Building a Healthy America

Why systems and access matter more than wellness fads

I see a lot of comments floating around lately asking, "Why don’t doctors, scientists, or public health folks want to make America healthy again?" And I want to say this clearly— we absolutely do care about health. So many of us have dedicated our lives to exactly that. In fact, you can see this article from 2016 from the Boston University School of Public Health that gives 10 examples of things that can help make Americans healthier.

So the issue is not the goal, but how we get to that goal.

Because improving health isn’t about removing food dyes or banning ingredients. It’s not about tossing out medications or vaccines. Those things are easy to focus on and serve as distractions. They’re not the real issues. I know this, because I have lived it (and plenty of data backs it up).

Photo by James Cousins on Unsplash

My story

I grew up poor. Not just the poor where we needed a strict budget, but really poor. My dad left when I was around ten, and while he paid rent and utilities, he gave us just $20 a day for groceries. That’s what we lived on – if we were lucky and he remembered to drop it off. My mom didn’t drive or work. There were days we didn’t know if we’d eat. I imagine now how often my mom probably went hungry to make sure we didn’t.

We ate the food we could afford which meant there was a lot of pasta, frozen meals, very little variety and very little fresh food. I didn’t have red meat until I was a teenager. I didn’t try seafood until my college mentors took me out for some before I moved to Maine.

And while food access was hard, healthcare access was even worse. I had chronic health issues as a teen, and we couldn’t always afford to go to the doctor or pay the co-pays. Forget dental care, I had to have teeth pulled as a child, and then struggled to access dental care until I was in my twenties.

We didn’t have the time or resources to exercise much beyond walking a lot because my mom doesn’t drive. But that also wasn’t enough to fix the health issues we dealt with. As soon as I could I began to work. Then all my free time was spent working, doing homework and taking care of my family.

My health was a mess by the time I went to college, and even more so by the time I graduated. I was dealing with many health conditions. I struggled to walk up two flights of stairs. I was in pain all the time. I remember one doctor being very concerned and in addition to prescribing some medications, told me that I needed to eat better, exercise, manage my stress and lose weight.

I left the office in tears because maybe exercising and eating healthier could help me feel better (or maybe not, its not that simple for everyone). But I couldn’t manage anything more than what I was already doing. I remember feeling hopeless, trapped, and as though I would never feel good.

My family wasn’t alone. We have many pieces of data that show that people with lower incomes have worse health outcomes.

For me, my health improved over time as I progressed in my education and experienced upward mobility. I was able to move away for graduate school. There I began to have access to systems and support. I had health insurance so I could get consistent care, a stable graduate school stipend so I could buy my own food and a free employee gym on campus. I slowly began running and hiking, and discovered I loved both. I had enough money to buy good running and hiking shoes to support my body. I had the time to actually hike or run without having to spend all my hours in a week on courses, homework, family care and working.

So I say this not from a place of judgment, but from lived experience: Health isn’t just about personal choices about types of food and ingredients. It’s about access. It’s about support. It’s about systems.

Wellness advice misses the mark

This is the part that’s missing from most wellness advice:

• You can’t yoga your way out of contaminated water.

• You can’t supplement your way past a broken healthcare system.

• You can’t green-smoothie your way out of a lead exposure or an infectious disease outbreak.

• You can’t eliminate food-dyes and not address food access.

• You can’t tell people to just exercise more when they are barely making enough money to survive.

Real and lasting health for all Americans requires infrastructure. It requires public systems that quietly do their job to protect us all and study how to improve human health. It requires supporting those most in need. And right now, those systems and supports are being dismantled.

Support for American health is being dismantled

Don’t believe me? Here are some examples:

Widespread layoffs of people within HHS tasked with protecting health from many different sides.

The FDA has suspended milk quality testing, failed to notify the public of a deadly E.coli outbreak and has cut employees working in food safety, medical device testing and tobacco regulation.

The EPA has started lifting many regulations focused on protecting our water and air. Including lifting restrictions on the mercury and air quality standards coal plants are required to follow. This is happening at the same time worker protections are being removed, leaving miners and other workers more at risk of workplace injury.

The CDC denied the request from a Milwaukee school to help them deal with their unsafe lead levels, and shuts their office studying effects of alcohol, which we know are associated with poor health outcomes.

Programs to provide heating assistance and childcare to those with low income are threatened to be cut, and the heating program had their entire staff fired.

NIH grants are being cut that were studying topics that could help individuals live healthier lives. Examples can be found here.

Worse, there was a leaked budget with DEVASTATING cuts to NIH and CDC and other programs, which suggests these things are only the tip of the iceberg.

If we are serious about wanting to make America healthy, then these actions are a slap in the face to the many things that go into better health. People want simple solutions, but these are complex issues that won’t be solved by the actions we are witnessing occur right now.

Actions we need instead

If health is the goal, then we need:

• The CDC to fund disease detection programs, track health inequities, provide vaccines and protect us from outbreaks (yes, even on cruise ships).

• The EPA to regulate pollution so kids don’t grow up breathing or drinking harmful chemicals.

• The FDA to make sure our medications, medical devices and food are safe.

• Worker protections. Especially for firefighters, miners, sanitation workers and others who face high risks on the job.

• The NIH to have increased funding for biomedical research to study critical topics like infectious disease, heart disease, cancer, Alzheimer’s, heart disease and more.

• Access to basics like fresh food, shelter, heat, healthcare and prescription coverage.

• Support systems for families to implement lifestyle changes.

• Provide educational opportunities for all Americans

These aren’t “nice to have” things. They are the foundation needed to build a healthier society. This is also not an exhaustive list, but a start!

Yes, we can (and should) talk about improving all these systems. No agency is perfect and all of them can benefit from improvements over time. But improvement needs to be done carefully and thoughtfully, with evidence and expertise. Gutting budgets, firing scientists and undermining public trust won’t improve human health.

What’s happening right now is not reform. It’s reckless. And it will hurt people—especially the people who are already the most vulnerable like I was when growing up (more on that here).

As someone who grew up without access to so many things, I know what’s at stake. This isn’t hypothetical. This is personal. Everyone deserves the chances I was given that have helped me transform my life in many ways . However, not everyone is given those opportunities because of systemic failures in our society.

If we really care about our health, our kids' health, and our communities' health then we need to protect and strengthen the infrastructure that makes it possible, and provide the support needed for all Americans. That’s not happening now. We need to hold people accountable and point out these contradictions as they are happening.

More soon!

In the meanwhile please use the comment or reply feature to let me know what topics you’d like me to cover.

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