The following speech was delivered by Victor J. Dzau, MD, President of the National Academy of Medicine (NAM), at the NAM Annual Meeting on October 16, 2017. View a video of this address.
As the president of the National Academy of Medicine, it is a privilege to serve all of you and the nation.
One year ago, I stood before you reporting on our progress in our first year as a full Academy. And at last year’s President’s Forum, our distinguished panel, including Mark McClellan, Tom Daschle, Mike Leavitt, Risa Lavizzo-Mourey, and Larry Tabak — discussed the future directions of health and health policy in anticipation of the upcoming Presidential election. Now, one year later, it is safe to say that since the election, our world has been full of surprises and unexpected developments. The Chinese have a famous saying: “May you live in interesting times.” Well, we are living in interesting times indeed — often filled with uncertainty about the future. This uncertainty extends to developments in health and medicine. I’m sure you are all too aware of the tumultuous attempts by Congress and, most recently, by the U.S. President to repeal and replace the Affordable Care Act. Indeed, the plans and actions of the new administration and Congress have raised significant questions about the future of our nation’s health and health care, our investment in biomedical research, and U.S. support for global health. These uncertainties have shaped much of the NAM’s activities in the past 6 months and have kept us very busy. As the nation’s premier independent and trusted advisor for health and medicine, our work is more important than ever.
Health Care
As the Institute of Medicine and now the National Academy of Medicine, we are ready to serve the nation, just as we have for decades, regardless of which party is in power. We can and will continue to have real influence on the future of health and medicine in this country. How? By continuing to do what we have always done so well: provide independent, objective, and nonpartisan advice to policy makers and the public. Indeed, this is the foundation upon which our reputation is built, and this is why our voice carries real weight.
The debate around the repeal of the Affordable Care Act is one such issue. There is a desperate need in our nation for a blueprint to build a better health care system that control costs and improve health outcomes while providing access for all. This is why we launched our Vital Directions for Health and Health Care Initiative. This nonpartisan, evidence-based effort addressed soaring health care costs, disparities in health, the burden of chronic illness and disability, and other national challenges. We identified three core goals: better health and well-being, high-value health care, and strong science and technology. Informed by 19 policy papers addressing key issues in health and medicine that were written by 150 of the nation’s leading experts, Vital Directions called for the nation to focus on the ultimate goal of improving health for all through an effective health care system – one that not only helps people prevent and treat their ailments but also helps every American reach their best health and well-being. Our publications captured significant public and private attention. We believed that the messages from Vital Directions could serve as important guideposts for members of Congress and the White House as they debated the future directions of US health care. Since March, we met with more than a dozen members of Congress in both parties, including the chair of the Senate HELP committee, House minority leader, and the former Secretary of HHS as well as leaders of the FDA and CDC, to discuss how the findings of the Vital Directions initiative should inform future health reform. In our discussions, we emphasized that as a nation we must refocus on the fundamentals needed to improve health: we must ensure access to health care that is both high-quality and affordable. The conversations, though difficult, generally went well, and we will continue pressing this message as Congress tackles this challenge, hopefully in a bipartisan manner moving forward.
Speak Up for Science and Evidence
Another area that is important to the future of health and medicine is investment in biomedical research. As you may recall, the Administration’s proposed 2018 budget slashed the National Institute of Health’s funding by about a fifth, or $5.8 billion. Fortunately Congress instead bolstered funding by $2 billion for the remainder of FY 2017, and now it appears that the NIH may receive a minor increase in 2018. This is an encouraging development. However, final outcomes are still far from certain, and our Academy will continue to reach out on this issue in the coming months. In these challenging times, we must stay true to our mission and values, and that means standing up for the crucial role of science and evidence in guiding policy decisions. There is no denying it — research and evidence are under siege on many fronts. Let me put this simply: science is not a political issue. In fact, science can and should unite us, because its benefits belong to everybody. Science improves human living, cures diseases and keeps us healthy. It lifts nations out of poverty, and helps us understand ourselves and each other. Science will predict the next hurricane and help design infrastructure that can withstand it. Science is sparking our children’s imaginations and fueling our economy. Science is not, and should not be, an ideological issue. People’s lives hang in the balance. Today, we must reaffirm the NAM’s commitment to science and evidence. It’s an essential foundation for any policy affecting our lives and livelihoods. The National Academies are in a unique position to take on the most controversial issues and provide society with reliable and effective solutions. Now more than ever, in this age of junk science and willful ignorance, even manipulation, of hard-won scientific truths, we must remain dedicated to advance science and evidence and to defend it vigorously. I often refer to a quote from Albert Einstein engraved on the wall of the National Academies Keck Center – a daily reminder for me and my staff. Einstein said: “The right to search for truth also implies a duty; one must not conceal any part of what one has recognized to be true.”
When trust in science and evidence begins to erode, the consequences can be dire. The anti-vaccine movement is a perfect example. Some parents – including some well-off, well-educated parents — mistakenly believe that vaccines cause autism or might otherwise somehow harm their children, even though we at the NAM and many other medical organizations have repeatedly debunked the junk science that fueled these concerns. Just look at what happened in Minnesota, which reported 79 cases of measles in 2017 — more cases than there were in the entire country last year. It turns out that for a few years prior to this outbreak, anti-vaccine groups that falsely touted a link between vaccines and autism targeted a specific community and preyed on parents’ fears by repeatedly handing out literature and speaking at community health meetings. As a result, many parents opted out of vaccinating their children, and the vaccination rate in this community in Minnesota dropped dramatically: from 92 percent in 2004 to just 42 percent in 2014. This is especially frustrating because we know without a doubt that such outbreaks are entirely preventable. We can’t afford to go backward — not on vaccines, and not on any other issue that science has settled.
We should also make our voices heard when evidence is being ignored or misrepresented. At a town hall meeting discussing the repeal of the Affordable Care Act, a member of Congress said, and I quote, “Nobody dies because they don’t have access to health care.” This claim was widely criticized, and for good reason — because the evidence says just the opposite. People do die when they don’t have health coverage. One of our own IOM reports, from 2002, found that approximately 18,000 Americans die each year because of lack of health insurance. Newer data suggest that number may be as high as 45,000. All too often, in discussions of controversial issues, evidence is disregarded or cherry-picked to support one side or another. This happens frequently in debates on immigration policy. I’m a proud American who is also a grateful immigrant. I would assume that most of you sitting in this room are also immigrants or descendants of immigrants. Indeed, we are a nation of immigrants. If we want to strike the right balance on immigration policy, we need a full examination of the evidence.
Fortunately, a recent National Academies report provides a comprehensive assessment of the economic and fiscal impacts of immigration based on evidence from the last 20 years. While the short term effects of immigration on government budgets are mixed and vary considerably across states and localities, the report finds that immigration brings long term measurable benefits — including in economic growth, innovation, and entrepreneurship — with little to no long-term negative effects on the overall wages or employment of native-born workers. For these and so many other issues, science and evidence can – indeed must — guide the debate. This is why the NAM and its members must speak up for science and evidence. In fact, as scientists, health professionals, and experts in our fields, all of us share in this responsibility. As NAM members, you are the flag bearers for science-based policy in health. We can and must share our knowledge with as many diverse audiences as possible. There is no other option if we want to continue building on the remarkable progress in health and medicine we’ve made in recent years.
Communication and Dissemination
It is even more critical now that the NAM’s work is shared far and wide. Our reports and initiatives will have little impact if policy makers and the public aren’t aware of what we have to say. At the heart of our communications strategy is understanding our audiences and involving them at every stage of our work – from conception to completion – and being sure that we invite them to be active participants and contributors, rather than passive receptors of our messages. And we’re making a major effort to engage groups beyond the usual suspects – particularly, to build awareness of our work at the community level – and to communicate through new mediums.
We are developing innovative programs at the National Academies such as
- America Asks, Science Answers
- From Research to Reward
- Koshland Public Engagement Program
- Culture of Health Community Art Show
- “Knowledge Hubs” to share information about promoting clinician well-being & building a culture of health
Another important area is our effective use of social media, and we are making a concerted effort to ramp up our presence online. Nowadays, many more Americans are getting their news through Twitter, Facebook, and other social media channels. The National Academies have a combined Twitter following of well over 100,000, but we need more followers. We need to be the trusted source and the go-to place for issues related to science and evidence. Then, when an issue like climate change, immigration, or vaccine safety enters the news and then the Twitter feeds of Americans, we will tweet a quick, easily understood reminder of the evidence. We aim to be the same trusted voice to the American public as we are in the halls of Congress. Going forward, we will need your help to develop our communication outreach. We are exploring strategies to equip NAM members as ambassadors for our work in your own communities. Keep an eye out for more to come on this — and let me know if you would like to become involved.
NAM Priorities
In these interesting times, it’s critical that the NAM is proactive in taking on issues important to our nation and the world. As you know, the challenges facing society in health and medicine are enormous. Our work must make a difference in the lives of the people we serve. In this next segment, I would like to review our priorities using examples of the work we have taken on. We have identified three priorities for the Academy that have guided our work for the past three years:
- Respond to critical and pressing issues
- Advise the nation and the world on the future of health and health care, and
- Lead and inspire for the future
First, the NAM and the Academies must provide guidance and leadership on the most critical societal issues concerning health and medicine. It’s hard to think of a more pressing issue right now than the opioid addiction crisis. Indeed, the US President has designated the opioid epidemic a national emergency.
The health community has an urgent responsibility to do its part to right the course. In July, the National Academies released a consensus study that lays out regulatory strategies to counteract opioid over-prescription and misuse. And just last month, we released an NAM special publication, in collaboration with the National Governors Association, which outlines actions for care providers. As the NAM, we also must respond to critical issues in emerging areas of science and medicine. That’s what we’ve done through our Human Gene Editing Initiative, which we launched together with the National Academy of Sciences to provide leadership on this rapidly advancing area of research. Precise new editing technologies such as CRISPR have greatly expanded interest in genome editing research to improve human health. But they also raise concerns and present complex challenges, particularly about the possibility of modifying the human germline.
We kicked off our initiative in 2015 with an international summit, which we co-hosted with the Chinese Academy of Sciences and the UK’s Royal Society. And in February 2017, we released a comprehensive report, under the leadership of co-chairs and NAM members Alta Charo and Richard Hynes, that provides guidance on the science, ethics, and policy of this important research. Our initiative has sparked international dialogue on human gene editing research. We are in ongoing discussions with the Chinese Academy of Sciences and the Royal Society about how to continue this dialogue. Also this year, we began addressing another pressing issue in health care: the epidemic of clinician burnout, depression and suicide. It is a serious, pervasive, and all-too-often overlooked or hidden problem– as many as 400 physicians commit suicide each year, double the suicide rate of the general U.S. population. That’s deeply disturbing to us as health professionals, but even more so when we consider the impact on patients and society. To take on this complex problem, we launched an Action Collaborative on Clinician Well-Being and Resilience, co-chaired by Darrel Kirch, Tom Nasca, and myself, to bring together representatives from professional organizations, health care centers, government, payers, technology vendors, and other stakeholders. Fifty leading organizations such as AAMC, ACGME, AMA and others serve as members of the core sponsoring group; and another 80-plus participate in our broader network.
We are planning a set of collaborative activities, grounded in evidence-based knowledge, to (1) assess and understand the underlying causes of clinician burnout and suicide, and (2) advance multifaceted solutions that reverse these damaging and disturbing trends. So I think you’ll agree that the NAM is being proactive in responding to these and many other critical and urgent issues in health and medicine. A second priority for our Academy is to continue to advise the nation and the world on the future of health and health care. Earlier, I discussed the impact of our Vital Directions initiative shaping health and health care priorities going forward. Another example is our Culture of Health Program. We all know that individual health is shaped by economic and social factors, such as geography, poverty, and structural racism, and it is NAM’s obligation to act. With generous support from the Robert Wood Johnson Foundation, this multiyear collaborative effort will identify strategies to create and sustain conditions that support equitable good health for all Americans.
We are working with stakeholders from multiple sectors and regions across the U.S. to impact policy, science, and practice to improve many of these social determinants of health. In January, we released the first consensus report, titled Communities in Action: Pathways to Health Equity. The report focused on root causes of health inequity, and laid out several specific approaches for communities to take in order to address this. We’ve also conducted a series of “listen and learn” meetings in diverse communities across the United States to hear concerns and share strategies for improving health. We plan to undertake two more consensus studies in this coming year. The NAM’s third priority is to lead and inspire for the future. As the leading Academy for health and medicine, we can galvanize the nation and the world, and activate public-private engagement to tackle big problems that are of enormous importance to society. Grand challenges are big – often audacious – goals that require visionary thinking and broad, sustained collaboration across disciplines – academia, industry, philanthropy, government, and the public.
Our inaugural Grand Challenge in Health and Medicine is focused on Healthy Longevity. By 2050, people age 65 or older will make up a full 20 percent of the U.S. population. And the projections are even higher in some countries around the world, such as Japan. Without action, this could put a significant strain on economies, health care systems, and societies around the world. We urgently need solutions from biomedical, behavioral, and sociological research that will keep us healthy, productive, functional, and free of disease as we age. With the right solutions and actions, healthy aging can become a major opportunity rather than burden for our society. The NAM grand challenge will have two components. First, we’re considering a strategic, comprehensive, global initiative called the Global Roadmap for Healthy Longevity. This will provide an assessment of the challenges and opportunities presented by global aging. The Roadmap, which is still under development, will consider issues and solutions pertaining to science and technology, community and social determinants, health care and social systems, practice and policy. Second, we plan to establish a program of Grand Challenge Awards and Prizes. This initiative, led by Tachi Yamada, Bob Horvitz and others, will stimulate transformative science by inspiring biologists, engineers, social scientists and others to come together as teams to identify important breakthroughs that could mitigate, if not reverse, the degenerative effects of aging and to develop technologies that will transform the lives of the elderly and significantly improve health span. It is our hope that this Grand Challenge will significantly advance science and medicine and mobilize public support and awareness around this common goal.
Global Health
A lot of the issues I’ve touched on so far center around U.S. challenges. But let me be clear: Just as science and medicine are increasingly international endeavors, our Academy is more committed than ever to help guide policy not only here in the U.S. but also around the globe. It’s undeniable that the health and prosperity of any one nation – including our own — is very much dependent on the health and well-being of others. In our global economy, improving international health is essential for economic security and prosperity here in the U.S. At a time when the U.S. appears to be pulling away from international engagement, the National Academies are playing a crucial role in providing much needed leadership and guidance in this area.
That’s why a recently-completed National Academies study is particularly timely. It makes a strong case for continued U.S. government investment in global health to maintain the success of recent decades. Four critical priorities are laid out: pursuing global health security, addressing continuous communicable threats, saving and improving the lives of women and children, and promoting cardiovascular health and preventing cancer. But the report highlighted that the way global health is conducted needs to be reevaluated and cannot be “business as usual.” Improving global health access, affordability, and outcomes will require scientific and technological innovations, new and appropriate incentives to catalyze research and development, and diversification of the sources and mechanisms of global health funding. The NAM is committed to ensuring that this important report has lasting global reach. We’ve published a Special Report in the New England Journal of Medicine and a Commentary in the Lancet. We also organized a dissemination meeting in conjunction with the World Health Assembly in Geneva. And we met with key administration officials at the White House and with U.S. national security staff. We are also planning a global health symposium later this week in Atlanta to further focus on these issues.
What’s Next for the NAM?
Now that we have established ourselves as an academy, we are looking to position ourselves for the future. Yes, we’ve accomplished a great deal in the past two years. And when you count our legacy as the Institute of Medicine, we’re approaching five decades of service to the nation and the world. In 2020, we will be celebrating our 50th anniversary. But how will we build upon this success going forward? What kind of future do we envision, and how will we get there?
Many of you have been advising us on this issue lately. I have enjoyed hearing your thoughts at the informal regional gatherings of NAM members. I’m exceedingly grateful to those of you who have volunteered your time and expertise as members of the planning committee that created our strategic plan for the next five years. Simply put, our vision is a healthy future for everyone. And we developed a new mission statement: To improve health for all by advancing science, accelerating health equity, and providing independent, authoritative, and trusted advice nationally and globally. In everything we do, we will adhere to our core values:
- scientific excellence and rigor,
- objectivity and independence, and
- diversity, inclusion, and equity.
Our mission statement and values will inform our work going forward. But how will we put this into practice? First, as we have already discussed, we have to be proactive in taking on the most critical societal issues concerning health and medicine. Next, we want to increase the NAM’s capacity for doing the work we do. That means a significant investment in building a sustainable infrastructure, with an engaged and diverse membership and staff who can help implement a broad portfolio of work. Third, we need to be proactive in establishing a diverse membership for the future. I’d like to underscore this point: Diversity is not just a buzzword for this Academy – it is a key element of our strategic plan. The NAM is committed to building a more diverse and inclusive membership and engaging younger emerging leaders and scholars to be sure we are prepared to address new challenges and evolving contexts. That’s why we established the Emerging Leaders Forum to increase our engagement with exceptional early- and mid-career professionals working in biomedical science, health care delivery, health policy, and related fields. These future leaders gain exposure to the Academies activities and mentorship and in turn the NAM is connected to a broader network of new energy and perspectives and provides a mechanism to learn what issues younger generations consider the most critical. As I discussed earlier, we’ve worked hard to establish a strong global presence. But we can’t stop here – we need to do more to increase our international engagement. Finally, we will continuously monitor and evaluate our progress toward our mission. We are forming working groups to establish plans for implementation of our strategic plan including setting benchmarks for measuring successes and making adjustments as needed. I have no doubt that we’re going to accomplish great things in the years ahead. But we can’t do it without you. We wouldn’t be here today without our incredibly talented and dedicated members and supporters. We’ll need your ideas, your commitment, and your dedication. We’ll need your expertise and enthusiasm.
