In 2002, Ravi K. Sawhney moved to Washington, D.C. to look for any job that would allow him to work in health policy. An orthodontist by training, Sawhney describes himself as a person who likes to fix things. He chose orthodontics because he liked the way braces fixed his own teeth. Then he studied molecular and cellular biology to better understand how teeth move and develop ways to improve orthodontics. “But I started to realize that we’re not suffering from a lack of good orthodontists or molecular biologists,” he said. “It’s that we have weird policies that aren’t working to make health better.”

After two jobs on Capitol Hill, he landed in Building One, the Office of the Director of the National Institutes of Health campus in Bethesda, Maryland. The NIH, the largest biomedical research organization in the world, includes the National Cancer Institute, the National Institute on Aging, the National Institute of Mental Health, and 24 other institutes or centers. Its 2020 budget was almost $42 billion. The Office of the Director, which oversees the entire enterprise, is comprised of dozens of administrative units, including the Office of Science Policy. That’s where Sawhney was working when, in 2006, he learned of some new research findings that became his obsession.

By then, the U.S. had been losing ground on life expectancy, relative to other countries, for decades. The disparity had been attributed to America’s high poverty rate and racial inequality. But that reasoning became more complicated when a research team stumbled upon the fact that White Americans are significantly less healthy than the British. “It was a bit of a big shock,” Michael Marmot, a professor of epidemiology and public health at University College London who led the research, said in an NPR interview at the time. “I just didn’t imagine we’d find it consistently across the board, with worse health in the United States compared with England.”

Marmot — actually Sir Marmot, having been knighted in 2000 for his extensive research into health inequalities throughout the world — and three colleagues were trying to find out why poor people are less healthy than rich people. Because they were exploring how income and education influenced health independently of other factors, they looked only at non-Hispanic White people aged 55 to 64 in the U.S. and England. What they learned: In both countries, people with less education and income had worse health than their more advantaged countrymen. Writing in the Journal of the American Medical Association, they reported that White Americans had worse health than their British peers at all rungs of the socioeconomic ladder.

In Sawhney’s view, that should have prompted some introspection at the NIH. But in the ensuing years, Sawhney grew frustrated that America’s health disadvantage did not get high-level attention, even though additional research showed that older Americans were not just less healthy than their British counterparts, but less healthy than other Europeans as well. “When you find out that every other rich country in the world — without better technology, without more spending on biomedical research — is healthier, it undermines your case that what you are doing is right,” he said.

So he spearheaded the effort to get a bigger set of eyes focused on the issue. The National Academy of Medicine (then known as the Institute of Medicine) is a nonprofit organization that, as part of the National Academies of Sciences, Engineering, and Medicine, is authorized by Congress to advise the federal government on medical and public health issues. Its members are elected because of their important contributions to their fields, and it undertakes big-picture research studies on a contract basis along with the National Academies’ research arm, the National Research Council. In this case, the NIH funded research to review health data for all ages of life, not just older people.

Woolf was recruited to chair the panel; other members were primarily academic experts in epidemiology, demography, and economics. Many had spent their careers looking at international health comparisons, but none had ever seen the data for all health conditions in one place before. “There were many of us, including myself, who expected we would outperform some countries in some disease areas and underperform in others,” Woolf said. “But what was so stunning to us was that, with very few exceptions, we were consistently underperforming.”

Laudan Aron, now a senior fellow at the Urban Institute, a Washington D.C.-based think tank, was the Shorter Lives study director, responsible for editing and writing the report along with Woolf. Panel members were struck, she said, by how consistently the U.S. health disadvantage washed across Americans from all subsets of the population — rich and poor, highly educated and not, old and young. Members of some racial and ethnic minority groups have much worse health than their White compatriots, but even well-to-do, highly educated White people with health insurance suffered a health disadvantage because they lived in the U.S.

There were some bright spots. Americans who manage to reach the age of 75 live longer than their peers in other countries. The U.S. also has higher rates of cancer survival, better blood pressure and cholesterol control, lower stroke mortality, and lower smoking rates. But, compared to peers in other rich nations, many Americans do not live to see old age; since 1980, the U.S. has consistently had the first or second lowest probability of surviving to age 50.  Continue

Visual: Matt Anderson - - "Source" -

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