Speech given at the induction ceremony of the American Academy of Arts and Sciences, Sanders Theatre, Harvard University, Cambridge, Massachusetts, October 7 2017
The Past, the Present or the Future
By Gerald Chan
Whereas each of classes one through four consists of individuals in coherent fields of scholarship, class five is a diverse collection of people in business, education, public affairs, philanthropy, journalism, and more. As I am to speak on behalf of this medley of distinguished women and men, I can only do justice to the diversity by speaking on something that is of sufficient generality. I shall begin with life and time.
Axiomatic to all biological life forms is that life is bounded by time. We celebrate birthdays year after year to remember the beginning of life and to mark the progression of time. For a young person, this progression means growth, but past a certain inflection point, this progression equates to inching ever closer towards a terminus. The most primal assessment of a person’s life is simply how long did he live. I am cognizant of this conjuncture of life and time because much of what I do in biotechnology can be characterized as being in the business of giving life more time. Sometimes we succeed in bringing people back from the verge of expiration. Other times, the best we can do is to effect some form of disease modification and offer the patient an extended interregnum somewhere between life and death.
I remember when my grandmother turned 60, I thought she was really old. My childish perception was not too wrong because statistically, she could expect no more than another decade of life. At the dawn of the twentieth century, the life expectancy of an American person was 47 years. At the close of the century, that life expectancy had climbed to 77 years. Within the century that saw two world wars fought with ever more deadly weapons of mass destruction, humanity has also made great strides in the direction of beneficence.
Recent data, however, have called into question whether the success of this life extension project can continue ad infinitum. Two years ago, the world was stunned by a paper published by Anne Case and Angus Deaton (I should note that Anne is also being inducted into the Academy today) which showed that since 1999, death rates have been climbing among middle age, white non-Hispanics in this country. This phenomenon was not observed for comparable cohorts either from other ethnic groups in this country or from other developed countries in the world. More granular examination of the data reveals that this phenomenon was most pronounced for the less educated and that the leading causes of death were drug overdose, suicide and cirrhotic diseases of the liver resulting from alcohol consumption or viral infection. Geographically, the phenomenon was particularly pronounced in rural America and former industrial towns now left behind by a new economy powered by technology and globalization.
These data speak to the grip of social determinants on population health and life expectancy. Indeed, the earlier works of Sir Michael Marmot and others from the UK have shown a tight correlation between income and life expectancy. For example, Marmot followed a train line across the city of Glasgow in Scotland and showed that with every stop, income level dropped and life expectancy dropped in lockstep. He then repeated the study along a train line from Montgomery County in Maryland to Washington DC and saw the same concordance. For every one and a half miles along the railroad track, life expectancy declined by one year.
Such population health data are a glaring reflection of social conditions. The study by Case and Deaton reveals that in parts of America, people are dying the “death of despair” at an alarming rate. In a connected society, it is simply not possible that the plight of this dispossessed population will not be felt by all even though they may live in small towns and we live in prosperous metropolises like Boston. History shows that at a certain point, the dispossessed will radicalize the polity whether it be effected through violence or through the ballot box. Signs of this were clearly evident in the voting pattern of last November’s election. What happened in Charlottesville, Virginia this past summer will happen again as long as the same social conditions persist and irrespective of whether statues of Confederate leaders remain on public display. When the present is so unpalatable and offers no hope for the future, people will engage in a rabid pursuit of a vanished past, or worse yet, an imagined past.
The answer to reversing the decline in life expectancy is not a further increase in healthcare expenditure. America already spends 18% of its GDP in healthcare and yet the life expectancy of the American people is inferior to many nations which spend far lower percentages of their GDP on healthcare. We have long passed the point of diminishing return.
I submit that the answer lies in education which is one of the strongest positive determinants of life expectancy. It is baffling to me that year after year, healthcare expenditure grows in this country while the public sector budget dedicated to education shrinks. Witness the finances of the great state universities in this country. When I talk to my friends at UC Berkeley, I get the sense that the neglect by the politicians in Sacramento has the effect of dismantling that great university brick by brick.
Healthcare expenditure is an expenditure for the benefit of the present generation. Considering that the consumption of healthcare is weighted heavily in the latter years of people’s lives including especially end-of-life care, it may be said that such expenditures represent an attempt in stretching the past. Education, on the other hand, is what we give to the young. It is an investment in the future. If we accept that resources are finite and that debts will have to be repaid, spending on the past or the present cannot but be at the expense of the future. Between the past, the present and the future, there are hard choices — moral choices — that our society can no longer afford to sidestep.
If I am being recognized today for my philanthropic work, I’d like to note that for me, philanthropy is a voluntary departure from a rights-based rubric of how one relates to his fellow men to one that has its source in duty, empathy, community, an exalted view of man and an abiding commitment to the dignity of all. As much as we cherish rights, some natural and unalienable, over-assertion of rights does have untoward consequences. For the individual, it leads to narcissism, disregard for history and posterity, and will produce an atomized and alienated person. For society, it accentuates differences and risks social fragmentation and eventually breakdown of society. Such are the perils facing our nation today.
In 1780, this Academy was founded explicitly with the future of the nation in view. John Adams, one of the Academy’s founders, once wrote to his wife Abigail, “Posterity, you will never know how much it cost the present generation to preserve your freedom.” It is only right that each generation should make sacrifice for the good of its children. I recently attended a concert of Czech music in which I heard these lyrics:
Lord God, our Father
Turn your eyes on the multitudes,
Whose hands clasped in prayer reached for the weapons
In order to create bread for their children out of blood.
It is with this concern for posterity that we are being called to the Academy today. It is a calling to share in the stewardship of this country’s future. The American Experiment is as yet unfinished even though the American Century, in the lifetime of we the Baby Boomers, has come and gone. We press forward, still affirming that this is a nation conceived in liberty and dedicated to the proposition that all men are created equal.