America Can Redefine Health & Reinvent Civilization
America is on life support but holds the keys to save humanity
In late 2022, I returned to the US after a decade in Europe and Asia. I’ve bounced between the continents since childhood, but I wasn’t prepared for this.
American health has plummeted. I saw it in airports and streets on our coasts and center. In faces, physiques, words, and actions of fellow Americans, family, and friends. Not in everyone or in everything, but enough to jolt me into a crusade.
While we’re physically sicker, more jarring is our energy. We’re anxious, cynical, divided, addicted, lonely, and depressed. It’s contagious, and society reflects it.
As our health gradually deteriorated, we’ve tacitly accepted and normalized poor health as a consequence of American life. But for me, the shift and contrast were sudden. Imagine falling asleep in 2012 and waking up in 2022.
How could such an abundant society be so unhealthy? In pondering the question and penning a polemic, I found hope.
We can change course quickly. When we expand our definition of health, we see we have ample agency and countless levers to restore and reinvent ourselves. But we’d better act because our trajectory is grim, and the health of America determines the health of the world.
In this essay, I’ll attempt to:
Promote a framework for health
Diagnose America
Present a vision to save her and humanity
I’ll also reveal how to replace healthcare, how architects might be the root of all evil, why our exercise is in vain, and how McDonald’s can heal the planet.
The Five Factors of Health
By first defining health, we can chart a path across its continuum. If death marks one end, the other is yet unreached. We’re far from peak health.
Americans have long defined health as physical, focusing on the visible and measurable. The WHO defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” While the definition is broader, it’s unattainable and incomplete.
Health is living with energy, agency, authenticity, and purpose, in harmony with nature and each other. Health is not the absence of suffering but our ability to endure and find meaning in it.
Health comprises five factors: physical, mental, social, environmental, and spiritual. It’s simplified,1 but we intuitively grasp each factor’s influence. They’re core human needs and provide a framework for individuals and societies.
Physical health ultimately expresses the other factors. Mental health includes awareness, cognition, emotions, and resilience. Human relations shape social health. Our environments—natural and artificial, seen and unseen—influence every factor.
Spiritual health is harder to define but universally recognized. It covers transcendent feelings of love, peace, meaning, purpose, awe, and wonder.
We cannot achieve optimal health without all five factors. Improving just one factor can improve our health and boost the rest. Destroying just one can destroy the rest. The tragedy is in how we view them in isolation or disregard one or more.
America’s health crisis is existential2
Our ~$4.5 trillion 2024 healthcare spending is nearly 20% of GDP (up from 5% in 1960), and 90% goes toward chronic, preventable conditions. 74% of adults are overweight, 42% obese. Over 60% live with at least one chronic disease, and 40% with two or more.
Over half of kids have one or more chronic illnesses including obesity (20%; 50% of teens), autoimmune disease, diabetes, autism, asthma, and allergies. Cancer is afflicting younger victims. Digital devices are damning them. 1 in 5 high schoolers report serious suicidal thoughts. 1 in 10 made at least one suicide attempt.
These figures are just a sample. Whatever dystopian future is feared, consider that we’re already in one. We’re not the health exceptions we each think we are, either.
Modern society has overwhelmed our slow-evolving physiology. Our unhealthy bodies and minds are natural reactions to unnatural conditions.
Our abundance conflicts with our scarcity instincts. We consume unprecedented calories, comforts, and pleasures but have lost the struggle, reward, and joy in pursuing them. Even the luxury of choice plagues us.
Metabolic dysfunction affects 93% of Americans, and its symptoms read like every malady we observe. Ultra-processed foods comprise over 60% of the American diet and 70% of kids’ diets.
Growing up abroad, parents warned us if we ate like Americans we’d look and act like them, and the message was self-evident. Europe shunned or banned many US food practices, while US brands told kids that leprechauns, tigers, bears, and clowns wouldn’t betray them. This year’s Super Bowl ads juxtaposed peak athleticism with dead-eyed celebrities promoting iridescent sodas and snacks.
We’ve never been so alone. We evolved as a social species but let our communities and families erode. The decline of Christianity and church erased shared orientations and rituals within proximity-based communities that enforced pro-social behaviors and curbed extreme ones. Nothing has replaced this function at scale.
Digital devices, under the guise of convenience and connection, are atrophying every health factor, deepening hyperindividualism, and rewiring our brains. We’ve surrendered to sedentary, solitary, passive consumption of what are history’s greatest addictions. Dopamine indulgences became vital anesthetics.
Once reliable sources of spiritual nourishment, our art, music, and entertainment have been captured by corporate committees that kill creative risk to appease and imitate our lowest common denominators. Sardonic trends, worn-out motifs, and recycled IP insult or destroy our taste, curiosity, and intelligence.
In sacrificing form for myopic function, we’ve stripped our environments of nature, beauty, and connectivity, and this might be our greatest sin. Cities fell into a dark age of faceless concrete, tinted glass, artificial light, and neon advertising, with parking lots covering over a third. Decorative, vibrant city centers became blocks of incohesive storefronts. Places that still hold appeal lose it from inadequate access.
This environmental degradation reinforces our social and spiritual detachments and ready acceptance of synthetic substitutes.
Events of the last decade lit a bonfire of the sanities. Political and cultural reactions divided us with little conviction and less consistency. The pandemic and response spared no one, and our kids bore the brunt. We lost trust in experts, institutions, and each other. We feel pessimistic about our future and powerless to change it.
When spirits are low, nihilism runs high. Corporations, politicians, and media exploit biases and fears, real or imagined, turning us into caricatures on limbic autopilot. If free will exists, we stopped exercising it. The capture and depletion of our attention have bred the short-term, negative-sum games of a society in decline.
American Sicko
We relinquished agency over our health to a system never meant to manage it. Our more aptly-named sickcare reacts to physical crises and ignores other health factors. Imagine doing no maintenance on your car and only seeing a mechanic when it breaks down. This wait-and-see approach is increasing costs and worsening outcomes. 70% of Americans say the system is failing them.
Doctors specialize by function or disease, but we mistake them for health experts.3 It’s not their fault. They’re products of the system and suffer from it too. Hospital food and lighting alone confirm that health is neither the system’s expertise nor its concern.
Our tools and language limit us. A clean bill of health can be a visual scan detecting no illness and confirming a handful of biomarkers fall within accepted ranges of a progressively sick population. We say we “get sick” or “catch” a sickness and discount how our choices contribute. Pain and discomfort are vital feedback loops, but we rush to numb them instead of addressing their source. We create identities of our symptoms—a woeful hyperstition.
When incentives favor fee-for-service, we become patients as annuities. Pharmaceuticals merely ease symptoms, requiring frequent or lifelong use, often with worse side effects. Over 66% of US adults are on prescription drugs and 40% are on three or more. A third of teens are on them. The sickest people I know stack prescriptions and are passed around by specialists without questioning why no cure is provided or agency encouraged. The healthiest don’t even own Advil.
We’ve begun to acknowledge our tanking mental health but treat it in isolation from other health factors and made it a catch-all term for severe anguish to natural reactions to life’s challenges. Incentives lie in pathologizing emotions. Therapy leads to more therapy, and pharmaceutical solutions are ineffective at best.
Insurance companies became the clients of healthcare instead of patients, leading to higher costs and inefficiencies in a bewildering swamp of perverse incentives by an industry never beholden to the Hippocratic Oath.
I owe my life to emergency medical care, but if our healthcare system were made both free and efficient, it would not turn our health around.
We’ve further commercialized health into a $450 billion wellness industrial complex that dwells on the physical, with brazen attempts to sell mental and spiritual health. Earnest people are doing effective work but exist in a minefield of ads and influencers shouting one-size-fits-all shortcuts and brand-sponsored lies.
Nutrition and physical activity are essential, but we’ve converted them into solitary chores and non-trivial expenses to squeeze into hectic lives, when all we want is relief and find it in cheap, instant, and addictive gratification.
Exercise as we package it is undesirable or unsustainable, whether counting reps in HVAC air under LED light amidst noise-canceling strangers or being yelled Peloton platitudes at home from yet another screen. What we gain in body we lose in spirit.
It is no measure of health to be well adjusted to a profoundly sick society. – Jiddu Krishnamurti
Many Americans face adverse socioeconomic conditions, but improving their standing in a deeply unhealthy society is not the solution. Indeed, most Americans have the means to improve their health but aren’t doing so.
We cannot envision health with our narrow definition of it. We’ve devised an embarrassment of physical and mental health practices but are blind to our social, environmental, and spiritual deficits.
The further we are from health, the more willpower and patience we need to restore it. Americans today must summon Herculean strength and Sisyphean resolve to wrestle with themselves and push against societal forces.
The surging numbers in addictions, suicides, and the homeless (an egregious misnomer) are not surprising. Many more of us will check out or break altogether.
It’s as if salt is being poured into our freshwater habitat, but we cannot see the fatal water we’re swimming in. We all feel it, but questioning society is too unsettling. So we choose denial, distraction, or anger in defending it, mimicking the initial stages of grief and preserving our learned helplessness.
Experts analyze, diagnose, and treat unfavorable outcomes without admitting that freshwater fish will never be healthy in saltwater. It’s like treating the speech and balance of drunk people while quietly refilling their drinks.
The insult to all injuries is that they’re unforced errors. Millennials, having lived on both sides of the extreme societal shift, ought to know better and be indignant at our idiocracy. Our complicity is killing our loved ones earlier and causing our youth to develop conditions that will afflict them for the rest of their lives.
If we, the sickest rich country, expect the same paradigms to yield healthier results, we are insane too.
Giving up on America is giving up on the world
America has been the reigning global soft power for a century. I’ve seen firsthand how the world consumes and behaves as we do. US media, apps, and algorithms shape and power the digital world, fast becoming the dominant reality. If the world continues to mirror us, what world does that create? How long does it last?
It's easy to criticize America, but she has always been a process—an imperfect, dynamic one that has fueled more innovation than any other nation. And, as author Regina Brett puts it, “If we all threw our problems in a pile and saw everyone else's, we'd grab ours back.”
America’s can-do spirit, while flickering, starkly outshines the generational malaise across the Atlantic and the prevailing alternatives in saving humanity and doing so in time. We’re not the world’s only hope, but we’re its best chance.
Salvation lies not in preservation but in reinvention
America must reinvent itself.
First, for survival. Not only is our trajectory terrifying, but we face novel physical and digital threats. We can survive them with strong bodies, clear minds, loving support, and united resolve.
Second, to progress. A society that truly prioritizes health might escape humanity’s tedious cycles and ascend to unreached heights. We’re holding ourselves back.
Health is elementary, and its five factors offer a lifeline and roadmap. Knowing we can move on to magnificently more beautiful and interesting lives should make us impatient for this future and compelled to create it.
The five factors of health are our first line of inquiry
We used to recite their maxims. That we are what we eat, speak, see, hear, read, and believe. That a sound mind is in a sound body.4 That we are the company we keep. That our art, buildings, and tools shape us.5 That the body without the spirit is dead.6 That in nature nothing exists alone.7
My lifelong health interests have yielded more questions than answers. I’ve seen people suffer in surplus and thrive in deficit. I know radiant, resilient, devout Filipinos sharing a roof with three generations in appalling environments. Curious, content, clear-eyed Danes cycling to and from chain-smoking, binge-drinking social sessions. Fit, fetching, all-organic LA professionals drowning in neurosis and loneliness. I couldn’t tell you who’s healthier.
Our insistence on managing only what we measure is killing us. We barely understand the links between the five factors, but we can trust our intuition to reap their benefits. We can draw on factors we control to compensate for those we cannot. What we believe, enjoy, and compare to can matter more than what we do.
The placebo effect, proof of the mind-body connection, is so powerful it’s required in benchmarking drug trials yet ignored in medical and personal practice. Its opposite, the nocebo effect, is equally potent but cannot be ethically tested. These phenomena have profound implications when considering their ability to alter anything, how we might wield them, and how they already influence us.
Social and emotional health in childhood shape the rest of our lives. I’ll never forget visiting a friend’s family in Mexico and feeling the warmth and safety of belonging to a loving home and community. I was like a rescued pup experiencing love for the first time and cried when I had to leave. I spent my life chasing that feeling in inferior substitutes, and I’ve seen what we become never knowing or finding it.
Loneliness can be deadlier than the individual risks from cigarettes and obesity. A retired Texas prison guard I met is convinced it’s the root of all suffering. The most hardened convicts are kept in line by the threat of solitary confinement, preferring prison itself to being completely alone.
Environmental psychology is obvious but overlooked. We meticulously select neighborhoods, tend gardens, and decorate rooms because we yearn for beauty, symmetry, and coherence but have to find them by making sanctuaries of our homes. It’s why we flock to and wander the streets of Paris, Copenhagen, and Kyoto for days but wouldn’t dream of doing so in our cities (exceptions proving the rule).
Victorian doctors prescribed sunlight, sea, and country air as panaceas. We remain drawn to nature but seldom consider how our physiology reacts in its presence or when deprived of it for most of the year.
History teaches us the power of the human spirit. How faith and hope can overcome formidable trials. From Shackleton, Solzhenitsyn, and Frankl to our American Revolution, Civil and Women’s Rights, and Space Race.
Literature enshrines the lessons. Milton proclaims that our minds can make a heaven of hell and hell of heaven. Hamlet despairs that nothing is either good or bad, but thinking makes it so. Nietzsche asserts that our why can bear any how. Proverbs warns that without vision we perish.
The blueprint for health is a blueprint for society
We can optimize for all five factors. Health need not be an identity or act of rebellion. I'd rather be oblivious of my health in a healthy society than track sleep, steps, and calories in an unhealthy one.
We won’t end all health problems, but we’ll reduce many. We are not who we think we are. Our misfiring minds and mismanaged bodies exacerbate even our noblest causes.
Government can jumpstart our recovery by enforcing transparency, correcting misaligned incentives, and ending the mass poisoning in our food, drugs, water, and environments. Yet no administration in my lifetime has done so, and it’s hard not to attribute malice. Still, I cling to hope.
We cannot wait for sclerotic leadership. Culture beats policy in the long run. With a vision of health, we can force transparency to improve policy.
The future is already here, it’s just not evenly distributed. – William Gibson
We already possess intuition and natural feedback loops, but to restore us urgently and en masse, our modern problems require modern solutions. Humanity and technology must save each other. It’s time we embrace our symbiosis.
We often view problems through a static lens and overlook how innovations change the entire debate. AI is expanding the frontiers of knowledge and will make giant leaps in biotech, education, robotics, and materials science. We are on the path to abundant energy, a deflationary deus ex machina that unlocks untold possibilities.
We can restore our health through four pillars:
Applied technology to reimagine healthcare and accelerate reinvention
Restored transparency to maintain direction
Personal agency to unlock our potential
United action to reshape incentives, supply, and environments
The following is a fanciful vision of the next decade. It assumes net positive AI outcomes and improved socioeconomic baselines. The concepts exist or are in progress, and better ones will unfold. In the worst case, our health may be the only thing we have agency over, and its five factors still hold.
We’ll need proofs of concept to gather critical mass. Mass awakenings cannot be planned ethically, and societal engineering has ugly traps. But health is the ultimate wealth and freedom, and no dogma is needed to look and feel better. We need only taste freshwater once to know we’re swimming in salt.
Medicine 3.0
If our current healthcare system is designed to pull drowning people out of a river, we can go upstream, erect signs and fences, teach people to swim, and soften the current.
Healthcare will be preventive, proactive, and personalized. Diagnostics, wearables, and scanners will track biomarkers and flag risks before disease or dysfunction develops. AI will chart predictive paths to optimal health with real-time coaching. Passive patients will become informed, active agents. Healthcare will tilt from in-person services to consumer products, slashing prices and extending global access.
We’ll combine traditional and modern practices. Food, movement, nature, love, laughter, and rituals will be medicine. We and our fish will wean off pills. We’ll integrate placebos and mitigate nocebos. Hospitals will be emergency regeneration centers. Doctors will be more like empaths and architects. It would be malpractice not to use AI. Second to nth opinions will be instant if not redundant.
We’ll uncover new variables, correlations, and power laws. Where clinical trials are impractical or unethical, we’ll combine evidence-based data with evidence-informed and close the gap between discovery and application.
We’ll learn how our physiology responds to actions, thoughts, others, and environments. Personalized results will settle or dampen debates. We'll increase lifespan by 20 years and square the healthspan curve. Deaths from heart and Alzheimer’s will dwindle. Deaths from cancer will be rare. Insurance trivial. We’ll see real-time blue zones and throw resources at remaining red ones. The revelations will catalyze long-term behavior.
R&D will go toward enhancement, fertility, cleaning the environment, and getting the plastic out of us. Concerted efforts on longevity—think Manhattan Project magnitude—will produce breakthroughs that will alter every civilizational paradigm.
Transparency is a panacea
Healthcare must strive to be transparent and free from bias, ideology, and political influence, all of which have led us to this point.
While the health solution is not yet clear, transparent or decentralized AI models will make information a trusted commodity that will challenge orthodoxies and entrenched beliefs (including mine strewn here—no sacred cows), provide softer off-ramps, avert misguided intentions, and reveal truths that have long required trust.
Transparency is an outcome of unrelenting curiosity and freedom of speech, both of which we are losing in the war for our attention.
I can do nothing for you but work on myself. You can do nothing for me but work on yourself. – Ram Dass
Even when we conquer disease, our health remains upstream. If we accelerate civilization with immortal bodies but current social discord or spiritual bankruptcy, we will pave the road to hell at a faster rate.
We are the best stewards of our health and must take personal agency. Unsolicited or prescriptive advice is rarely heeded or sustained, despite reason, and less so when given by unhealthy people. Severe shock or loss can trigger turning points, and given our current state that moment for many is near.
We each must find our why and choose our how. Technology will aid self-awareness, show the long-term effects of our self-destructive behaviors, extend options, and track progress. Power laws govern simple actions of both reduction and addition, invariably resembling a rejection of modern norms for more primal ones.
Our efforts will compound quickly and seem miraculous. We’ll notice our patterns and rewrite our identities. We’ll realize how harming ourselves harms those around us and, conversely, how helping ourselves is our first step in helping them. It’s a crucial reframing that creates compassion and purpose.
A healthy society is a united one
With restored transparency, intuition, and natural and technological feedback loops, we become caring, discerning citizens and muster the courage to realign incentives.
When we realize the critical role of social health and the cruelty of denying it, we’ll prioritize the health of our children and forgive our siblings and parents. We’ll learn to heal and rehabilitate our broken, instead of treating them like pesky raccoons. We’ll make meals and everyday routines social again. We’ll draw on our cultural and generational diversity to help navigate this brave new loving world.
We’ll be less vulnerable to manipulation as we realize the benefits and dangers of digital devices and see algorithms as the mirrors they always were. We’ll reinvent the digital paradigm to tilt the balance from captive consumption to curated education and creative expression.
Organizations will compete to maximize stakeholder health. Marketing will prove how products enhance our lives rather than conflating desires with needs. It’ll be harder to lie to ourselves. Imagine health as the ultimate loyalty program.
We’ll add meaning to our work by binding effort to outcome and imagination to reality. We’ll match the joy of a good’s creation with its consumption. Imagine the impact as genius and drive within and around us are awakened.
We’ll see health scores by cities and regions and rally communities to keep pace. We'll vote through the lens of long-term health and realign policy. Health will be an arms race. Imagine measuring national strength by health instead of consumption.
Only demand reshapes supply
We’ll identify and reject harmful products and practices and deploy a host of alternatives awaiting application.
We’ll make healthy food delicious, convenient, and affordable. Farming will go regenerative or vertical, lowering costs and rescuing soil, water, and wildlife. We’ll never have to decipher ingredients. Livestock will live their best lives. We’ll laugh and cry remembering how organic, natural, and humane labels were once selling points.
As food becomes medicine, the finest US companies will rebuild supply chains and raise global food standards. Those who start today will lead and catalyze the rest. McDonald’s can readily serve billions of revitalizing meals. Coca-Cola and Starbucks can refresh and stimulate every corner of the globe with a glut of elixirs.
We’ll upgrade consumer products, fashion, chemicals, packaging, and our favorite vices. Foreign companies will follow or falter. Even Shein will fall in line or lose us. Never conceding the moral high ground to Americans, Europe will overcorrect.
It’ll be a continuous process of discovery and tradeoffs. We’ll look back on what we consume and advertise today as reprehensible. Surviving brands and institutions will whitewash their pasts. Kellogg’s will make Marlboro look quaint. It’s less a condemnation than a sign of progress.
Our built environments must eclipse virtual ones
We can build for posterity the places the world flocks to without needing a monarchy or papal patronage. Form enables and sustains function. Quality and intention are free. We have no excuse for stale imagination. No excuse for another strip mall.
We must be inundated with beauty to become intolerant of its absence. Artists and architects will be roused and emboldened. Past and present movements will help craft a new American aesthetic.
We’ll embellish building facades with coherent features, vines, and colors. We’ll enrich rooms with sunlight, fresh air, and natural tones and adorn them with flowers, art, accents, texture, trim, and fabrics. Lipstick before surgery.
Robotic labor and cheaper energy will hasten the transformation. We’ll build with stone, wood, brick, metals, terracotta, and tile. We’ll ground our residences, revive central staircases, resurrect columns, cornices, and pilasters, and take ceilings seriously. We'll condemn lazy design, overhead lighting, synthetic surfaces, plastic blinds, and printed art.
We’ll make daily life default active and social with sidewalk seating, bike lanes, waterways, gardens, playgrounds, pull-up bars, courtyards, markets, squares, amphitheaters, and mixed-use zones. Engaged communities will vote on proposals. Cities will experiment in expressing themselves and come alive in doing so.
Transport will be autonomous and routed inconspicuously, whether surface, aerial, or subterranean. Road deaths and injuries (43k and 2.5m in 2022) will be eliminated. Imagine never again looking for parking. Safe, quiet streets will echo wind, birds, barks, and laughter. Nature will come roaring back, and we’ll keep her safe and close.
We are not human beings having a spiritual experience. We are spiritual beings having a human experience. – Pierre Teilhard de Chardin
Health is a worthy vision, and we’ll have to unite to restore it. But a healthy, abundant society must find new meaning. Thoreau cautions that comforts hinder our elevation. Reward comes only through struggle, and we create the latter when we cannot find it.
I pray we find unity in grander visions and new frontiers, whether in my desired Renaissance and Romanticism, redirecting ourselves toward space, or pursuing Humanism or Ultrahumanism. However, vision alone won’t fill our spiritual void.
Spirituality takes many forms, but infinite wonder awaits us. We’ll reimagine religion. Psychedelics will stir many. Perhaps our makers deign to reveal themselves. We may never definitively answer our God question, but it’ll be devilishly fun to try.
Health as America’s soft power
America can be the city on the hill she intended to be. We can stop the bleeding and claw our way back with the same ruthless efficiency that got us here. In the words of JFK in 1960 on the New Frontier, “A whole world looks to see what we shall do. And we cannot fail that trust, and we cannot fail to try.”
Our current paradigms show deep cracks and cannot last with few healthy or happy role models. We’ve seen in the last decade how zeitgeists can shift, exposing our narratives and divisions to be as fluid as they are manufactured. Incumbents will resist and be unscrupulous in descent, but transparency will allow truth to prevail.
Utopia is not a destination but a direction. We find it through progress. Optimism has always been our moral duty, a self-fulfilling force that has since changed my perception. I see growing awareness and opportunity. Every day, I see Americans taking agency and doing their best despite the challenges. I see progress.
Thanks to , , , and friends for feedback. For inspiration and optimism, , , , , , , , Matt Ridley, Adrian Aoun, David Robson, Calley and Casey Means, Bryan Johnson, John Mackey, Josh Clemente, Joe Vennare, Dr. Gabor Maté, Dr. Peter Diamandis, Emi Gal, Dr. Peter Attia, J. Sanilac, Rebecca Kaden, and more.
Commonly derived and still limited by knowledge and language. Factors aren’t mutually exclusive in all examples but are in terms our culture understands. I believe the factors are comprehensively exhaustive today, but do share what does not fit into the five.
Given inherent sampling biases, perverse incentives, and limitations in our language and knowledge of pathology, I assign careful confidence to all provided numbers. But I have no doubt that our health is in a state of emergency.
Many exceptions exist with good people and intentions.
“Mens sana in corpore sano.” — Juvenal, Roman poet
Oscar Wilde, Winston Churchill, Henry David Thoreau
James 2:26, The Bible, KJV
Rachel Carson
Here's to a better us.
...stoked to see this in the world brother...