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 ideas on how to respond, however, focused downstream, such as urging individuals to use more efficient lightbulbs. In the intervening years, greater awareness and activism around the world have moved the focus far upstream.
For example, many countries signed onto the Paris Agreement in 2016 to voluntarily mitigate global warming by reducing its primary causes. Most nations have made efforts, with some progress . . . . Young people, such as Greta Thunberg, will be the most impacted by global warming. They have mobilized in major ways. Read books on organizing movements. The climate justice movement, albeit with a slow start, is now well under way as a result of youth activism. Learn their techniques and transfer them to population health issues.
Past social movements have used a variety of techniques ranging from protests and blockades to the mass mobilization seen in the abolition and civil rights movements. In the 1700s, women in New England, concerned about slavery, wanted to draw attention to its brutality. They formed “sister societies,” speaking at community gatherings about the ills of slavery. Their efforts spawned the abolition movement that long afterward ended slavery.
The social movement for suffrage grew out of the abolition movement. Suffrage for women was limited to white women. A formerly enslaved person, Sojourner Truth, spoke out publicly in 1851, saying, “Ain’t I a woman?” Some of the key leaders had also fought against slavery, such as Susan B. Anthony and Alice Paul, both Quakers.
To draw attention to their cause, the suffragettes launched fashion trends. Some ran for political office—despite not being allowed to vote. They also joined forces with similar movements in other countries. Success came in 1920 when women gained the right to vote in the United States. Black people were guaranteed the right to vote after 1965. Some fifteen states had already granted women voting rights before it became federal law. States can lead the way.
“If 1 percent of the American public focused on our staying alive longer. . . . This would lead to interdependence rather than hyperindividualism, reciprocity rather than dominance, and cooperation rather than hierarchy.”
Social movements are becoming more visible each year. A 2015 U.S. Supreme Court decision legalized same-sex marriage following grassroots action for gay rights. Other efforts have provided a range of protections for LGBTQ+ people that were unthinkable just a few decades ago. The history of progressive social change is inspiring, and not the work of individuals. Progressive change requires a social movement for success.
Audio cassettes catalyzed the Central American political uprisings that produced massive physical protest. The Arab Spring in 2011 prompted a series of protests, movements, and rebellion against oppressive governments in the Middle East and North Africa, organized on social media, that led to massive numbers protesting in public, especially at Tahrir Square in Egypt. It birthed an effervescence of rebellion which was suppressed by the powerful few. The movement will rise again.
A single event involving one person can catalyze a global movement, just as Rosa Parks’s refusal to give up her seat on a bus propelled the civil rights movement forward, the killing of Matthew Shepard fueled gay rights movements, Erin Brockovich spearheaded legislation protecting consumers from exposure to industrial toxic waste, and George Floyd’s murder galvanized the Black Lives Matter movement.
Charity or solidarity? The rich and powerful create philanthropies to throw crumbs at us, and they decide which scraps to toss. Philanthropy exerts power over public life. Meanwhile the wealthy enrich themselves rapaciously, as we have seen with COVID-19. Activism and solidarity must become a normal activity throughout society, rather than something only a few engage in.
Numbers matter. If 1 percent of the American public focused on our staying alive longer, that would compel the powerful to acquiesce, especially once they recognized they would live longer. This would lead to interdependence rather than hyperindividualism, reciprocity rather than dominance, and cooperation rather than hierarchy. This challenging goal will be politically realistic after a few more catastrophes.
Major economic shifts are essential to address our health decline. Those changes will require a broader awareness of the effects of upstream factors on our health. The groundwork is being laid: Public resistance to our increasing inequality is growing, with disaffected Americans recognizing they are being exploited by the sick system. Our future work needs to focus on exposing the ways in which rampant social injustice affects not just our economic well-being but also our prospects for a healthy life. Inequality kills!
Twenty years from now, you will be more disappointed by the things that you didn’t do than by what you did. What matters is not to know the world, but to change it. Start doing new things, and share your good ideas with me. Don’t be missing in action. We must organize or die.
Excerpted with permission from Inequality Kills Us All: COVID-19’s Health Lessons for the World, by Stephen Bezruchka. Copyright © 2022. Available from Routledge.