Make America Healthy Again

An open letter to the next Director of Health and Human Services about how infrastructure is crumbling our minds and bodies.

Someone will soon be appointed the highest-ranking health official in the country. Whether it’s RFK, Jr. or someone else, it’s clear that “Make America Healthy Again” will be a part of Trump’s second term.

Most people who work in a field related to urbanism aren’t taught about the mental and physical outcomes of their work. Even though I have zero credentials as a health professional (other than owning a white lab coat), unhealthy infrastructure is one of my favorite ranty subjects. You may or may not know that I’m embarrassingly overdue on delivering a full-length documentary about the links between health and infrastructure. The purpose isn’t to persuade people to change their personal lifestyle, but to shine a light on how our surroundings can help or harm us.

I did release a 20-minute mini documentary, Healthy Havoc, that’s available to paid subscribers. (If you’ve upgraded but haven’t received the link, please let me know so I can get you the link.)

Movies can be persuasive, but they certainly aren’t the only proven method to reach people. Sometimes a good old fashioned letter writing campaign works wonders. Below is an open letter to the next Secretary of Health and Human Services. Feel free to share it with others, or to use it as a template for your own letter to HHS.

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Dear Secretary [Whomever]:

Congratulations on your appointment to lead the Department of Health and Human Services. You are stepping into a role at a pivotal moment—America is facing skyrocketing rates of chronic disease, mental health struggles, and the financial strain of an overburdened healthcare system.

But here’s some good news: local solutions exist right outside our front doors that don’t require new pharmaceuticals, expensive hospital expansions, or complex policy overhauls.

Walkable, mixed-use neighborhoods are an overlooked way to help Make America Healthy Again.

The Public Health Crisis That No Pill Can Fix

America is experiencing a chronic disease epidemic, and it’s not simply a matter of diet or exercise—it’s also about the way our communities are designed. The built environment does not fit who we are as humans. Our surroundings play a critical role in shaping our health outcomes, but for decades, local land use policies have prioritized car-centric development, unintentionally fueling a range of preventable health crises.

Physical Inactivity: A Silent Killer

Sedentary lifestyles have become the norm, not by choice, but by design. Most suburban and exurban developments require a car for even the shortest trips, removing natural opportunities for daily movement. The result? An explosion of lifestyle-related diseases:

• Heart Disease. The leading cause of death in the US, accounting for 1 in 5 deaths annually. A lack of physical activity is one of the strongest risk factors.

• Diabetes. More than 37 million Americans have diabetes, with Type 2 (strongly linked to inactivity) comprising 90-95% of cases.

• Obesity. Nearly 42% of US adults are obese, driving up healthcare costs by $173 billion per year.

The CDC recommends 150 minutes of moderate exercise per week, but for many Americans, the only way to achieve this is through structured workouts—something that often falls by the wayside in a culture dominated by long commutes, desk jobs, and auto-dependent errands.

Social Isolation: As Deadly as Smoking

Humans are social creatures, and social isolation is increasingly recognized as a public health crisis. Studies have linked loneliness to a 29% higher risk of heart disease, a 32% higher risk of stroke, and a 50% increased risk of dementia.

Local land use regulations that require sprawl exacerbate this issue by physically separating people:

• Long commutes reduce time for family, friends, and community activities.

• Single-use zoning ensures that homes, schools, businesses, and community centers are far apart, requiring a car for every trip.

• Aging in place is difficult, leaving many older adults cut off from their communities as they lose the ability to drive.

The Consequences of an Engineered Health Crisis

Beyond physical inactivity and isolation, America’s car-dependent culture has additional direct health consequences:

• Respiratory illness. Traffic-related air pollution contributes to lung disease, asthma, and other chronic respiratory conditions, especially in children. Studies show that people who live near high-traffic roads suffer higher rates of asthma, cardiovascular disease, and premature death.

• Stress and mental health disorders. Long commutes are linked to higher rates of anxiety and depression, largely due to stress, time lost, and lack of physical activity. People with shorter, active commutes (such as walking, biking, or transit use) report significantly lower stress levels and greater life satisfaction.

• Severe traffic crashes. The US has the highest per-capita traffic fatality rate of any developed nation, with over 40,000 Americans dying in crashes every year and millions more injured. Every month we experience the equivalent of a 9/11 attack, but Americans just shrug off traffic violence as a necessary evil.

Decades of mandated sprawl have removed natural movement from our daily lives, discouraged social connection, and subjected millions of Americans to chronic stress, air pollution, and dangerous road conditions. The result? A sicker, lonelier, more over-medicated population and a healthcare system drowning in preventable costs.

Infrastructure that prioritizes and often requires a car-dependent lifestyle is a national health emergency.

The Evidence for Healthy Neighborhoods

Fortunately, the solution isn’t futuristic or complicated—it’s as simple as reintroducing mixed-use design into our neighborhoods. We can build health back into our communities at the local level.

The built environment is one of the most powerful, scalable public health interventions available.

• People who live in walkable neighborhoods get more daily exercise simply by commuting, running errands, or socializing—often meeting the CDC’s recommended 150 minutes per week without ever setting foot in a gym.

• Access to green space and daily social interactions reduce rates of depression and anxiety, leading to lower mental health treatment costs.

• Mixed-use zoning allows essential services (groceries, pharmacies, healthcare clinics) to be within a short walk or bike ride, ensuring that healthy food, medical care, and community support are easily accessible to all income levels.

Encouraging active transportation is one of the most fiscally responsible healthcare strategies the US can pursue:

• Every dollar invested in walking and bicycling infrastructure returns up to $10 in healthcare savings.

• Cities that prioritize walkability experience lower emergency room visits, reduced medication reliance, and longer lifespans.

• Businesses in walkable districts see higher foot traffic, stronger local economies, and improved job retention—leading to greater economic stability.

The humble bicycle is a powerful drug that reduces the top 10 causes of death. Half of America’s car trips are under a few miles—bikeable distances—but junk infrastructure traps most people in motor vehicles.

Your Leadership Can Shape a Healthier America

As HHS Secretary, you have the opportunity to support policies that transform America’s neighborhoods into healthier places.

1. Incorporate walkability into public health policy—align federal health initiatives with transportation and urban planning.

2. Draw attention to active transportation—expand the MAHA discussion to include bike lanes, trail-oriented development, and transit-oriented development.

3. Make walkability a healthcare issue—ensure that medical professionals consider the built environment as a social determinant of health.

This isn’t about banning cars or forcing lifestyle changes. It’s about giving Americans the choice to live in places where health happens naturally—where walking to the store is as easy as driving, where kids can bike safely to school, and where seniors can age in place without isolation.

Walk-friendly, bike-friendly, mixed-use neighborhoods are a prescription for a healthier, more resilient America. Let’s make them a national priority.