The United States is the only developed country without universal healthcare. Although the Affordable Care Act helped millions gain access to healthcare, we still fall short of ensuring everyone in this country can receive healthcare when they need it. But will that healthcare make us healthy? For that matter, will exercising regularly, eating healthy food, and getting our annual physicals and preventive exams help us to live longer? Mostly not. If you were born in the United States, you’re already at a disadvantage compared to other rich nations. The health of people living in the United States is worse than that of people in all the other rich nations – and not because of our diets, or lifestyles, or even our limited access to healthcare. It’s because we’ve made political choices that have placed us at the bottom of high-income countries when it comes to our health, and our lifespan.
Born Sick in the USA: Improving the Health of a Nation makes the diagnosis that our nation has misguided priorities, so we live shorter, less healthy lives. The root cause of our shorter and sicker lives is the huge economic inequality we tolerate, together with a lack of attention to our early years, when so much of our lifelong outlook for health and well-being is shaped. This is not intuitive to most people residing in the United States of America. We presume that by eating right, exercising regularly, and taking our medicines, good health is under an individual’s control. To the extent that we do consider broader social factors that influence our health, we tend to focus on our access to medical care resources. Universal healthcare will give us all an equal shot at good healthcare, and thus, at health, this reasoning goes. We need universal healthcare – that is, access to quality healthcare for all people regardless of ability to pay – however, that alone won’t fix the nation’s health problems. Our nation’s history, rooted in land expropriation, genocide, and slavery, and the pattern of political choices have more to do with the health we experience throughout our lives than any other factors.
Pointing out that the health of a nation results from political and historical factors is challenging. But as you’ll read in the chapters that follow, scientific evidence has shown time and time again that America is a sick nation, and it doesn’t have to be this way. We can do as well as other rich countries. Where and why are we falling short, and how can we do better?
Throughout this book I presume the reader to be a US resident (not necessarily a documented one). Your own nationality might be different. Nonetheless, because I am now an American (having been born in Canada) and largely writing this book to illuminate a critical problem in our society, I speak to the reader as a fellow American. I recognize that the word America represents a huge landmass comprising North, Central, and South America. The United States of America comprises only about 23% of that landmass and 28% of the population of the Americas. America will be used occasionally to refer to the US, but I will also use the correct terms: US, USA, United States, and the United States of America. I draw on the colloquial use of the term as it is understood here in the United States, and in other countries. This book is an appeal to the United States of America, and those who live here, to unite people, and to improve the state of our population’s health.
Regarding racial designations, in concert with the Black Lives Matter movement, I will refer to people of African descent living in the US as Black, and to people of European descent as White. Both terms are capitalized to honor the weight of Black cultural continuity and surface how Whiteness functions in relationships, institutions, and communities to support systemic racism. If I refer to a study, I will use the terms used in that document.
I hope that after reading the concepts presented in the following chapters, those of us living in the US will take on the challenge of making America healthier. That we were one of the healthiest nations some 70 years ago means we can become so again. The “medicine” required is not one we will get from our healthcare system. It will require transforming the United States into a country based on principles of justice and fairness for all, not just for a few. Let’s begin the healing. Be prepared for the most important lesson on health you’ve ever encountered.
