Atul Gawande will shape global health policies under President Biden
This week, President Joe Biden nominated Atul Gawande as the Assistant Administrator of the Bureau for Global Health, United States Agency for International Development (USAID).
USAID’s goals include protecting America’s security at home and abroad. In fiscal 2021, it had a budget of $41 billion, of which $11 billion was spent on global healthcare.
In 2019, USAID and its partners around the globe helped 84 million women and children access essential health services; helped protect 94 million people from malaria by distributing over 47 million mosquito nets; and reached more than 24 million women and couples with voluntary family planning services.
Gawande has done extensive research and has decades of experience in these areas. He recently served on President Biden’s COVID-19 taskforce.
Earlier, he led teams that created simple, scalable tools that rapidly changed medical practice nationally and globally during critical moments: a hospital worker checklist during the 2014 Ebola Virus Outbreak; a checklist for prescribing opioids to those in chronic pain; and a patient care checklist for the 2009 H1N1 (swine flu) epidemic.
This week President Biden also nominated Rahul Gupta, another Indian American, to tackle the soaring opioid deaths in the U.S. as the Director of National Drug Control Policy.
Innovation is the simple solution
Through his clinical practice, his writing and public health research, Gawande found that the fundamental disease of health care systems is lack of execution. The cause is complexity. The solution is health systems innovation.
To drive solutions, Gawande has launched several start-ups and built coalitions across the health care, technology, and other business sectors. He helped design a sponge-tracking technology, now sold as the SurgiCount Safety-Sponge System, that has eliminated for hospitals in the U.S. one of the most persistent, harmful, and costly surgical errors: forgetting sponges in patients during procedures.
In 2012, Gawande became the founding executive director of Ariadne Labs. He built the Boston-based center from a research start-up into a leader of health systems innovation. With 100 employees and more than 100 affiliate and associate faculty members across the Harvard medical system, it has around $20 million in annual revenues.
Gawande and his team at Ariadne have designed and tested healthcare solutions, including crisis checklists to prevent life-threatening errors in surgery, childbirth and to improve care for those with serious illness.
Writing to understand issues he could not explain
Around 1995, Gawande started writing after an editor friend asked him to write a column on being a doctor. Though he struggled at first as he told a reporter for The Denver Post, he enjoyed the process. “A lot of the topics I ended up writing about…were often things patients ask about and I don’t have answers for, and I wanted to get answers.”
Gawande is the author of four best-selling books. In his first book, Complications: A surgeons notes on an imperfect science, using true cases he explores the power and the limits of medicine. The book, a 2002 National Book Award Finalist for Nonfiction, describes a science not in its idealized form but as it actually is―uncertain, perplexing, and human.
In The Checklist Manifesto – How to get things right, Gawande finds a remedy in the simplest of techniques: the checklist. First introduced decades ago by the U.S. Air Force, checklists have enabled pilots to fly sophisticated, complex aircraft.
Gawande takes us from Austria, where an emergency checklist saved a drowning victim who had spent half an hour underwater, to Michigan, where a cleanliness checklist in intensive care units virtually eliminated a type of deadly hospital infection.
Now checklists are being used in hospitals around the world, helping doctors and nurses respond to everything from flu epidemics to avalanches.
In a 2010 New Yorker essay titled Letting Go, Gawande asked, What should medicine do when it can’t save your life? That question led Gawande to write Being Mortal: Medicine and What Matters in the End. With his accompanying Emmy-nominated documentary, the launch of the Serious Illness Care Program at Ariadne Labs, and the co-founding of the Massachusetts Coalition for Serious Illness Care, Gawande played a key role in transforming the understanding of how to better care for individuals facing serious illness.
Tackling healthcare costs as Haven CEO
In July 2018 Gawande was hired as chief executive of Haven, an independent organization not motivated by profit. It was an ambitious effort to reduce healthcare costs by three billionaire CEO’s: Jeff Bezos of Amazon, Jamie Dimon of JP Morgan and Warren Buffett of Berkshire Hathaway.
They launched Haven, “because they have been frustrated by the quality, service, and high costs that their (1.2 million) employees and families have experienced in the U.S. health system.”
Big companies in the U.S. spend an average of $20,000 a year to provide medical insurance for each of their employees and their families. This major cost for companies rises by about five percent a year.
In 2020, Gawande left Haven and the business was shut in January this year.
The son of Indian immigrant physicians, Gawande grew up in Athens, a small town in Ohio. Following degrees at Stanford and Oxford, he developed an interest in health care policy as a Congressional staff member. He then became the chief health and social policy director for the 1992 presidential campaign of Bill Clinton.
After a year with the Clinton administration’s unsuccessful effort at healthcare reform, he returned to complete his medical degree at Harvard.
For more than two decades, Gawande has worked on both direct patient care and population-level impact, asking a question: How do we fix health care systems to deliver better care for every person everywhere?
He will soon be pursuing fixes for major global healthcare issues, If confirmed as a top official of USAID by the U.S. Senate - which is likely. He will lead the agency’s global efforts, which focuses on three priorities: preventing child and maternal deaths; controlling the HIV/AIDS epidemic; and combating infectious diseases.
As Gawande notes, at the heart of his work is a commitment to the highest principle of medicine: All people have lives of equal worth.