Robert Reich’s urgent call in “How Do We Get Out of This Mess” delivers more than a diagnosis of America’s economic malaise — it offers a blueprint for rescuing both democracy and public health. Reich makes clear that decades of deregulation, wage stagnation, corporate consolidation, and erosion of labor power have hollowed out the American middle class. The result is not simply inequality in dollars and cents, but inequality in years of life, in access to care, and in civic voice. “What good are more jobs,” he asks, “if those jobs barely pay enough to live on?”
Here, Sameera Fazili’s work on inclusive economic growth and the social determinants of health (SDOH) becomes a natural companion to Reich’s argument. Her research at the Federal Reserve Bank of Atlanta and her leadership in national economic policy show how upstream economic interventions — from affordable housing investments to Medicaid-financed preventive care — can bend the curve toward better health outcomes. When zip code predicts life expectancy more powerfully than genetic code, the economy itself becomes a public health intervention.
Both thinkers converge on a radical yet practical conclusion: economic reform is health reform. A true strategy for what might be called profound economics must view living wages, paid sick leave, universal healthcare, affordable housing, and climate resilience not as policy options but as basic conditions for human flourishing. Reich’s prescriptions — strengthening unions, restructuring taxation to capture extreme wealth, guaranteeing jobs, and protecting Social Security and Medicare — align with Fazili’s findings that community-level investment and cross-sector collaboration lower costs and improve outcomes.
To move from analysis to action, the next phase of conversation must be bold and integrative. Hospitals, public health leaders, and community developers should jointly finance interventions like supportive housing and food access programs. Policymakers must expand the use of community development financial institutions (CDFIs) to channel capital into health-promoting infrastructure. Business leaders must be engaged as partners — and held accountable — for ensuring that jobs do not trap workers in poverty.
Finally, we must frame these issues not just in economic terms, but moral ones: a nation that allows preventable deaths due to lack of care, or hunger due to low wages, is failing its social contract. Profound economics asks us to measure success not by quarterly profits but by human outcomes — health equity, educational attainment, civic participation, and trust in democracy.
The path forward is clear: integrate economic and health policy, invest in upstream determinants, and guarantee that every person has the material conditions to live with dignity.
Essay based on Robert Reich’s “How Do We Get Out of This Mess,” with direct parallels to the equity-focused economic work of Sameera Fazili : ‘Can Community Development Improve Health?’ Emerging Opportunities for Collaboration between the Health and Community Development Sectors.
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