How to Change the World: The COVID-19 pandemic made it clear that inequality kills. We must respond.

• Author: Bezruchka, Stephen
• Position: BOOK EXCERPT

As I write this final chapter, COVID-19 has killed more than a million Americans. It didn't have to be this way--hundreds of thousands of lives could have been saved. But political decisions prevented that from happening. Given our ineffectual response to COVID-19, how can Americans respond to future health threats? What can we do? What are you going to do with your one and only precious life?

You're only one person, so you can't do that much. But so is everyone else. Don't be one person! People working on critical, timely issues as individuals, and then together with those others, is how social movements begin. These phenomena have influenced how our culture evolved.

Movements all start small, as renowned anthropologist Margaret Mead said, "Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has." Large-scale efforts to address our increasing mortality are beginning. We've not yet had deniers of our health decline. The dead (mortality statistics) don't lie. At this point, increasing mortality is mostly an American phenomenon; before COVID-19 we were about the only industrialized country seeing increased death rates. There is no "Make America Healthy Again" action cry yet.

Recall the Hawai'i Department of Health mountainside graphic; the first approaches that come to mind for improving health are aimed at downstream effects: promoting health care and getting individuals to modify personal behaviors. That is where the river's current has taken us. But such work has been carried out for decades, and our current state of health status decline shows these efforts have by themselves been grossly inadequate. At the waterfall are the social determinants, focusing on improving conditions that produce health. Finally, at the upstream source of root causes, are the political issues that affect those social determinants. An active, relevant, and effective social movement for health must include this level, while not minimizing the more downstream factors.

The climate crisis response presents approaches that may be effective in fostering a social movement for health equity. Efforts to create awareness of global warming have been ongoing for more than twenty years. Former Vice President Al Gore drew attention to the crisis in the 2006 Oscar-winning documentary, An Inconvenient Truth, depicting his lecture circuit efforts to raise awareness on climate disruption. Many of the early...