In his 1961 inaugural address President John F. Kennedy (JFK) said, “Ask not what your country can do for you – ask what you can do for your country.”

What was the reason for this effort to inspire a redirection of America and its political thinking? During the roaring twenties, a hundred years ago, the country allowed a few people to amass tremendous wealth. That culminated in the stock market crash of 1929, which led to the Great Depression. Then America’s very popular President, Franklin Delano Roosevelt (FDR), ushered in the New Deal. The government put in place policies to give people jobs, provide social security for the elderly and disabled, and provide other benefits to the population, all of which were paid for by taxing the rich. In 1942, FDR proposed a maximum wage. Big business and the rich were livid, of course, but FDR wanted to save the American capitalist economy at any cost. The Federal Debt was modest then because of progressive taxation that had the rich paying their share. Meanwhile, the wealthy exerted pressure on the political system to regain their spoils, an action familiar today.

In the ensuing age of economic growth and prosperity for many Kennedy’s seemingly innocuous statement helped the rich to succeed by producing a situation where American expectations of what the country could do to help them shrank to almost nothing. In the 1950s, the United States had one of the highest life expectancies of all nations, a sign of good health. We will see that Kennedy’s pitch resulted in worsening that favorable health status we enjoyed as a country.

I graduated from Stanford medical school twelve years after Kennedy’s statement. I believed then that personal care, supplanted by healthcare when needed, was the road to health. Tom Ferguson, a doctor who gained media attention, championed Medical Self Care, emphasizing personal responsibility for individual health. He was a major influencer on the self-help road to health. In 1981 President Ronald Reagan supported JFK when he told us government was the problem, not the solution.

With health being a personal responsibility, we could only blame ourselves and not the government for bad outcomes. A subliminal concept, it birthed healthism, coined in 1980, to fit in with JFK’s admonition to do the right thing for your country by being healthy.

The basic tenets of healthism relate to what individuals need to do for their health: eat right, exercise, avoid bad behaviors, and seek medical care when needed. Food products, branded such as Healthy Choice®, were supposed to nourish us. Influencers such as Kenneth Cooper MD coined the term aerobics to popularize vigorous exercise as a path to health. Smart watches allowed us to track our daily steps. We did this for our country in order for it to be healthy. What did we get in return? Shorter lives and poorer health and the highest obesity rate of any nation. Contrasted with our good health in the 1950s our health today, in comparison to other nations, has precipitously declined. Healthism hasn’t worked. Our healthcare has become a for-profit system comprising a sixth of our economy. It became the false pathway to produce good health.

Then after working as a doctor for almost two decades, I became aware that medical care was largely impotent as the force to improve health. Many studies confirm that premise. In the United States about 10% of mortality outcomes is averted by healthcare with the same being true in other nations. That leaves 90% dependent on other factors!

I began questioning the healthism dogma thirty-five years ago when I couldn’t explain why a Bangladeshi man then had longer survival than a man from Harlem in New York City. This led me to study public health, where I learned the key concepts in health production: social and political factors matter most. They influence outcomes much more than genetics, personal behaviors, the physical environment, or medical care. What are those social and political factors, the 90%, that need to be in place, for a population to be healthy?

To begin, about half of our health as adults is programmed in the first thousand days after conception. There is little an individual can do be as healthy as possible in that period besides wisely choosing their parents and the country in which they live. This is not a choice that the infant can make.

How to maximize adult health during those first thousand days? The United States is one of only two populous nations worldwide that doesn’t have a national policy of providing paid maternity leave (the other is Papua New Guinea). Most mothers in the U.S. can’t afford to take substantial unpaid leave from work, so they return to the workplace soon after having a baby. That maternal absence takes its toll on the health of her newborn.

While wealthier parents can afford being at home with their infant, other practices that benefit the newborn infant are often neglected even in richer families. Providing the very important benefit of six months of exclusive breast feeding after birth is rare even for wealthy Americans. Despite knowing that breast is best, the lucrative baby formula industry makes feeding easy, though more costly, and preys on the few mothers who are not able to breast feed. Our neglect of providing for a robust early life is one reason why the healthiest or longest lived person is never in the United States.

The U.S. has no national program of paid parental leave following the birth of a child, as most other rich nations have. Our government does not provide free or low-cost daycare as is also the case in wealthy countries. Instead, it becomes a personal responsibility that consumes much of a family’s budget. Governments in healthier countries spend much more on the critical first year of life than in any subsequent year. By contrast, the U.S. spends much less per person and applies it in later years as remedial efforts that could have been avoided by redirecting the spending to the earlier period. In the race to be healthy Americans are left behind in the starting blocks.

The other political factor that overrides most others is the vast income and wealth gap present in the U.S. that produces worse health outcomes. We can’t tell someone to be born in a country with more economic justice, meaning a small gap between the rich and the rest of us. That results from political choices made. When Americans are confronted with the harms produced by inequality they are not motivated to decrease the gap, as in other rich nations. Why? It may be the iconic American Dream, namely believing that before we die we will all strike it rich. That dream has turned into a waking nightmare for too many of us.

So where does this crisis leave us? We live shorter, sicker lives than people in all the other rich countries, as well as a significant number of poorer ones. Despite any evidence to dispute that finding, few Americans are aware or our being dead first.

Our ethos for producing health is grounded in the do-it-yourself model. This is doomed by a huge industry that wants to fill our stomachs with more food and endless supplements and tells us to exercise while producing more labor saving devices. It distracts us from what really matters by the biggest marketing force on the planet, driving us to buy stuff that is harmful and that we can’t afford with money we must borrow. Although our founding fathers entitled us to pursue happiness, that outcome is declining despite our desperate attempts to purchase it.

”Health habits” for improving health, such as exercising and eating well, and avoiding bad behaviors such as smoking cigarettes, are beneficial. But like the limited impact of medical care, they address only the tip of the metaphorical health production iceberg. Below the waterline lie the political choices needed: policies to assure the best possible early life for infants, together with robust efforts to decrease inequality that will lessen the stress that the big gap produces—the force that eventually does us in.

That we will grasp at straws while drowning is evident from today’s dysfunctional Federal government. Instead of the richest paying their fair share in taxes, the government borrows from them and then pays them interest. The interest payments on the Federal Debt amount to over a trillion dollars yearly, an obscene amount that alone could pay for a 21st Century New Deal!

Right now, today, we must sound the alarm and demand that our government do what is necessary to decrease our record inequality. We can use principles advocated by FDR, or those of the legendary Robin Hood – the rebel against tyranny, to take the spoils from the rich and give them to the poor. Producing a more equitable society will improve the health of even the wealthy. Using the booty gained can support early life, with paid parental leave policies that allow parents to be with their infants and children. Provide low-cost or free day care to continue the support as babies become toddlers. And enact policies to provide free education at all levels as so many other countries do.

We can set a health goal to return to the longevity realm enjoyed by so many other nations.

Let’s monitor progress by seeing death rates decline rather than increase, as they have been doing recently. It took us over half a century for our health to descend into this purgatory. We must be patient, as the political medicine will take decades to work. But the alternative is being interred too soon in the American graveyard, a dream gone awry.

Stephen Bezruchka, Seattle, Washington