social well-being, including right here in the United States. The US economy depends on a growing, vibrant global economy as trade between the US and the developing world continues to increase.
So let’s match the Academy’s unequaled research prowess with developing country policymakers, financiers and practitioners and put the science to work not only to save more lives, but also to implement practical solutions that will give every child an equal chance in life.
Third, let’s build a science of delivery. Whether we are talking about pandemic preparedness or early child development or a host of other global challenges, the real constraints are often not the basic science knowledge or clinical science evidence, but rather our continued inability to effectively deliver the treatments and interventions we already have. Let’s finally decide that a science of delivery or implementation or quality or whatever we want to call it, is every bit as important as neuroscienceor clinical epidemiology – and is every bit as essential for sustained impact on health outcomes. This is a lesson I first learned from my dear friend and mentor Howard Hiatt, who has been a pioneer in bringing molecular biology to the attention of the great teaching hospitals in this country after his work with Francois Jacob during the very year that Professor Jacob discovered messenger RNA. Professor Hiatt brought clinical research to the forefront through the clinical effectiveness program he founded with Lee Goldman in the early 1980’s and, more recently, to delivery science, through his support of the work of Don Berwick and so many of us who needed his help in mobilizing Harvard’s resources in many schools—business, medicine, and public health—to begin building this nascent multidisciplinary field.
With a concerted global push on improving delivery science, just imagine how profound the Academy’s global impact could be:
o You could help health systems extend their reach to the more than 400 million people in developing countries who currently lack essential, quality care; while helping ensure that 100 million people annually don’t fall into poverty simply to pay for the health care they need.
As Rudolf Virchow said,
Politics is nothing else but medicine on a large scale. Medicine as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution; the politician, the practical anthropologist, must find the means for their actual solution.”
As doctors and scientists, the National Academy of Medicine has been paramount among organizations trying, as Virchow suggests, to point out problems and attempt their solutions. But now I’m asking all of us to become equally “the practical anthropologist”—I dare not say “politician” to this crowd of physician scientists tonight, in this city—finding the means for the actual solution.
Just a few weeks ago, I announced that according to World Bank data, extreme poverty has now, for the first time in human history, dipped below 10 percent. But reaching the remaining 10 percent will be our hardest task, as these are people in some of the most desperate situations and some of the most remote corners on earth. But just as our oath compels us to administer care to the sickest and neediest patients, we should feel compelled to put our knowledge to work for the world’s poorest people who lack access to basic, lifesaving care.
At the World Bank Group, we’ve set ambitious goals to end extreme poverty and boost shared prosperity by 2030. But really our goals are the same: yours and ours. Only a few weeks ago, world leaders met at the United Nations and endorsed them as part of the new Sustainable Development Goals. Goal #3 is to ensure healthy lives and well-being for all. Or in other words, to deliver quality health care to everyone.
In 2030, we’ll also gather together to celebrate the Academy’s sixtieth anniversary. I hope at that time we can raise a toast to the critical role the Academy has played in solving the most difficult global health security, equity, and delivery challenges. We can only do that if everyone here tonight continues to insist that every person on this planet must taste the fruits of your labor, whether in the research lab, in the clinic, in the halls of power just down the road, or in the slums of Nairobi. The only way we will achieve a grand convergence in health outcomes is if we ourselves experience a grand convergence around this fundamental commitment – our work must benefit everyone, and not just those who can afford to pay.
As Martin Luther King said, the arc of history is long, but it bends toward justice. But the example of Dr. King’s life has taught us that the bend toward justice doesn’t happen on its own. We in this room tonight have the opportunity to grab that arc and bend it toward justice. Through better health outcomes for everyone, we can become the first generation in human history to end extreme poverty. I hope that we’ll meet again in 2030 to celebrate that historic achievement together.