POV: Creating a Healthier America—The Challenges and Opportunities for the Biden Administration
SPH dean offers four issues the new president must address to move us forward
Joe Biden will take the oath of office as the 46th president of the United States today amidst turmoil that is unprecedented in recent times. The number of challenges that face the country—and the new administration—right now are truly staggering. We continue to be living in the middle of a raging global pandemic that has now killed more than 370,000 Americans. The economy is still struggling to recover after the initial efforts to contain the pandemic precipitated a global recession, with the gains in employment slowing as the pandemic lingers. The country is reeling from the constitutional crisis precipitated by a mob takeover of the US Capitol, incited by President Trump himself, after months of falsely claiming the election was improperly stolen. And all of this is playing out against a backdrop of continuing, and deepening, inequities, with deep social and economic divides compounding centuries-old racism and anti-Blackness, brought vividly to life in civil protests during 2020 that may have involved more than 20 million Americans—making them the largest protests in US history.
If the new president were taking office facing any one of these challenges, we would consider this to be the major problem facing his administration, and one that will likely color his first few years in office. That President Biden and his team are facing all four of these challenges at the same time is remarkable and suggests an imponderable mountain to climb.
Importantly for all citizens of the country, none of these challenges are distant problems, removed from our lives. They all very much affect our health and well-being. The most obvious of these, of course, is the COVID-19 pandemic, which has direct consequences for our health and threatens all of us on a daily basis. While we have been able to resume some semblance of function in some of our institutions, including our University, through careful observation of social distancing and mask-wearing, the threat of infection remains real and requires all of us to maintain vigilance for the near and medium terms, until enough of the population is vaccinated to make wholesale reentry into full social engagement possible.
The economic recession is having, and will have, lasting implications for health. Unemployment and lower incomes are associated with poorer health in the short term, and with premature mortality in the medium and long terms. And the consequences of both the pandemic and its economic effects are being experienced unequally, with a disproportionate burden of both accruing to persons of color. While the challenges to our democracy themselves may seem distant from health, they reflect the core of the political dysfunction that has fundamentally shaped our national mishandling of the COVID-19 pandemic and that will threaten our health in the long term if our political system does not resume effective functioning.
How then can the new administration best turn the corner, move us collectively towards becoming a healthier country? Do the challenges of the moment present opportunities? The Biden administration has already announced a plan for tackling the COVID-19 pandemic. The plan is technically competent and can, if implemented, accelerate containment of the pandemic while vaccines are distributed nationwide. But stopping there would fall short of what we can do as a country—of truly recognizing the depth of the challenges we are facing and using those challenges to create pathways of change that were previously not possible. To do that I would suggest four paths forward.
First, there can be no substitute for rapidly ending the COVID-19 pandemic and the faster an all-hands-on-deck approach to resolving the pandemic is implemented, the better. Fundamentally, this will involve more efficient vaccine distribution, with help for the states to deliver the vaccines effectively, all while continuing to emphasize mitigation efforts through universal mask-wearing, prudent and widespread adoption of social-distancing measures, and the aggressive protection of high-risk populations.
Second, there can be no separation of economic well-being from the health of the population. It has long been clear that the health consequences of COVID-19 would be due as much to the economic impact of mitigating the pandemic as to the coronavirus itself. While the recent stimulus package was welcome, it is likely that the economy will need further stimulus to support the millions who have lost livelihoods during the pandemic. We should see economic policy as health policy, and focus unremittingly on restoring economic function, for the sake of the health of all of us.
Third, we are living in a moment in time of real opportunity to address long-standing racial and social inequities. The ravages of racism, poverty, and systemic marginalization have been in the public conversation, reflected in COVID-19 rates, like never before. This presents a unique moment in time where we can reframe the public conversation, elevating the importance of creating a country that values opportunity for all and is serious about creating the structures that create those opportunities. President Biden can do this through his words, and in time, through actions that elevate equity in all policies.
Fourth, and not least, President Biden can return us to a functioning politics of unity, overturning the past four years of a politics of division. I wrote early in the Trump administration’s tenure about the problems inherent in the divisive rhetoric that seemed native to President Trump. Those divisions reached their apotheosis in the recent attack on the Capitol, a tangible manifestation of how such division begets rupture that breaks social bonds, marginalizes and excludes, and limits our imagination of a better world. The Biden administration can return us to a politics that brings us together rather than divides us.
And that may do more for our collective health than anything that has happened in the past four years.