Newsletter | Can Wellness Save America?

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Wellness is back! With your personal life coach and raw milk subscription and supplements regimen, you are on the vanguard of the new age of personal health empowerment. And now everyone’s favorite wellness guru, Robert F. Kennedy Jr., is poised to take over as Secretary of Health and Human Services. We live in the healthiest of times.

And - oh yeah - the unhealthiest of times, with chronic disease at record levels and all the trend lines going the wrong way.

This disconnect was brought home to us reading Shayla Love’s new story in the Atlantic: “America Can't Break Its Wellness Habit.” RFK Jr., she argues, must be understood as the latest in a long line of wellness figures who have battled against conventional medicine. What’s interesting about Love’s analysis is the way she teases out the relationships among conventional medicine, wellness and public health:

“For more than a century, alternative health practices—what we now call wellness—have seduced Americans not because of the accuracy of their claims, but because of what else they offer: a sense of certainty, an outlet for mistrust, a pseudo-religious belief in the ‘natural,’ and an affirmation of modernity’s limits. Because it satisfies those needs, wellness has a pattern of success in presenting itself as a replacement for the failures of medicine, even though the goals of wellness radically diverge from those of public health.”

Wellness movements emerge in the vacuums created by the ineffectiveness of traditional medicine. Nineteenth century medicine was, in Love’s telling, a jumble of practices that were questionable at best and hucksterism and quackery at worst – leading people to seek alternative cures, from alternative providers. This was followed by the “golden age” of medicine in the early 20th century, when antibiotics and vaccines brought huge success in combating and preventing acute and infectious illnesses. The subsequent massive improvements in health, a result of both medical advances and a burgeoning public health infrastructure, led to greater trust in health and healthcare institutions, and dampened demand for alternatives.

But since the last half of the 20th century, Love points out, conventional medicine has fallen short. It’s been ill-equipped to combat those chronic illnesses, many of which result from modern life, that now plague so many Americans. There is, to be sure, medicine for these illnesses - but that medicine doesn’t seem to do much for us.

The extent of that failure is documented in a new study that calculates the “lifespan-healthspan gap” for all 183 countries in the World Health Organization. The study compares national life expectancy with health-adjusted life expectancy (which factors in years living with disease or disability). With a lifespan-healthspan gap of 12.4 years, the US leads the world. Note also that the gap has been rising – it was 10.9 in 2000 and the larger gap is almost entirely due to increases in life expectancy.

It’s a bit wonky, but simply put, the results suggest that, in the US, we are much better about keeping people alive than keeping them healthy. In the US, life expectancy is now at 77.5 years. But if we consider the less common measure of health-adjusted life expectancy, the US punches in at about 65 years. Makes you wonder quite what we get for that $4.5 trillion a year.

No surprise then, that so many people are looking elsewhere for the answers to better health. As Love points out, part of the wellness movement arises from distrust in institutions, but part of it is also a reaction to the challenges of modernity – whether that’s forever chemicals in the environment, ultra-processed foods, smartphone addictions or the financial complexity of healthcare. 

The problem, though, is that wellness only goes so far as an actual antidote. We’re not talking about its general lack of evidence, but rather because wellness typically locates its response in the personal, rather than the collective. While the diagnosis – modern life makes it hard to be healthy – mirrors our own at Building H, the response is quite different. Vaccines, for example, are both a private and a public good, and opting out of them (as many in the wellness world so choose) elevates private choice over collective benefit. (just check out the Bad Medical Takes account on Bluesky for a taste of the zaniness here: “Polio is a weird one to be concerned about…Nobody has died of it since 1990.”)

Similarly, wellness often emphasizes personal solutions to public problems. It values Peloton over bike lanes, diet apps and supplements over food policy changes, and meditation apps over healthier work environments. 

Part of this, we’re afraid, is rooted in the singularly American strain of individualism, where the rights of the individual are paramount and dominate over the common good. Alas, health and healthcare take this on the nose, because the public health so depends on notions of collective responsibility and the social contract. And so for many this just rings true: If medicine isn’t going to help us, then it’s up to you to save yourself.

Of course, it’s empowering to take action - to do something. And there’s an enormous market to serve that desire: McKinsey estimated the US wellness market to be $480 billion in 2024. That’s a far cry from the $4.5 trillion spent on health care, but it’s nearly $1,500 a year per capita. It’s such a lucrative market that it’s attracted the big tech companies, who, in addition to selling products and services that result in poor diets, less sleep and sedentary lifestyles, now sell products and services (e.g., wearables) designed to counter those effects. 

The downsides of all the wellness solutions aimed at individuals include the diversion of funds available to pursue collective, public solutions and the implications for health equity. To the degree that better health is pursued through commercial wellness products, it isn’t available to people with fewer resources.

As Love notes, “the goals of wellness radically diverge from public health.” Which suggests a massive conflict in the offing: a leading wellness influencer is now poised to take over the world’s largest public health operation, the US Department of Health and Human Services. So what are those committed to public health to do? 

It’s not an easy question to answer. We take some hope in the sheer effectiveness of the US public health system. Though the CDC, FDA, and other federal agencies and services are far from perfect, they have a legacy of decades of success in mitigating disease and fostering effective treatments. These agencies are staffed by thousands of hugely talented scientists and civil servants. And Americans depend on them and benefit from them, far more than most are aware. 

And then there’s the tendency of wellness to overreach and underdeliver. The recent struggles of Goop and corporate wellness programs illustrate that there’s a limit to the utility of wellness, when it comes to real concerns and conditions.

But proactively, public health needs to do more demonstrating of the benefits of collective action and less time validating what’s already been shown to work. That is, too many resources in public health are spent preaching to the choir of regulators and policy makers and academics, rather than making the logical but non-intuitive argument of the greater good to the greater public. 

And people in public health need to demand more from our peers in healthcare and medicine, to see the bigger picture and develop population-level solutions for chronic disease. This may involve more medicine - GLP-1s for all! (?) - but it surely also involves bringing health and joy to everyday life in ways that all people can feel and experience. The more we all realize that more healthcare isn’t solving anything, and we start bringing more health to more life for more people, well, that’s a result that few will argue with.

This is our last newsletter for 2024. Thank you all for reading and for your support of Building H. We wish you happy holidays and a happy and healthy 2025!

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