In the late 1970s, President Carter tried to stand up tougher federal enforcement for a nationwide 55 miles-per-hour speed limit established in the name of fuel conservation and public safety. But opponents were in a big hurry to put the brakes on that idea, said Atul Gawande, assistant administrator of the Bureau for Global Health at the U.S. Agency for International Development, or USAID.
"We in public health could say, 'We can quantify how increasing the speed limit would cost thousands of lives,' and the country still said, 'Too slow, it's just too slow. We're going to take that risk, we're going to tolerate that higher rate of death,'" Gawande said Friday at a Johns Hopkins Health Policy Forum event. A shift toward deploying counter measures like anti-lock brakes instead is just one example of the balance public health experts have to find to achieve the greater good, he said.
Gawande, a public health leader, surgeon, and writer, joined Johns Hopkins Bloomberg School of Public Health Dean Ellen J. MacKenzie for Friday's virtual conversation, which touched on the COVID-19 pandemic, improving the delivery of primary care and mental health services around the world, and what MacKenzie and Gawande agreed might be the greatest challenge facing the public health community: widespread skepticism, which has plagued the nation's response to the COVID-19 pandemic.
"As scientists we need to understand where the line is between politics and public health," Gawande said. "I think there has been a legitimate dialog around the risks that people want to take and accept around the country. … We need to address questions of who is harmed and whose harm are we willing to accept or not. But at some level we have to be clear that many of these questions fall into the political arena, where we have reasons to advocate the same way we advocate for people to not smoke, the same way we advocate for our patients in primary care to wear their seatbelts and cut back on high-risk alcohol use, and to be vaccinated. But there are competing values, and being clear when we are making a political choice as opposed to the scientific one is an important space for us."
Despite the challenges—and perhaps because of them—Gawande seemed excited about the future of public health scholarship and encouraged students who were watching the livestream forum to put their individual strengths to work for the cause.
"If you care about improving the human condition, there couldn't be a field more exciting to enter," Gawande said. "We're facing a generational challenge about how to enable our capacity to give people long, healthy lives and have a chance to achieve their potential. Whether you are interested in being a doctor, nurse, physician's assistant, or dentist, or you're a quantitative person who needs to help us solve what's the cost-effective way to make our choices and deliver solutions, there's possibilities for everyone. For almost any skill set, it's just a matter of are you excited about solving some of the most complex challenges in the world and doing work that is meaningful and makes a massive difference."
Gawande is the fifth expert to participate in the Health Policy Forum series, which launched in fall 2020 to highlight the university's engagement with key leaders on matters of health policy and health care. Previous events featured Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (October 2020); Rochelle P. Walensky, director of the U.S. Centers for Disease Control and Prevention (May 2021); Robert M. Davis, CEO and president of Merck (October 2021); and Chiquita Brooks-LaSure, administrator for the Centers for Medicare and Medicaid Services (January 2022).
The Health Policy Forum series is jointly hosted by Johns Hopkins University's Bloomberg School of Public Health, Carey Business School, and School of Nursing along with Johns Hopkins Medicine.