Many people sense something is wrong in the world, in the United States, and in other places. Call it a sickness if you will, maybe even a new epidemic. What would the diagnosis be? One approach would be to look at various measures to see what the problem is. Consider these tests like one might do with a sick individual.

Begin with what are considered common measures, using the U.S. as our example. The commonest indicator, computed every minute of every business day, are stock market indices. The Dow Jones and many others. The assumption is that since the stock market is doing well, so is the United States. Something is wrong there; it’s not the measure we need as we witness the continued growth of stock market wealth while economic hardship increases and health status declines.

Economic growth is another benchmark. The increase in Gross Domestic Product, or GDP. If the economy is growing, then all is fine. Wait a minute, prices are going up which is seen to be good for that measure but so-called affordability is problematic. And as Kenneth Boulding pointed out long ago, anyone who thinks that the economy can keep growing forever in a finite world is either a madman or an economist (and I might add, a politician, even a common citizen). Again, GDP growth isn’t a good indicator of what’s going wrong; it actually may mask reality.

What else might be examined to diagnose the problem? Why not the health of people in that nation. How to measure that? Since most people think it is healthcare that produces health let’s look there. The U. S. spent $5.3 trillion dollars on healthcare in 2024 which represented 18% of its total GDP. This represents almost half of all such outlays world-wide and per capita is at least double that of other rich nations. Are Americans the healthiest people on the planet?

Assuming so leads to a paradox. People in the U.S. live shorter lives than people in all the other rich nations and a number of poorer ones. They have more illnesses too. Being alive rather than dead is a reasonable measure of health. All rich nations and many others track births and deaths allowing mortality rates and measures such as life expectancy to be calculated. Period life expectancy in a given year can be considered the average length of life if mortality rates didn’t change.

For 2023 Americans lived shorter lives than people in some 50 other nations. If the three leading disease killers in the U.S. were eradicated (heart disease, cancers and unintentional injuries – conditions that will kill almost half of the people) America would only be close to being the longest lived nation. We are talking about a big deficit in U.S. health.

Yet the shameful health status of people in the United States is mostly unknown there. The numbers, though, can be found even on the Central Intelligence Agency’s World Ranking website. And from many other sources including the World Health Organization, the United Nations, the World Bank as well many websites such as Our World In Data. It shouldn’t be a secret but most people in the U.S. remain unaware. No politician wants to touch it. It is the best kept secret.

Given the choice almost everyone would prefer to be alive rather than dead. I propose the health of people in a nation is the key measure to diagnose the problem. But living people prefer to not be sick or disabled. Measures such as healthy life expectancy or Disability Adjusted Life Years incorporate state of health. The United States does even worse in these very valid measures.

Recall the rights from the U.S. Declaration of Independence to life, liberty and the pursuit of happiness. Yes, Americans have the right to life but it is only a short one. The right to liberty is an illusion given their very high rates of incarceration (close to one in two hundred Americans are behind bars, one of the highest rates in the world). But how successful are we in our pursuit of happiness? No matter where you optimistically look, happiness is declining in the U.S. Consider how often you are told to have a nice day, something we didn’t do half a century ago. Nice days are eluding us. Being told to have a nice day isn’t working.

To confirm that the U.S. is not doing well consider how many very expensive wars we have lost since the Second World War. Vietnam, Afghanistan, Iraq and more recent proxy-wars in Ukraine and Israel suggest victory has been elusive. Waring is not good for health, especially in your own country as the ICE raids demonstrate.

What about the national debt? In the U.S. it stands at over $38 trillion and rising by the minute. Instead of raising taxes to increase revenue we continue to borrow heavily to pay for government expenditures. Eventually debts have to be repaid. But in the interim we pay interest to the lenders who are mostly a couple of rich countries (China and Japan) and some rich Americans. The yearly interest payment is over a trillion dollars. This is not a fiscally healthy situation.

Global warming is a huge threat to human life. Species extinctions don’t bode well either. The nuclear annihilation threat looms larger.

So where does the U.S. lead the world? We are still the largest economy although we will soon be overtaken by China. The dollar is still an important reserve currency but that may also change, it’s under attack from various angles. The U.S. ranks near the top in global innovation and in developing technologies such as artificial Intelligence. U.S. higher education used to lead the world, but with various recent federal cutbacks its advantage is quickly eroding along with declining scientific research capabilities. Nearly a quarter of U.S. adults are considered illiterate and more than half read below a sixth-grade level, No question that U.S. military power is dominant. Should that make us comfortable? Does that make us healthier? What should the goal be?

Countries have goals such as when the United States, overshadowed by the Russian launch of the first satellite, Sputnik, in 1957, vowed to land a human on the moon by the end of the following decade. What should the goal be today? Or what should the United States be best at or do to dominate in the world, if that’s the goal? That is the wrong question if we want to treat the world of its maladies.

Geoffrey Rose began his book The Strategy of Preventive Medicine stating “There is no known biological reason why every population should not be as healthy as the best.” If everyone in the world was as healthy as they could be that would end much of the misery we see today. Among the ways to accomplish that, from my perspective, would be for the United States to regain the health status it had in the early 1950s when it was close to the best. Changes to achieve that would collapse the national and global power structures that lead to so much trouble today.

Beginning steps would be to make Americans aware of their being so unhealthy. Then begin a discussion why and deal with it. Then act on and measure progress in decreasing health inequities globally. We do have plenty of indicators to measure this. Seemingly, though, we have already dropped the ball. The sense that something is wrong will continue.

Stephen Bezruchka, Seattle, WA