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Like every new administration, this new one inherits a country facing many challenges. These include challenges in our energy sector, at our border, the emergence of natural disasters, and the geopolitical tensions that threaten to destabilize our world. They also include, centrally, challenges in health.
The U.S. faces a range of problems that have held our health back relative to peer countries, such as substance use, gun violence, chronic disease, mental illness, and deep inequities that have created pockets of persistent poor health among populations. For example, black Americans sicken and die at a much higher rate than white Americans from a host of health challenges, such as diabetes, heart disease, and asthma. Black maternal mortality is also higher, as is the likelihood of this population being injured or killed by gun violence. The scale of these problems echoes the scale of health challenges we see at the global level, including under-five mortality, the threat of infectious disease, and inequities in health that concentrate a disproportionate burden of poor health in certain regions.
These challenges raise the question: How do we create health? This question is core to public health, and our efforts to answer it have yielded a great deal of data on how to build a healthier world. Building a healthier world takes creating healthy conditions, such as clean air and water, nutritious food, accessible education, livable wages, and an end to the misogyny and racism that deprive many of opportunities for health achievement. Ensuring these conditions can play a decisive role in improving health locally, nationally, and globally.
Ultimately, our decisions about health at the collective level are political choices. Politics is about resource allocation and energy within a society, an allocation that is central to whether we can live healthy lives. This means that, while it may seem harsh to say it when we see our health lag behind the health of peer countries, we are seeing the results of a political choice we are making—and that we could, if we wanted to, unmake.
Sometimes, what may appear to be a rejection of health is a reasonable engagement with the tradeoffs in a particular policy under consideration. During the pandemic, for example, there were conflicting opinions within public health about how to approach lockdowns. These opinions reflected the complexity as much as they reflected philosophical differences within the field. In 2020, we faced a novel virus, in the context of evolving data and a bright media spotlight on public health. Under these circumstances, some thought the moment called for an effort to drive COVID cases down to zero chiefly by embracing open-ended lockdown policies, prioritizing safety from the disease over other considerations. Others saw lockdowns as a more temporary measure, a blunt but necessary response to our early, less-informed engagement with the virus, which came with its costs in educational disruptions, isolation, and inequalities between those who were able to more easily adapt to a fully remote life and those who were not. Choosing to curtail lockdowns later in the pandemic, in recognition of these tradeoffs, was not a rejection of health, but an effort to balance competing factors in the creation of the conditions that support it.
But, more often than not, I think, we turn aside policies that would support health not after thoughtful consideration of tradeoffs but because of shortsightedness in our engagement with health, a spirit of neglect that too often characterizes the politics of the issues that determine the health of populations.
For example, a range of ingredients go into the food we eat, some of which are good for us, some of which are bad, and some have an ambiguous nutritional value. The reason many companies use these foods often has less to do with taste and health and more to do with using the cheapest possible ingredients to create a product that turns a profit. We could more effectively regulate companies, as many European countries do, to ensure our foods are healthier. We could stop subsidizing the production of cheap, unhealthy ingredients such as high-fructose corn syrup. We could more aggressively take on the entrenched corporate interests that have kept our national diet less healthy than it could be.
These are political choices we could make to become healthier. That we have not yet made them, reflects, in part, the difficulty of a real reckoning with the political forces that help keep our food, and our populations, unhealthy. But politics is not an arena for easy struggles and quick victories. It is, as Max Weber said, “a strong and slow boring of hard boards.” Choosing to be healthy at the political level is not an end but a beginning, the start of what is often a difficult path to enacting policies that support a healthier world. We should be clear-eyed about this. Making the political decision that health matters is committing to the long-term task of making the world healthier. This means bringing together stakeholders to build a big-tent movement for health, marshaling energy and resources, and investing in the policies and infrastructure that support health. It entails detail, complexity, and hard work. It starts with the political choice that health matters. Everything else flows from that.
In this time of high political dudgeon, it is our job to make the right political choice, to choose health. Perhaps this choice can help shore up our commitment to local and global impact in this moment—because health is interconnected and creating a healthier world for some means creating a healthier world for all, the ultimate lesson of the COVID years. This means pushing forward a politics that guides us in a healthier direction, supporting science, and shifting values toward a more robust consensus that health matters and is worth striving for, and, at times, struggling for.
This also appears in Substack.
