This morning, I woke up after seven hours of air-conditioned sleep during a visit with a childhood friend. Yesterday, we walked plenty, prepared and ate food, and drank several glasses of water. I drove several hours before arriving, guided by GPS and secured with a seatbelt. Days ago, I completed an annual checkup at the nearby university medical system and enjoyed earnest conversations outside.
Without valiant effort, I have managed to move through the world not dying from heat stroke, dehydration, or food poisoning, free from the pains of a car wreck, untreated ailments, chronic loneliness, and air pollution. (Hooray!) I neglect, daily, to marvel properly at this miracle.
Daily survival is built on unseen protectors. When oblivious to what doesn’t kill us each day, we lack gratitude for our protective systems and, as a result, overlook their maintenance. This devaluation dominoes into preventable tragedies, even death. Hank Green calls this the tragedy of prevention.
To further understand what “prevention” means here, let’s first consider what it doesn’t.
Reactive life-saving measures, unlike preventative ones, occur in response to perils of a clear threat. For example, imagine you’re cutting up grapes for your babbling child to eat. Upon turning away, the chatter ceases, and you realize, in horror, that your four-year-old is choking. Eyes widened, you spring into action, performing the Heimlich. After a few moments, all is well.
By contrast, preventative life-saving measures occur before a threat, in protective anticipation. They are less flashy, less panic-inducing. Such action consists only in cutting up the grapes before serving them to your hungry toddler.
It’s curious. We don’t want the four-year-old to choke during snack time, and, similarly, nearly no one objects to setting broken bones in a cast or seeking a remedy while sick. However, driving the speed limit, and counting two rounds of A-B-Cs while hand-washing are less popular. It sounds like undeveloped object permanence, an inability to realize something out of sight still exists. When behind the wheel or a faucet, I rarely consider possible hospital visits or days of fever.
Striving to attend to the tiny tasks that save one’s own life is valuable; however, prevention does not begin and end at the individual level. Ongoing policy debate suggests that, even if lowering mortality is an agreed-upon aim, the methods by which a collective seeks to do this is contentious.
Take the One Big Beautiful Bill Act (H.R.I.), which passed through and to the House after a Vice Presidential tie-breaking Senate vote last week. As amplified by popular media, support for and contestation over the legislation seems rooted in reaction to the tens of billions in cuts to The Supplemental Nutrition Assistance Program (SNAP) and Medicaid.
These programs, insurance and food assistance, are preventative. They save lives less dramatically than the rescue of a car accident victim, aiding people in hopes of avoiding crisis. Related categories of prevention include the social determinants of health (SDOH), which the U.S. Office of Disease Prevention and Health Promotion groups into five domains: economic stability, as well as quality of and access to education, health care, built environment, and social community. In other words, where and how you are able to conduct day-to-day life factors into how long you have it.
Gaps in global mortality rates reflect this story. According to Our World in Data, global life expectancy—one’s expected number of years alive — doubled from the year 1770 to 2000. However, though the Americas saw a rise from 34.8 to 73.2 in this time, average lifespan moved from 26.4 to only 53.7 in Africa. In the last near-quarter century, low-income countries experienced ten years of growth — 53.1 to 63.8 — while high-income countries — 77.6 to 81.4 — break into an eighth average decade.
War, natural disaster, and localized traumas could explain inter-state divergences. However, investigation suggests that some fare better than others, at least in part, due to disparities in resource access between and within countries. For instance, the United States observed a post-coronavirus dip in life expectancy. Yet, within this same country, one racial group experienced average losses of 2.1, while, at the highest end, another faced an estimated 6.6.
Given that most of us live in societies, not remote isolation, meaningfully reducing these gaps perhaps involves anticipating threats and responding preventatively to historical trends. Local and global collectives comprise a substantial portion of the response to early mortality risk factors like food insecurity, dense living conditions, and poverty. Such institutions range from food banks and domestic abuse crisis centers to national and global programs, like the National Oceanic Atmospheric Administration (NOAA) and United States Agency for International Development (USAID).
But institutions aimed at prevention are not without their own fraught spotlight this year. Allegations of “waste and abuse” prompted cuts to 83% of USAID’s humanitarian and development aid, terminating 52,000 contracts worth $54 billion. Several headlines responded to this action citing an evaluation that, due to cuts, more than 14 million avoidable deaths could occur by 2030. In response, Boston University Mathematician Brooke Nichols created a PREPFAR Program Impact Tracker, estimating the number of deaths associated with the freeze and discontinuation of USAID’s program that supports people living with HIV.
If prevention is an invisible helper, then it could be easy to claim that — and perhaps more difficult to discern when — resources are used ineffectively. The painful truth might be that absence has a knack for highlighting the goodness we took for granted at the start. If funds are being misused, such conclusions will be hidden under waves of realizing what has been lost. And when quiet, preventative structures fall away, reactive ones might loudly, frantically attempt and fail to take their place. Consider, for instance, February’s NOAA cuts, which resurfaced amid this week’s heated disagreement of their role (or lack thereof) in the tragedies of recent deadly Texas flooding.
Connecting the dots between abstract public policy decisions and felt societal impacts will always be speculative work. Unfortunately, the political menu often offers only simple, all-or-nothing selections. Loud voices will, understandably, continue to amplify opinion on the distribution of resources that impact human lives and wealth on the national and global scale. However, the fundamental principles informing use of public provisions are seemingly messy by nature. Someone could genuinely want everyone to be taken care of without knowing how and where collected public resources ought to intervene.
For instance, we know clean air is healthier air. Does this justify annual emissions testing? Banning smoking — or all non-electric cars? Ought the reason for, opportunity cost of, and amount of pollution impact this decision?
Consuming poisoned food is deadly, so should we always accept the Food and Drug Administration’s (FDA) regulations on and evaluation of our groceries? What about outlawing digestible but addictive consumables like added sugar or alcohol? Should a regulatory standard for food and drink be edibility or health promotion?
What if you have food and healthcare, but your neighbor does not? What if you have no kids, but your coworker has three, and childcare costs are as high as your salary? If there’s a loneliness epidemic, then do we divert public funds to build more parks? What are public funds for?
We need a lot of support to live healthy lives. The extent to which a government should supply the structural support to construct them for its citizens, however, is not immediately clear. And when preventative systems do cut our grapes up for us, we’re, tragically, quite good at eating them in oblivious, underappreciated safety.
As the news continues to unfurl, I wonder if catching up with daily (or hourly) changes distracts, more than anything else, from the essence and productivity of what any of us are really after. Perhaps latching, instead, onto a foundational normative question might help unearth grounding and well-reasoned solutions:
What kind of lives, exactly, do we owe each other?
