by jodrellblank | 2025-05-27 02:55:03+00:00
> "societal capacity for healthcare (and overall prosperity) will dwindle"

This is not a complete discussion without the elephant in the room - diet and lifestyle are making us sick and much of that is a choice of how we design our world. most Americans and Britons are overweight or obese, and the Coca Cola company and Nestle and all the rest are doing everything they can to encourage their product sales, and society is not doing much to counter it. [smoking deaths halved in the UK between 1990 and 2021 [0]]

America and the UK are car-centric, the CDC says less than half of Americans meet the guidelines for physical exercise[1] and UK Gov says 1 in 3 men and 1 in 2 women are not active enough for good health[2]. People say that if the health benefits of exercise could be bottled up and sold, it would be one of the most potent drugs known, and we're designing places and lives which get rid of it as a regular part of life, and make it harder to add in. UK Gov link says "can help to prevent and manage over 20 chronic conditions and diseases, including some cancers, heart disease, type 2 diabetes and depression". There's millions of people with type 2 diabetes, which is reversible for many people with low-carb eating and fasting and exercise. The Lancet[4] paper saying 4.5 million people were diagnosed with liver disease in the USA in 2021 and alcohol is responsible for almost 60% of cirrhosis cases.

Then there's cities which build car-dependent suburbs, so they can get money today from new build taxes, but set themselves up for large maintenance bills paying for the sprawling roads and water/sewer/electric infrastructure with such a sparse tax base. This is bankrupting cities in North America, which are having to allow more sprawling suburbs today to pay for yesterday's suburb's maintenance in a pyramid style.

Then there's big box stores[3] which sued state governments to stop taxing them as functioning businesses on the grounds that they build their buildings so shoddily they are completely worthless to sell to anyone else or use for anything else, and should be taxed like an empty valueless building. Walmart pays employees so little that many of them need food stamps (SNAP) and those get used at Walmart which then moves the money out of state. Big box stores make cities poorer.

When cities and states say there's no money for pensions, care homes, social services, health services, public transport, it's they're busy mismanaging it and spending it all on subsidising wealty car-dependent suburbanites and 'prestigious' big box store developments. Not to mention health insurance middlemen denying treatments and taking money from the sick and wasting the time of healthcare professionals tying them up in paperwork.

If things were better, with more long-term thinking, people would be healthier and need less support for that reason, things would be closer and easier for people to walk/use public transport to get there so they could remain independent longer in declining health, healthcare would be a lesser demand on society, and there would be more money available to fund it. Then add the 'missing-middle' of American housing so people who have aged and their kids have left could downsize to a smaller home in the same area with the same community, and they would have a more manageable home and more of their money for healthcare.

This is like writing a bubble sort and then declaring that sorting is too expensive so we just can't have sorting in the future.

[0] https://ourworldindata.org/smoking

[1] https://www.cdc.gov/nchs/fastats/exercise.htm

[2] https://www.gov.uk/government/publications/physical-activity...

[3] https://thecounter.org/how-dark-stores-loophole-helps-retail...

[4] https://www.thelancet.com/journals/lanchi/article/PIIS2468-1...