Friday, March 17, 2023

Opinion Today: Atul Gawande’s post-pandemic prescription

Covid decimated the health care system. It's time to invest in its recovery.
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By Susannah Meadows

Senior Staff Editor, Opinion

In Atul Gawande's 2014 book, "Being Mortal," there's a line that I've never forgotten. "There's no escaping the tragedy of life," he writes, "which is that we are all aging from the day we are born." Not the easiest reality to face, but for Gawande, honesty is a starting point for trying to make things better.

Now overseeing foreign assistance for global health at the United States Agency for International Development (U.S.A.I.D.), Gawande told me that in his writing, research and public health work, his goal is also: How do we make it real? "The surgeon in me wants to know, 'How do we do it meaningfully and get started now?'"

In a guest essay this week, he writes about another hard truth: the fact that by the end of 2021, Americans were dying, on average, three years earlier than they were before the pandemic, an astonishing decline seen planet-wide. He explains that while much of that drop is attributable to Covid deaths, the pandemic also killed people by doing damage to health care more broadly — disrupting treatment, diverting resources and driving health workers from the field.

In typical form, Gawande turns to how we can reclaim that loss. "But that requires holding on to our sense of urgency and moving beyond simply hoping things will turn around," he writes. "The aftermath of pandemics requires as much focus and response as the start. And the United States' leadership is crucial. We rallied the world to invest in emergency relief. Now, we must rally the world to invest in recovery."

He argues that our priority needs to be restoring the decimated ranks of primary health care workers. "Attention in crisis tends to focus on hospitals and emergency responders," he writes. "However, primary health workers deliver the vast majority of the services responsible for longer lives, including for stopping the next pandemic."

The other night, as we were finishing edits on his essay, I asked Gawande if he was a hopeful person, though I was pretty sure I knew the answer. He responded without hesitation: "Completely."

What Our Readers Are Saying

I'm a retired hospital R.N. who started my career at my local hospital in the eighties. Each decade that went by, profit became increasingly the priority. My job as a direct caregiver was to assess, document, teach (my patients and their families), and administer medications and treatments, in a compassionate, respectful manner. I retired a few years before the pandemic, leaving the profession years before I had planned to. I was constantly working short staffed, providing horrible care to my patients. I did a two-year stint as a nurse manager. Our weekly meetings with the director of nursing and monthly meetings with the C.E.O. were ALWAYS about money, how to save it, how to make more. I agree with this writer, we should be funding health care around the world. But until profit is taken out of health care in our own country, and the focus and the financial investment returns to the direct care givers (M.D.s and R.N.s), there will continue to be horrible outcomes in our country. — Nora, On A Remote Beach

As a family physician, I am grateful that Dr. Gawande places the responsibility for connecting patients with primary care on myself and my colleagues worldwide. Every day, I see patients whose self-imposed exiles from health care have resulted in delays in care of chronic diseases (hypertension and diabetes, foremost among them) and screening for cancer and other treatable diseases. We enthusiastically accept the responsibility for reconnecting our patients with a system that, prior to the pandemic, extended life spans and enabled detection and treatment of diseases at an early stage. Of course, this does nothing for the tens of millions of people without access to health care, owing to economic factors, race, gender, immigration status or any of a number of other inequities. We're going to need help reaching these people. — Famdoc, New York

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