Achieving Healthiest Nation Status Is Both Attainable and Desirable

This issue of AJPH contains a thoughtful commentary by Zohoori (p. 259) about the issues surrounding the American Public Health Association (APHA) strategic vision to create the healthiest nation in one generation. Achieving healthiest nation status is indeed an ambitious, audacious goal. But those in public health have the responsibility of being the chief health strategists for the nation’s health, and if we are to accept that responsibility, we must set a goal that meets the highest possible vision of that challenge. It is true that the United States spends much more on health care than do other high-income countries.¹ Despite this level of investment, we have poorer overall health system performance and poorer overall health outcomes.² History has shown that the United States has the capacity to be an exemplar in anything that it puts its national will, creativity, and enormous resources to.

When the APHA originally took as our strategic direction becoming the national leader in health improvement, we understood the enormous challenge it would be. We also understood that we as an association could not do it alone. We took seriously the 1988 Institute of Medicine report’s description of the mission of public health as “fulfilling society’s interest in assuring conditions in which people can be healthy” (https://www.ncbi.nlm.nih.gov/books/NBK218215). To that end, the APHA has worked on building the political will to make becoming the healthiest nation a goal and has advocated adequate resources for a robust and adequately resourced national public health system to achieve this goal. During National Public Health Week in April 2016, which focused on becoming the healthiest nation by 2030, we brought attention to this effort.³ We have now built a movement through social media called Generation Public Health that has more than one million individuals dedicated to improving the public’s health and that we believe is building the political will for change.

There have clearly been setbacks along the way. Epidemics of obesity, opioids, and now COVID-19 have stymied this effort, resulting in continued decreases in life expectancy over the past few years. For 2020, life expectancy fell an additional 0.6 year because of increases in mortality attributable to “COVID-19, unintentional injuries, chronic liver disease and cirrhosis, suicide, and homicide.”^4(p6) Nevertheless, the APHA continues to believe healthiest nation status is achievable. Whether it is international sports, scientific achievement, or the space race, Americans are a competitive people. We like to win. Imagine what we could achieve if our national will was focused on having healthy people in healthy communities. What if we received the best value for our enormous fiscal investment in health by ensuring universal health coverage, increasing our focus on prevention and primary care, and addressing with intention the social determinants of health? What if we truly strove to achieve equity in health status?

Following this pathway would lead us to success. We have work to do to reverse several years of declining life expectancy. Choosing to take the pathway toward becoming the healthiest nation is desirable and attainable and is, in fact, our only choice.