I began my career in public health more than 20 years ago, when HIV was raging in many countries around the world. The U.S. government’s strategic response to attack this brutal disease overseas has saved more than 25 million lives and shaped my understanding of what strong public health policies can accomplish. It was a certain PEPFAR.

Today, as New York City’s health commissioner and a practicing physician, I see a dire need for similar focus and ambition here in the United States. The major health crisis we face is not the coronavirus or any single epidemic. Cancer, diabetes, and drug overdoses are not the only causes. In America, the decline in life expectancy is a national emergency. Combating declining life expectancy could become a unifying focus of the second Biden administration. Because putting our country on a path to longer, healthier lives will require a concerted effort and significant investment across government, along with other sectors. .

After nearly 10 years of flattening since the end of World War II, there has never been a time when so many years have been taken away from our collective lives as in the three years from 2019 to 2021. The coronavirus was a factor, but it wasn’t the only one. Countries with comparable economic power have suffered less sharp declines in life expectancy and have largely regained the ground they lost during the coronavirus pandemic. Chronic diseases like diabetes and heart disease, along with drug overdoses, suicide, and violence, have kept the United States from becoming one. Some groups, such as black Americans, have suffered even greater declines. People without a bachelor’s degree lose more years than their college-educated peers.

To reverse these trends, the United States should devote resources to a coordinated industrial policy for health. Industrial policy requires government action and private markets to work together to meet complex challenges and achieve common goals. When this nation needed a transcontinental railroad in the 19th century, we built it through concerted federal action. When developing countries needed HIV treatments, we created a system that allowed companies to produce HIV treatments at low cost while building medical systems to deliver them to patients who needed them. When the world needed a COVID-19 vaccine, we combined government-funded research with private initiative and a large-scale distribution campaign.

So what happens when we focus all our efforts on solving the problem of shortening lifespans?

First, we must end our reliance on clinical care for new diseases and spend more on preventing health problems in the first place. The United States spends lavishly on clinical care, spending $4.5 trillion in 2022 alone, more than 17% of gross domestic product. Prevention accounts for less than 3% of total health care costs. This ratio leaves us with the poorest health and shortest life expectancy in the developed world.

We need to significantly increase spending on prevention in two main ways. The first would directly increase funding for public health departments to expand core services in areas such as health education, infectious disease surveillance, chronic disease screening, mental health services, and doula programs that address maternal and child health. , and these activities have been proven to be effective in prevention. Illness or long-term health problems. The creation of a national public-private fund will attract investment from industry leaders to match increased government spending and channel that money directly to community-based organizations that run many local and state government public health programs. You can do it.

The second part is to redirect hospital and health funding to preventive care and social services essential to long-term health. We are working with so-called Centers for Medicare and Medicaid Services waivers that make clinical funding available for nutrition programs in places like North Carolina and to fund housing services for people facing homelessness. We have seen a recent example of how the exemption was successfully utilized in California. . The Biden administration has approved eight Medicaid waivers, including one recently approved in New York. This number should be significantly expanded in Biden’s second term, along with expanded social needs exemptions in Medicare and incentives for employer plans.

Achieving an industrial policy for health also requires making it fundamentally easier and cheaper for individuals and industry to make healthy choices, and harder and more expensive to make unhealthy choices. . That means seriously considering measures such as imposing excise taxes on sugary drinks and ultra-processed foods. Ban menthol cigarettes and set minimum unit prices for alcohol, as proposed by the Food and Drug Administration. When these and similar actions were taken, even in the face of difficult politics, they yielded positive results. We need a combination of voluntary efforts, FDA regulations on labeling, and more incentives for SNAP and WIC eligible families to buy fresh produce to reduce added salt and sugar in our food system. We also need more incentives for healthy behaviors, such as helping consumers save for insurance plans to join a gym or buy fresh produce at the grocery store.

Rethinking health plans and how health care is paid for will require policymakers to ask different questions. If new housing is planned, authorities would not be expected to simply ask how many families could live there, how much it would cost, or whether the area was zoned correctly. They will also have to answer, “Will this make my constituents sick or healthy?” Will it lengthen or shorten lifespan? And could this impact how many units we build, where we build them, and how we set rents and further increase affordability? A new metric can be employed to predict the impact of a particular initiative on: lifetime return on investment (LROI).

Government spending may be formally aligned with LROI projections, and private sector incentives may also be aligned based on the same framework. For example, in tackling diabetes, policymakers could compare the LROI of taxing sugar and fast food to subsidizing the production and cost of new drugs like Ozempic. They may do both, or neither, but at least they will make informed choices based on concrete implications for life and death.

The idea of ​​integrating health directly into overall policy-making is not new. From 2012 to 2016, eight states and the District of Columbia passed “Health in All Policies” laws aimed at orienting government structures in the direction of welfare. Although these efforts were well-intentioned, they lacked the funding, metrics, and understanding needed to make significant advances in population health outcomes.

These shortcomings, and the significant decline in life expectancy that we have seen in our own data, have implications for the November 2023 launch of HealthyNYC, the Adams Administration’s plan to achieve healthier, longer lives in New York City. I gave it. In 2020 alone, life expectancy here fell by an astonishing 4.6 years to 78 years, the worst decline in the country. We have set an ambitious goal of reaching 83 years of age, the highest in the country, by 2030. We do this by tackling the leading causes of premature death across the board, from heart disease and overdose to suicide and cancer.

At the same time, we are creating a model where leaders across city government can begin to interrogate spending decisions based on their version of LROI. The New York City Council even passed a law codifying HealthyNYC into a plan and requiring regular progress reports and reassessments. Set life expectancy targets every five years and ensure that these are achieved across electoral cycles and unitary government priorities. This will be essential to the success of the federal government’s efforts.

A national project along these same lines goes beyond what most people believe our deeply divided political system is capable of achieving. That’s why we need to make an effort. President Biden has the opportunity to announce a national promise to restore average life expectancy for Americans as a centerpiece of his campaign and second term. The president has previously called the November election a battle between two competing visions: backward-looking politics filled with frustration, division, and demonization, and an inspiring, ambitious, and hopeful vision for America’s future. It was framed as a choice.

Industrial policies for health can offer hope and direction for the future and provide a remedy for polarization. I can’t imagine a more unifying proposal than: “We all have the right to live longer, healthier lives, and ensuring we achieve that should be a top priority for governments.” It Is difficult.