The proposed 20% cut to the National Institutes of Health budget would spark much less furor if we clearly differentiated “health” from “medical care”. More medical care – more advanced, more techy, more whatever – does not bring more health or longer lives, and it never will.
“Americans already live shorter lives and suffer more health problems than our peers in other high income countries.” American Public Health Association’s, Dr. Georges C. Benjamin is right on the money until he uses our shorter lives to decry the NIH cuts as “putting us further away from this goal.”
Really? These other countries spend LESS on medical care than we do. They live longer largely because they put resources into the social determinants of health status – things like early childhood education, housing, income support, and public health infrastructure. (For a terrific book on this, try The American Health Care Paradox: Why Spending More is Getting Us Less.)
If we wanted to lengthen the lives of African American males age 10 – 24, for example, we would work on the disease of violence and homicide. Murder is the reason for half of all deaths in that age group. If we wanted to lengthen the lives of middle-aged white Americans, we would work on the social stigma of opiate addiction. Drug addiction is one of the main reasons that American whites’ are dying younger now than in the past.
Yet, this is not what the NIH works on. Their focus on biomedical research is not their fault; it’s just too narrow, excluding the much larger drivers of health status. For example, NIH has a “Brain Initiative” which “will help reveal the underlying pathology in . . . Alzheimer’s disease, autism, schizophrenia, depression, epilepsy, and addiction.” This is a far cry from the immediate need for stable housing – something that has been shown to ease symptoms of alcohol addiction and reduce need for emergency care. (Yes – I’m putting apples and oranges into the same basket by comparing biomedical research to social programs; both demand the same color of money and other resources from us.)
By pouring billions into medical research and starving proven health-promoting social programs, we are squandering health and life – not saving it. When we could improve and lengthen thousands of lives by homicide prevention, why are we instead spending inordinate resources on medical care that will affect only those who can afford it? Meanwhile, the “those-who-can-afford-it” club gets more exclusive every day.
Patients’ lives are at stake, say the pundits. I disagree; everyone’s life is at stake.
The money cut from the NIH budget – if it ever gets that far – will not likely go to these other facets of health. For that reason, I’m a tepid supporter of the proposal. The day may come when we face the real tradeoffs we are making and I hope we shift our resources to things that create health, not more medical care.