Sandra Hernandez

The Leading Social Determinant of America’s Health


America’s growing political, cultural, and economic divides represent the biggest threat to the nation’s long-term health and well-being. If these divisions go unattended, America will struggle to protect — let alone improve — the health and welfare of its people.

The perils posed by the COVID-19 pandemic should provide motivation enough for Americans to come together, and yet we remain divided about what we’re willing to do to prevent the disease, as well as our beliefs about the role of all levels of government to respond to it.

A decade has passed since the Affordable Care Act (ACA) was signed into law, yet we still seem to have questions about the law’s legitimacy. A case against the ACA stands before the SCOTUS today despite the fact that tens of millions of Americans rely on the ACA for coverage, financial security, and consumer protection. How can we tackle major issues like rising health care costs, structural racism, homelessness, or climate change — and sustain hard-won progress — if our nation remains at war with itself? 

To be sure, today’s most glaring conflicts have been stoked by opportunistic leaders who seek and control power by turning ordinary Americans against each other. Their strategy works because the ties that bind us together as a nation have been weakened by social media platforms that elected politicians use to sow hatred, fear, and otherness. That fabric isn’t something that just weaves itself. It requires dedicated and sustained strategy and investment. 

I would like to see the Biden Administration propose that all 18-year-olds in America fulfill a national requirement of a one year of national service. It’s not a new proposal, but the urgency for it has never been greater. 

 A service corps could be deployed to meet needs in public health, education, environmental and infrastructure restoration, and many other fields. These young people would gain valuable life and work experience just when they are coming of age. Most importantly, it would be a way to rebuild America’s wounded culture from the ground up, anchoring our social ties in physical relationships, real life, and tangible experiences re-building America and its social fabric.

To get the truly transformational benefits of such a program, it ought to be universal.

Those of us in health policy talk a lot about the importance of whole-person care. A major new service initiative that included everyone would be an act of whole-nation care. It’s the kind of bold treatment America desperately needs.