What would making America healthy really mean?
Envisioning a better future
Given the current health and policy landscape, I’ll be sharing a different kind of post on Fridays—more reflective, less data-heavy. As I wrote in My Promise To You back in February, YLE will always stay grounded in evidence. But Friday reflections are where I’ll share my perspectives, distinguishing where the data ends and opinions begin.
This week, the dismantling of science and our health infrastructure continued—at a pace that’s both gobsmacking and grimly impressive. Just over the past few days, we’ve seen:
Vaccine policy-making stripped of its checks and balances
Federal scientists blocked from publishing peer-reviewed research
A federal budget that proposes to cut Medicaid, SNAP, and other essential services
The continued shutdown of federal health communications teams, like at the National Cancer Institute yesterday
The halting of biosecurity preparedness, like cutting flu vaccine research
And the MAHA report, released with fanfare last week, has some good ideas and intent, but it is incomplete and built on “studies” that aren’t even studies (possibly written by ChatGPT). It’s unclear whether scientists, public health professionals, or physicians with strong scientific research and writing skills were involved.
It’s hard to keep up. And even harder to stay grounded in this magnetic storm.
But when I step back, I keep asking myself: What are we doing?
Right now, people in the health ecosystem—federal scientists, researchers, students, community providers, and public health workers—aren’t being empowered to innovate, reform, or build something better. They’re jobless, paralyzed by uncertainty, or forced to defend a flawed system from becoming even more deeply flawed. This is not how we create a healthier, more resilient future. It’s how we stay stuck, spinning our wheels.
And we don’t have time for that. Americans are getting sicker, health systems keep failing patients, the workforce is stretched to a breaking point, and families are not supported. Life expectancy is falling. Bills are piling up.
But going back to the status quo won’t save us either. Which leads me to a second question: What do we want?
Imagine this
You live in a neighborhood where your kids can ride their bikes to a clean, safe park. Where the corner store stocks fresh produce, and the air doesn’t make your asthma worse. Where your job comes with paid leave and health benefits, and a support structure that actually works for your family and doesn’t cost a fortune.
When something goes wrong, a trusted app connects you to understandable, helpful, evidence-based information. It can also seamlessly connect you to a doctor who meets your needs—no frantic late-night Googling, no guesswork about networks.
If you’re in a rural area, you don’t have to drive three hours to a clinic. Once there, the nurse isn’t burned out or rushed. The doctor isn’t drowning in paperwork. The system gives them the time, training, and support to care for people, not just treat illness, but help you live a healthier life through prevention. A mental health counselor is just down the hall and already looped in. No phone tree nightmares. No surprise bills. No “sorry, we don’t take your insurance.” Your affordable medication arrives at your door that evening. A nurse calls the next morning to check in because that’s just how it works.
And that prescription? It didn’t break the bank. It’s not luck that your insurance covers it—it’s because taxpayer investments in science led to real solutions and affordable medicines. Industry still plays a role, but people come first.
When crisis hits—a wildfire, a virus—your community is ready. Alerts are fast. Help is immediate. Information voids are filled. Systems flex to meet the moment. Leaders respond in real time, not with spin or delay. Local organizations (your school, your church, your neighborhood center) have the funding and tools to deliver what people need, when they need it.
It’s no secret that this isn’t reality in America. But it’s not an unattainable utopia.
A radical transformation and rethinking of systems grounded in principles is needed to achieve the vision for the future we all deserve. Empowering people with the tools they need to stay healthy, like access to vaccination records or STD testing. It means strengthening systems that shape health, like clean air and water. It means integration of services for accessibility, instead of fragmentation or disinvestment. It means being transparent, like allowing scientists to speak freely. It means being responsive, like protecting Medicaid when Americans support it. It means being fact-driven—grounded in data and lived experiences. It means an accountable health ecosystem, with both efficiency and effectiveness.
Our leaders need to hear that this is the future we want and expect them to build.
So again I ask: What are we doing? And when will America start doing better? Not for politics, not for performance or bottom lines, not to prove some point, but to truly move the needle for the health of Americans.
From where I stand, I see wreckage and short-term gain at the expense of long-term health. I also see the need for a vision grounded in American principles born from imagination, innovation, hope, and most importantly, execution to achieve the health ecosystem Americans need and deserve.
Love, YLE
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Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. YLE is a public health newsletter that reaches over 380,000 people in more than 132 countries, with one goal: to translate the ever-evolving public health science so that people are well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below:
I think it's super important to remember that no matter our political persuasion, we really do want to build back better. The status quo wasn't so great that we should just fight to go back to it—we should continue to share ideas of how we WANT the future to look. When a crisis happens, the future takes on the shape of whatever ideas are already "lying around."
To that end, I dream of disconnecting benefits, at least Healthcare, from jobs. Not that people don't have to work, but that your Healthcare is independent. Sure that could be government, but it could also be widely available ACA plans where we all buy from the exchange. No losing insurance because your hours were cut. No incentive for companies to have part time workers instead of full time so that they don't have to cover benefits. No getting stuck with two deductibles in one year bc you changed jobs, and no golden handcuffs keeping you tied to a bad job bc you need the insurance. Then you could work a gig job if you want to take time off, or two partners with part time jobs still get Healthcare.
I am a physician and I visited Cuba several years ago and despite all the bad press it gets, I traveled extensively saying in people’s homes and visited their healthcare system and met with fellow doctors and nurses. That country actually seemed like what we wish for and you described! It can be done!!!