Beyond Boosters: Reimagining Public Health Post-Pandemic

Improving the health of our desperately sick society will require much more than vaccines and prescription drugs

Photo by Haley Lawrence on Unsplash

Raised by a Mom who was an early adopter of what used to be called “health food” way back when eating whole wheat (as opposed to white) bread was widely seen as quite weird, I never realized just how hard it is to develop healthy lifestyle habits until I had kids of my own.

This realization first hit me when my then-preschooler started lobbying me and my husband for McDonald’s “Happy Meals” with great passion and regularity. How the hell, I wondered, did he even know what a Happy Meal was? We never went to McDonald’s or ate fast food of any kind. I figured he must have seen some ads while watching cartoons on TV. That didn’t surprise me. But I was shocked by just how effective they were at convincing him that Happy Meals were something to be coveted so mightily.

Once I learned what’s in a Happy Meal, however, I understood the allure much better. Perhaps needless to say, it’s not the “food” itself. Rather, i’s the fact that the “meal” comes in a cool package and — most importantly — includes a little collectible toy that taps into some popular kid culture trend. And as anyone who’s spent much time around young children knows, they love cool little tchotchke toys.

Once a child’s imagination is captured by a toy, they cathect strongly to them. It’s a beautiful thing to see as a part of free imaginative play. But it’s disturbing — and eye-opening — to see how just how expertly such natural impulses are manipulated to induct children into an unhealthy, addictive, disposable culture.

When Food Makes You Sick

“More Americans are sick than are healthy,” the American Society for Nutrition recently reported, “with diet-related illnesses playing a major role.” Serious health issues associated with poor eating habits include obesity, type 2 diabetes, cardiovascular diseases, cancers, food allergies, and more. These problems have been growing worse for decades:

Between 1980 and 2018, the percentage of U.S. children with obesity increased from 5.5% to 19.3%, whereas the percentage of adults with obesity increased from 15% to 42.4%. Nearly 3 in 4 American adults are now either overweight or obese. Across all preventable risk factors for disease in the US, poor diet is now the leading cause of poor health, associated with more than half a million deaths per year—or more than 40,000 deaths each month.

Similarly, the Rand Corporation reports that “dietary risks are the leading cause of death and third leading cause of morbidity, with 46% of adults having a poor-quality diet.”

What constitutes “poor quality”? Michael Pollan put it succinctly: The “main features of the Western diet” are “lots of processed foods and meat, lots of added fat and sugar.” Our industrial food system makes it quick, cheap, easy, and addictive to eat “lots” of what’s literally killing us (particularly, but by no means exclusively sugar).

“Happy Meals,” indeed.

In contrast, eating what’s good for us — organically grown, minimally processed, locally sourced whole foods and a primarily plant-based diet — takes time, money, effort, and skill. One 2019 survey found that only 20% of Americans cook daily. Forty-four percent said they don’t know how, 45% that they don’t have time. More people regularly eat dinner on the couch or in the bedroom than at the table — a setup that’s obviously not conducive to a solid, healthy, sociable meal.

Smoking and not exercising enough compound the health risks of eating poorly. In combination, these factors have created an epidemic of chronic “lifestyle diseases” including heart disease, stroke, diabetes, obesity, metabolic syndrome, and some types of cancer. Even before Covid, these diseases accounted for over 75% of public and private healthcare spending and 7 out of every 10 deaths, killing more than 1.7 million Americans annually.

What’s incredible — and maddening — to think about is that it’s well accepted that the risk of developing these deadly chronic diseases could be reduced by 80% simply by exercising regularly, eating healthfully, and not smoking. Simple enough, right? Wrong. Most people don’t do it. And again, the trends have been growing worse for decades. (This is also true in many countries around the world that have adopted a similar “Western diet.” It isn’t simply an American problem, by any means.)

Beyond “Personal Responsibility”

By and large, the dominant cultural response to the fact that so many Americans suffer from preventable chronic disease is to blame individuals for not eating better and exercising more. And it’s true that each of us needs to do what we can to take responsibility for our own health. But such narrowly individualistic perspectives prevent us from seeing the powerful social forces that habituate people to unhealthy behaviors in the first place.

It’s sad but true: Living in a way that makes you prone to chronic diseases that ruin your quality of life and then kill you is normal in America today — if you define “normal” as what happens most of the time and is widely taken for granted. It takes far more money and time than most people have to access and prepare healthy food that they like, and exercise regularly and safely doing something they enjoy. (And enjoyment is important, because if you dislike something, you almost certainly won’t maintain it as a daily habit.)

Plus, to eat and exercise well requires a lot of knowledge that may seem boringly mundane, but is actually important and rare. To take just one example: You need to know how to determine what sort of food is actually healthy, as opposed to believing the latest faux-healthy marketing gimmick (e.g., the “nutritionally fortified” box of industrially farmed, uber-processed, GMO wheat based sugary cereal). When you grow up surrounded by endless amounts of junky industrial food that’s aggressively marketed to be enticing and scientifically engineered to be addicting, such know-how is not a given.

Plus, even if you understand it in theory, making a habit of it isn’t necessarily easy, particularly if that’s not what others in your circles are doing. Human beings are social animals. It’s hard for us to eat in ways that our peer group finds strange, off-putting, elitist, or distasteful. Food is a powerful part of culture. And most people aren’t keen on having what they see as normal, pleasurable, and/or necessary dissed.

Developing healthy food and exercise habits is made even harder by the dominant cultural climate. Whether consciously or unconsciously, many of us internalize the message that health only really counts if it’s capable of producing an Instagrammable image that meets some idealized standard of “beauty and fitness.” Both on regular and social media, we’re relentlessly bombarded with the message that what matters is how we look, not how we feel. This is a terrible standard by many measures, including the fact that our metabolic health is determined by the quality of what we eat and the strength of our bodies, not how much we weigh.

Such Photoshop-style imagery is the cultural equivalent of junk food: Cheap, ubiquitous, insidious, and all too often toxic. As such, it’s bad for our mental health, which is, on the whole, awful to begin with. More statistics: Almost a third of Americans are expected to experience clinical levels of anxiety at some point in their lives. Seventeen percent of young adults ages 17-25 suffer from serious depression. In 2019, suicide was the tenth leading cause of death overall in the U.S., claiming the lives of over 47,500 people.

Then there’s the alcoholism, drug addiction, and overdose deaths . . . the family breakdown, domestic violence, and child abuse and neglect . . . kids growing up on screens, manipulative media narratives, and evil algorithms . . . precarious labor, bullshit jobs, and unprecedented socioeconomic inequality . . . and so much more. After a certain point, listing more and more miserable statistics seems nothing but depressing, numbing, and overwhelming. It’s not helpful to pile the negative facts on so thick that it feels like there can’t possibly be a way out, at least on a societal level.

So I’ll stop. And circle back to the central point, which is that our “normal” way of life, including such basics as the food that we eat every day, constitutes a public health crisis. In fact, our regular eating habits are literally our number one public health problem. And while it’s true that each of us needs to take responsibility for our own health as best we can, blaming this situation solely on individuals, rather than looking at the social forces that have propelled so many people in such an unhealthy direction, is counterproductive.

Chronic “lifestyle diseases” killed far more Americans in 2020 and 2021 than Covid. And remember: These diseases could be reduced by 80% simply with better food and exercise. Plus, contrary to mainstream media messaging, they are almost certainly the primary factor that explains why Covid has killed such an exceptionally high percentage of Americans. Yet we hear extremely little about what the relevant numbers reveal in terms of our preeminent public health crisis.

Questioning the Covid Narrative

A recent New York Times story on why Covid “is killing Americans at far higher rates than people in other wealthy nations” offered no explanation for this tragic phenomenon other than our comparatively low rates of vaccination and boosters. And while it’s true that vaccination (and, to a much lesser extent, boosters) significantly reduces the risk of hospitalization and death, insinuating that this is the only reason our Covid numbers are so dismal is unconscionably misleading.

In March 2021, the CDC reported that 78% of people who had been hospitalized, needed a ventilator, or died from Covid-19 were overweight or obese. That’s a stunningly high number. Yet, the fact that excess weight is a powerful indicator of risk hasn’t been widely acknowledged or discussed. In fact, from what I’ve experienced, most people have no idea it’s the case.

When I spoke critically about this situation to a friend, she replied that it’s understandable that no one wants to talk about it because they don’t want to “fat shame.” And it’s true that issues of body size and body image absolutely do need to be handled with sensitivity and respect. That said, I think it’s wrong to erase the significance of such a major risk factor from public discussion. Plus, weight itself may only be a proximate indicator of Covid risk. As in the case of chronic disease, it could be that the core problem is an industrial food diet, not pounds per se. But if we never focus on the fact the issue exists, we’ll certainly never understand its dynamics.

Regardless, we already know that eating an industrially produced, highly processed, and sugar infused “Western diet” is terrible for your health, particularly in combination with lack of exercise. That’s beyond well established. So, I don’t think we need scientific verification to make the logical inference that the millions of Americans whose health has already been seriously compromised by this “normal” way of life are likely to be at higher risk from Covid. True, there are never any guarantees in life. But it stands to reason that the stronger your physical health and natural immunity, the more protected you’re likely to be from developing severe Covid – and vice versa.

Despite this common sense logic, the dominant narrative around Covid has consistently suppressed and even stigmatized any consideration of how people might better protect themselves from the virus simply by becoming more healthy overall. Again, we already know that the “normal” practice of eating a “Western diet” is the single biggest threat to Americans’ health. And while it’s very difficult to change those habits (and even more difficult to break the power of the monied interests that support them), it’s still possible for us to work to improve them. Presumably, If the significance of doing so had been underscored by the threat of Covid, it could have been a powerful motivator to action.

Plus, there are many other simple, everyday measures that people can take to improve their health, and perhaps even strengthen their immune systems and provide better protection against severe Covid in the process. Again, of course, there are never any guarantees. But if it might help and can’t hurt, why not encourage it? For example, my doctor has told me for years that it’s important to take Vitamin D regularly to strengthen my immune system. Yet when it came to Covid, the suggestion that it might be a good idea to take Vitamin D was relegated to the realm of right-wing quackery. Why? In logical terms, this makes no sense.

Instead, the dominant public message has consistently been to isolate yourself as much as possible (lockdowns, school closures, masking, and social distancing are all essentially isolation measures) and then to get vaccinated and boosted as soon as possible. All of the major Covid policies fit into this isolate-vaccinate nexus. Over the past two years, we’ve become socialized to think in these terms and no others. Whether we support these policies or oppose them, they’ve set the terms of public discussion and debate.

This isolate-vaccinate framework encourages a certain passivity around everyday health issues. People are told to do whatever they can to minimize the chance of coming into contact with the virus and follow directions from the experts regarding vaccination and boosters. Bracketing the question of whether each of the policies within the isolate-vaccinate paradigm were justified, it’s a set-up that leaves relatively little room for individual initiative, and even less for social groups and communities.

To my mind, this is not only unnecessarily disempowering, but as such, bad for your health. Because the more that we feel out of control of our lives and what’s happening in the world around us, the more stressed, anxious, depressed, and/or neurotic we’re likely to become. And there really is a strong mind-body connection. So, the more our mental health is undermined by such negative emotions, the more our natural immunity will be compromised. This connection between mental and physical health is well supported by scientific research. It’s also something that’s easy to see playing out in the course of our own life if you’re paying attention.

The isolate-vaccinate framework has also reinforced the pre-existing problem of having social structures that systematically promote poor health and premature death be taken for granted as “normal.” One might think that a global pandemic would be an excellent time to reassess just how unhealthy our society has become and rededicate ourselves to doing better, both individually and collectively. But that’s not what’s happened. Instead, we’ve doubled down on the normalization of social institutions and practices that combine to create a shockingly high incidence of ill health (e.g., industrial farm subsidies, the fast food industry, and, in general, accepting rather than resisting our addictive junk culture).

But really, there’s no way that we should accept that it’s “normal” is to subsidize, promote, and patronize a food system that’s systematically making millions of people chronically ill. We shouldn’t accept that it’s “normal” to think that our only recourse in the face of this insane situation is to have the pharmaceutical industry prescribe us more drugs. And we shouldn’t accept the narrative that tells us that there’s nothing we can or should do to improve our health and, in the process, perhaps increase our protection against severe Covid other than isolate and vaccinate.

Even if we achieve a 100% rate of vaccination and boosting (which we won’t), we’ll still be left with a desperately unhealthy society that’s spiralled down into an even deeper public health crisis. That needs to be problematized, not further normalized. And then, as much as possible, it needs to be constructively addressed not only by individuals, but also — and even more crucially — by our political, cultural, and community leaders and our public, private, and nonprofit institutions. Otherwise, even the best case scenario of finally getting Covid under control will, in the bigger picture, be nothing more than an “out of the frying pan and into the fire” shift when it comes to our escalating crisis of public health.