I am pleased to share with you my 2023 preview. It is intended to be fairly comprehensive, and at 6000+ words, it sure as shit better be. But it is by no means complete, or a mile deep. My goal was to paint a broad picture of where we are right now, to offer opinions on where I think we'll go this year, and ask questions that help you think constructively.
If you'd like to join me and the rest of our Members to discuss it, I'll be live in our Slack community all day Monday and Tuesday answering questions. You can join right now for $5/month or $50/year (a 17% discount).
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The popular economic historian Adam Tooze defines as: “A situation where you face multiple crises…where the whole is even more dangerous than the sum of the parts.”
Lots of folks looked around at 2022 and said “Yeah, that tracks”.
Lots of other folks feel like applying such a term to this moment is hyperbole, or that our combination of crises isn't so unique.
Which is fair. Tooze didn’t discover the idea, nor is it the first time he’s employed it, and TBH, history is full of eras that were decidedly hot trash garbage for just about everyone alive.
Slavery of all kinds has existed for millennia, everywhere, and still does. Internal Chinese wars killed upwards of 30 million people. The years before, during, and after World War I/Spanish Flu/Great Depression weren’t peachy! World War II had penicillin, bless, but otherwise sucked pretty hard. The sequel to the Dark Ages included the combo Black Death and Little Ice Age, you’re welcome.
My take: A huge bevy of crumbling systems isn't unique to history, but 2023's circumstances and consequences increasingly are.
And not just because they could, collectively, end the whole experiment, but because we can use them to build something incredible.
We are more connected (physically and digitally) than ever before, for better or worse. We have moved into and subsequently obliterated more ecosystems than you could ever comprehend. And while many "parts" or systems do indeed affect one another (climate and food, war and food, inflation and food, pandemics and food, I could do this all day), for others correlation doesn’t necessarily imply causation — yet.
I believe there are 80/20 solutions that can address many of the parts at once, relieving a massive amount of pressure on the system as a whole, but I do not believe there is a single fix to any one of them, like, say, getting in your time machine and teaching people how to wash their goddamn hands.
We need to mitigate and adapt at the same time, but we have adapted to and normalized so much pain already, especially among ecosystems and marginalized people, that I worry our way of dealing with the pace of change is to simply move on.
What seems most different today is how many more people are on this rock, competing for the same resources, and affected when those are used up, dried up, or threatened.
Billions of people in the West and Global North leveled-up by exploiting our lonely water planet’s natural resources, and in 2023, many billions more people in low-income countries are just beginning to do the same, despite (waves hands at headlines). Everybody else got to do it, why can't they?
The pace of change is only going to increase — as of literally whenever you’re reading this, India has probably grabbed the “largest country by population” crown from China, and just in time for manufacturers to start moving production en masse to the subcontinent. Tens of millions are moving into cities there, and across a very young Africa, too, shifting geopolitical trends for decades to come, requiring energy, transportation, health care, textiles, industry, and more.
Two ideas are important to hold onto as we consider the implications of a polycrisis, and as we barrel into 2023:
The sum is greater than the parts
This applies in both the negative and the positive
Thinkers like Steven Pinker are happy to tell you that humanity is on the whole better off than at any time since we started walking upright, and he's not wrong. But only at great cost to our air, water, land, and biodiversity. And while the baseline has improved, the benefits haven’t been anywhere near equally distributed.
The good news: So many of our better futures are indeed intertwined and even mutually reinforcing.
mRNA COVID vaccines don’t just protect each of us, but all of us, and our battered health systems, too, and pave the way for future use cases across other diseases.
Induction stoves don’t just boil your kids pasta water quicker, but reduce the odds they suffer from childhood asthma, and, when your whole neighborhood gets on board, the odds that a gas pipeline will blow up your apartment building.
Electric vehicles aren’t just cheaper to operate, and won’t just contribute fewer emissions and thus slow global heating, but also reduce local air pollution, and thus cardiovascular conditions and early death.
Community health clinics don’t just provide more and more frequent health care on the daily, and in pandemic times, but help rebuild trust right and when we need it the most.
It’s not all roses — there will be enormous, shitty tradeoffs. There will continue to be bad guys. Environmental justice and health justice must be predominant in all phases of rebuilding our economies, despite the massive financial incentives to continue business as usual.
But I do believe — with speed and direction — there is an absolutely wild amount of white space in front of us. Much is underway, and every action and election counts. Let’s see where 2023 might take us.
At best, international climate policy has been a story of snatching marginal but needed victories from the jaws of defeat, because of and despite the best efforts of so many.
Recent global agreements around loss & damage and biodiversity protections are impactful, however much more is needed, and should be considered building blocks for more and better agreements soon. 2023 should see the very first impacts of these.
Putin’s war in Ukraine is a savage, terrible one, but it has galvanized Europe and the world to (eventually) ditch gas. It won’t happen in 2023, but the impetus is finally there to remove Putin’s biggest leverage over the EU.
I am concerned about the proliferation of fossil fuel assets being offloaded to private equity, but eventually even those will become impossible to defend, much less profit from. Money costs a hell of a lot more than it used to.
I have to imagine even more green money will dominate bond markets as the electrification of transportation, buildings, and (on a much longer timescale) heavy industry increase. Oil prices should rise again as China abruptly and fully reopens, driving more short-term profits into literally dinosaur businesses and emissions into the atmosphere and ocean.
Lula’s re-election in Brazil — and the re-appointment of activist Marina Silva as environmental minister — is probably too good to be true if your expectations are too high. They’re not going to rebuild the Amazon with their bare hands. But as always there is nuance to everything and so any protections — literally fucking anything — is better than his predecessor. How many Venmos will Lula require from the international community to hold off meat-driven deforestation?
At home, it’s go time for IRA.
Clean power is gaining on fossil fuels, but we have a very, very long way to go. Besides major transmission and long-duration storage questions, I think there’s very serious risks from highly-concentrated solar supply chains in Asia and negative margins on increasingly huge wind turbines. Solar doesn’t face the raw materials supply issues that batteries do, but the actual manufacturing of panels — particularly around polysilicon — is where China just absolutely dominates, because we decided not to.
Don’t underestimate housing. In fact, I think it's impossible to underestimate housing. We need so much more housing — by some estimates almost 4 million new units — so cities are vastly more affordable, so commutes are shorter, to reduce homelessness, and of course, by doing all of these, we reduce emissions.
"America has an average of 1,000 square feet of parking for each car, vs. 800 square feet of housing per person."
-- Dayna Evans
Overall, I think it’s very, very difficult to underestimate how much we need to build across this vast country, and how logistically difficult it’s going to be if the status quo remains.
Housing permitting in New York or San Francisco has to look much more like Atlanta (still a suburb nightmare compared to European cities), and we need to be able to build power lines as quickly as we do gas pipelines. Permitting reform with an environmental justice backbone is priorities number one through six.
Will we get it? Well, I’m a pagan-atheist-progressive who thinks the government can play a huge role in funding the long-game, who gives enormous effort and sums to progressive young candidates at every level, but I’m aware enough to recognize how calcified the electorate has become.
Radical political change isn’t coming in 2023. It’s a game of inches and I will continue to fight for every inch.
"Hope is the distance between where we are and where we need to go, and it can only be closed by what the hell you’re willing to do about it."
If the incumbent gerontocracy we have in federal office now — the second oldest in the world — remains, the drastic change required may be difficult to come by. The House of Representatives is held hostage by far-right mobsters that make the Tea Party look like centrists. Obstruction and distraction will be the name of the game in 2023, stalling any further federal action.
So look for more executive actions around labor and soot, new rules from the EPA on clean power and tailpipes, more details on the new Green Bank (where there’s $27 billion to be sorted out), and a very, very busy Loan Programs Office at the Department of Energy. Good luck, Jigar!
Good news: To combine the international and national climate finance beat into one hyperbolic guess: I think IRA’s impact will be at least 10x as described.
Sure, NIMBY's continue to crush our ability to power factories with wind or solar, not to mention build power lines to connect one to the other, but if last year's battery, EV, and solar factory commitments across red and purple states are any indication for the rest of the decade, the amount of private capital brought forward or manifested entirely new by IRA should dwarf current estimates.
Even if we forget the desperate need to mitigate against inevitable climate impacts, energy security has always been the name of the game. But once again: radical permitting reform is absolutely critical to unlocking what’s required to turn this ship around.
What about you?
Thanks to IRA, consumers will see the most progress at the state level this year in 50+ different flavors. Federalism!
15 states are already required to get their power from 100% clean sources by some point, and 6 are phasing out gas and diesel vehicles. Will more follow this year?
I think we can get even more local, though. Land-use is a major question for solar and wind, and rightfully so — but remember that bit about all the fucking parking we’ve got? At all those big box stores? And publicly-funded stadiums? With the massive footprints?
France now requires many parking lots to be shielded by solar panels, reducing temps and driving local clean power. I’m keenly interested in transferrable local and state policy that emulates this and ASAP.
As I’ve covered in partnership with Rewiring America (with much more to come), home electrification is where it’s at. So many furnaces are emergency replacements, because who wants to actually plan ahead and deal with that shit, but that’s exactly what I’m asking you to do, and IRA incentivizes with heat pump cash galore. Along the way, you can trade gas stoves for induction, and get heat pump water heaters and clothes driers, upgrade your insulation, and more.
We have been straight up lied to about the dangers of gas, particularly stoves, but with this momentum, it’s difficult to just shrug at the absolute deluge of devastating research around childhood asthma and more.
And don’t forget: we can always, always make our homes and the appliances in them more efficient. America in general does a shit job of focusing on efficiency, but I encourage you to use IRA to get as efficient as you can, save some cash, and maybe the jet stream, too.
We have a bazillion EV chargers to build (and maintain) and will need at least 3x the power to…power…them, which is nothing to sniff at, but consumers and fleet operators (like Hertz) are already finding out how much less maintenance EV’s require, and thus how much money they can save by moving away from combustion. The USPS, which has finally agreed to go mostly electric, will soon discover the same.
I’m a big fan of meeting people where they are, so let’s talk trucks:
Yes, some heavy trucks and SUV’s are commercially-required, and yes, electrifying them is important because they inherently produce more emissions, so on the one hand, it's a big emissions lever to pull.
But on the other hand, emissions aren’t limited to tailpipes, and considering the electricity required to charge these massive death machines, it’s entirely possible that rushing to electrify all of these heavy vehicles will actually increase overall emissions because there will be so few battery materials and power left for smaller vehicles and micromobility.
Battery materials - mainly, cobalt, lithium, and nickel - are finite, and faster, larger vehicles with enormous blind spots suck up more of them, as the continue to run over adorable little children they cannot possibly see.
We need automobiles, and they should all be electric, but as we race to mine sustainably, to figure out battery recycling, to reform permitting for transmission and clean power, and figure out whether and how to tax vehicles by the pound without (more) riots in the streets, we should be doubling down on e-bikes (which receive nothing in IRA), walking, and public transportation.
Even as we build, Shit Giver, the climate impacts will grow, and will continue to affect marginalized, low-income, and people with disabilities the most. El Nino is coming, finally, which means 2023 could be the hottest on record. Despite this week’s rains, the US west drought will probably continue, if temporarily tempered. The Horn of Africa’s in very, very bad shape, and the only reason Europe isn’t freaking out about winter gas prices and blackouts, as predicted, is because it’s a hell of a lot warmer than it should be.
I am immensely privileged to have clean air, clean water, and shelter, and because of these things, and because of all of you, I don’t despair. Fighting every day for a better today and tomorrow for more people is all I can do. Mariame Kaba said "Hope is a discipline". That's what compound action is all about. One by one, day by day, person by person, we make change.
Let’s talk data.
2023 will continue to be a story of who else has your data besides you.
And that's either because you consciously allowed them to have it, because they collected it per the terms of a lengthy TOS they knew no one would read, because they collected it even when they said they wouldn’t or when you explicitly told them not to, or because they straight up stole it from you, your company, or an app or service you signed up for.
In 2022, the implications for data collection and brokerages, spyware and ransomware became more stark, and that should hopefully carry forward. Subject to ransom or court orders, more was on the line, and so more companies and infrastructure began to actually do the math on how much of your data they actually needed.
As ever, there will be tradeoffs.
For hospitals or banks, the answer is understandably “we need quite a bit of your data”, despite the personal health information of almost 50 million Americans exposed in just the past few years.
For others, like Facebook, the answer is...they don't have another answer. Sure, yes, no doubt, millions of small businesses depend on Facebook’s reach and tools — see: the entirety of the DTC revolution — but we have to do better and at this point I’m not sure how anything but severe consequences forces them to reassess how to provide a similar benefit with far less bullshit.
I think those consequences will continue to grow in 2023. The broad, rushed transition to “zero trust” practices across companies and the federal government continues.
Now, you may still be asking yourself, why would someone hack me? The answer remains: they don’t want to hack you. They want to swoop up the data of as many people as they can, all at once so they can demand the largest ransom possible.
And as rarely as you hear about data breaches at behemoths like Apple and Google, you should absolutely do a little audit of all of the pics and screenshots you’ve taken of your license, health insurance, social security cards, passwords, kids school info, bank account info, and more.
Quantum computers — however marginally quantum — seem able to break the most common encryption schemes, and lazy players like LastPass have screwed millions, so do the math. Passkeys can’t come soon enough.
Did AI write this?
No, but they may do me one better, and soon (it's a low bar).
Let’s talk about AI and GPT for a moment, shall we? I have no doubt the very intelligent and ambitious folks at Google, who pioneered useful search only to cannibalize their best product with ads and, usually, ads for their own doorbells, will catch up to this deluge of new OpenAI-powered tools, but wowzers.
The recently announced GPT and Bing team-up may result in nothing, but Microsoft invested in OpenAI three years ago, at my count, and well, somebody’s getting steak knives this week.
Next up? Word, Excel, Powerpoint. Everything — and I mean everything -- is up for disruption.
Back to search: This is the first real “oh shit” moment I can think of for Google’s most important revenue stream. Sure, Reddit and even TikTok are occasionally better at some searches, and this isn’t to say OpenAI is the only one who can play the game — reinforcement learning designed or at least tweaked by humans with HUGE AND TERRIBLE BIASES isn’t new or unique — or that Google can’t pivot, but again, if they were on it, why the decade-long focus on doorbells and weird machines that listen to you sleep?
Commercially, I think OpenAI actually has a better case for monetizing GPT than, say, Amazon ever did for Alexa, which, again, wow. And they have to. Every “Magna Carta but as Dr. Seuss under duress” term paper produced on demand, or “Winnie the Pooh as a 1950’s detective” image created is reportedly VERY costly. Some version of B2B licensing and consumer pro revenue could move the needle.
Would you pay for it? Will writers? Advertisers? Researchers? Students? Publishers? Everyone? At some point, and I think soon, it will be like performance-enhancing drugs in sports. The first players used them to get ahead, and eventually you had to use them to keep up.
Maybe we should define what “it” is, because it’s really not “it” — it’s multitudes, in implementation. It’s not one tool, it's a huge, HUGE variety of tools, with more proliferating every single day. How well will we adapt once we become dependent on them?
Let's be clear: If you’re a student and you’ve got to write a paper on deadline and your school system hasn’t banned it yet, you’re absolutely going to give it a shot. The whole process — minus some very important fact-checking — takes 30 seconds. Whether you’ve got the chutzpah to actually turn it in and potentially face the consequences is another question entirely.
Whether you consider what you lose by doing so — even if you don’t get caught — requires deeper questions I certainly wasn’t asking at 16.
We learn (and I still learn every single day) SO much in the act of writing (it's usually a horror show). As our thoughts spill out onto the page, we marvel or are ashamed by how they come to be, and how poorly we express them. And then we get to interrogate them on the page against research, and defend them, if that’s the assignment.
It's often brutal, and embarrassing, but wildly fruitful, and that’s how we learn. That’s what we lose by skipping to the end.
I don’t think bans are the answer, however terrified administrators are, and however overworked and underpaid teachers may be. One easy answer? Timed essays written in class.
But let's take a step back: Should students be lucky enough to attend schools with internet and devices, not a given by any stretch, GPT could be deliberately used in class to reverse engineer the writing or research processes. Why did a predictive text algorithm choose these words in this order, how does its assumptions hold up in the real world, etc?
Like any other technology, we can’t put it back in the box, but we can continually retrain ourselves to think about how we deal with the future. Because I have no illusions that the simple act of writing as a profession will continue unabated.
Look at it this way:
I love reading real books, and I mark them up constantly.
I also love reading on Kindle, and in Reader and Matter, so I can send digital markups to Readwise to review later.
But I also love listening to audiobooks, because of bike rides and dishes and long runs.
The examples are myriad, and none of this is black and white. People who harumph that audiobooks aren’t as good as real books blissfully ignore the thousands of years when oral stories and prettttty vital survival info were all our ancestors had. But on the other hand, there’s no doubt tools like Readwise make my reading more constructive and eventually, if you’re still reading this, useful to you.
Like a classroom flexibly situated for children with ADHD, very little English, or with physical disabilities, it’s time to commit to hard, wide-ranging thinking about onboarding GPT-3 and 4 and 5 and whatever comes with them, whatever tools are built on them, whatever white-collar professions they enhance, or made obsolete.
We are are just a pipeline of soft meat casings, trying to harness whatever tools are available to us from cradle to grave, and a new generation is coming online right now that will never know a world without this very first and probably rudimentary version of generative and assistive AI.
A new online era is beginning, just as another ends — I think.
Elon taking down Twitter from the inside parallels a raft of migration from and regulation of legacy players like Facebook and Google and even Amazon. Apple, too, is increasingly (and justifiably) under penalty for obscene antitrust practices (disclaimer: my family owns elevently-billion Apple devices), but it’s Facebook’s who's acted most egregiously, rivaled by only Google in the race to hoover up your life, and again rivaled only by YouTube in raw ability to stoke extremism, ferment civil wars, and tear down democracies.
All that said, the EU’s recent fines made me wonder not if Facebook will pull back on data harvesting, but how — it’s their entire business model.
Otherwise, I think Amazon is infrastructure now, and it seems like Biden’s SEC had their shot at breaking up big tech and couldn’t get there. Not that the EU’s model is perfect — GDPR has more or less backfired, stifling competition, and less granular tracking may do the very same.
Sure, Amazon is all ads now and Apple pivoted to advertising and services, but their moats remain strong. I think the hardware and logistical behemoths are better suited to survive this run of AI than their software counterparts (even if we’re due to very quickly run out of the hardware to power these fantastical new AI tools).
Speaking of finite resources: let’s talk food and water.
These are of course impossible to separate from the climate crisis, from blockades on Ukrainian exports to, again, the Horn of Africa, to the Colorado River, fertilizer prices, monocrops and unhealthy food, meat, and the ever-growing need to build better, faster, more flexible, and longer-lasting disaster relief mechanisms.
On the latter, I hope we can continue to future-proof relief organizations and mutual aid for what’s here and what’s coming: we need, in the short term, more rescue, power, food, water, breast milk, formula, and diaper capabilities, and in the long-term reconsidered philosophies and policy around new construction and insurance on the coasts, in flood plains, and in the wild land-urban interface, housing, and mold.
This section isn’t very long because it’s so interconnected and deponent on climate action, much of which can be affected at some scale this year: Reduced meat consumption everywhere, obviously, but also no-till crops, more legumes, reduced water use, farmworker heat protections, expanded immigration, slowing global heating, offshore crops, deforestation, a new farm bill, massively reduced food waste, and more.
Specifically food related, and coming back to baby formula, I’ll only say this: The FDA continues to struggle mightily to produce acceptable results at either of their jobs. They’re punishing American families and costing lives every day.
Of course, overall, it IS the best time ever to be alive.
Specifically, being born in America IS the most impactful golden ticket a human could ever receive, in history, zero question. But averages are misleading, and it’s a very very thin precipice of affordability, accessibility, and timing.
Hard-fought expectancy gains have reversed, but bans on conversion therapy are growing. Future pandemic preparedness is lacking, but universal flu vaccines and cancer vaccines continue to progress through labs and trials. Solar power is the cheapest energy of all time, but requires massive new land-use.
Despite a lifetime of inhaling WIRED, Popular Science, ScienceDaily, etc as soon as they hit my doorstep/iPad, I am at 40 and after a few years of doing this job overwhelmingly — but not exclusively — more interested in policy, behavioral science, and baseline public health strategies that benefit the many than I am technological innovations that help the few.
Don’t get me wrong: I think biotech is awesome. I wasn’t alone in hoping mRNA vaccines might quickly lead to a long-promised landscape of useful and profitable biotech advancements, the kind of shit that blows minds and treats or cures millions, if not more.
We make incredible advances every day, but that market still hasn’t come to pass -- and I'm ok with that. Science is hard. I think a lot of the fakers have been weeded out, but there’s much more to come.
I think/hope/plan on continuing to invest in and introduce you to people and places working on health tech and biomaterials, because, well, we have to, and because while most of this piece is about doing the basic shit that elevates the marginalized and improves our baseline, there's no good reason not to aim as high as we can.
In the meantime, we can do some very basic shit to make us drastically less reliant on future home runs.
COVID revealed the desperate need for multi-tool community health clinics and basic workplace protections for essential and underpaid hourly workers. Our maternal health situation, particularly among marginalized people, is an unacceptable nightmare, proving the need for more doctors and nurses of color, more doulas and midwives, universal health care, paid family leave, and paid sick leave.
It’s more complicated than that, but COVID didn’t cause these issues, it only further revealed them. I don’t know what will happen with future COVID subvariants — exposing however many millions of unvaccinated or under-vaccinated Chinese people to a far more transmissible version means a couple billion more opportunities for this thing to mutate.
Knowing nothing about how it will change, but looking at the facts on the ground as they are, I think we’ll see another 140,000 American COVID deaths in 2023. I want this to be very, very wrong, but we’ve normalized new baselines and quickly constructed narratives about what happened and why, who’s to blame, what works and what doesn’t, how we can protect each other, and ways we’d simply rather not.
It was easy to point fingers in the early days and say “these countries did it better” but however poorly we performed, most of that has evened out.
When you start to pull the string on the stories we’ll tell about COVID, it’s important to focus on the storytelling itself.
We need better frameworks and mechanisms for science communications — I cannot imagine a Twitter owned by Elon Musk in 2020 — but we also need time.
What does that mean? Well, I think we need more time to more honestly and completely analyze, synthesize, understand, and communicate not only COVID’s health impacts, but also the economic ones, educational ones, policy ones, and more.
But the more we pull that string the more questions arise, and they aren’t dissimilar from how history has been written and later taught: Who do we measure, when do we start measuring, and who gets to decide? Are there any agreed upon facts? Is there any standardized terminology, old or new, which can help us understand?
What does it mean that China is finally opening up, and yet we're 100% positive the information on risk, sickness, and death isn’t complete? Could two million die in a relatively old country, or more? What will ten times that many home sick over the next year mean for world manufacturing, and China’s own economy?
Time is everything: We need information to act quickly, but again, with China, we’re months, if not years away from understanding toll of COVID there — mostly because it’s really just beginning.
We know America’s elderly more or less stopped getting shots after the initial two doses. We’re about to find out exactly how many of China’s elderly actually got their initial vaccines. Or maybe we won’t, because Xi and company are refusing to share anything meaningful, not unlike Russia. So the data may come indirectly, through reduced output.
What will it mean politically? Years of lockdowns have enraged citizens and forced the party to radically adapt — the tradeoff being very low exposure rates. What have they wrought, and what will the health, civil, economic, and political implications be as Xi takes on his 3rd term?
To be clear, we seem to be fairly ill-prepared, if disinterested, in doing the math for ourselves. A country VERY caught up in erecting monuments to both controversial and real heroes has normalized not mourning those we’ve lost, or conversely, supporting those who prevented this thing from being much, much worse.
We continually marginalize and, if necessary, sacrifice the usual folks: young children, the elderly, Black, Brown, Asian, and Indigenous peoples.
It’s complicated! We’re repelled by the wisdom of our elders but refuse to elect anyone under 65. We pour billions into keeping them alive but sacrifice babies on the regular. Letting the child tax credit expire was the most unforgivable act of a Democratic congress in a very long time.
I continue to believe in the power of basic science. mRNA vaccines didn’t show up overnight, nor did cheap solar and wind, pig hearts in human bodies, birth control tests, new diabetes drugs, or even marginally helpful Alzheimer’s treatments.
We have to fund more basic science, and we need to act quickly and broadly to use basic science — “pollution makes people sick” — to deploy basic but aggressive policies that enable better outcomes on normal days, and better survivability when the next virus comes knocking.
This isn’t complicated, or at least, it shouldn’t be. Setting and then reverse-engineering policy, teams, funding, and processes from clear, measurable outcomes can go a long way.
We have to walk and chew gum, of course. This country has untold wealth and resources. We have to fund more structural approaches to identify and remove bottlenecks across science, fund more cross-disciplinary teams infused with ethical backbones, and more specifically, fund aggressive labs and ideas that will probably fail — I’m talking healthcare here, but also health tech, biotech, educational tech, and deep climate tech.
And we have to do a better job immediately imagining and preparing for “what happens next” — we’re miles ahead on disaster relief compared to, say, post-viral symptoms like Long COVID. Post-viral symptoms aren’t new by any stretch of the imagination, we should have anticipated a crush of new long-term care when the N was everyone on the goddamn planet.
This is all over-simplified, have no doubt. But failing to anticipate outcomes, to execute on the most simple, foundational premises — everyone deserves clean air, clean water, healthy, accessible, affordable food, paid sick leave, and access to trusted health care — gets us to where we are today: systemic issues, and massive opportunities to write a better future for more people.
I don't want more people to have health care. I want more people to be healthier. That's the outcome, and now we work backwards to design how we get there.
Again, in 2023, the opportunities to contribute to 80/20 solutions are everywhere, from your stove to your city council:
Less hot redlined city blocks
More and better and more affordale healthy food options
Vastly more housing (and a much more regulated airbnb/house flipper economy)
Equitable, accessible, affordable, destigmatized mental health care
Paid sick leave
Paid family leave
Half a million more nurses, and more nurses of color
Revamped education for medical schools
Expanded, free, and incentivized community college
More community health clinics
Better health literacy for everyone, but especially Black Americans
Improve on these, and we build better outcomes.
One outcome a bunch of sexist morons didn’t plan for: a shit ton of babies from people who suddenly couldn’t get abortions.
A fun story about pregnancy, forced or not: it’s a ticking clock. Unless something goes wrong, a maximum of 10 months after someone can’t get an abortion, a baby is coming. And even if something does go wrong, sometimes they have to deliver the baby anyways! So fun.
It’s been about six months since Dobbs, which means some babies have already been born early, and a hell of a lot more are coming soon, and that’s just since day one. And since we are absolutely shit at maternal health, especially in states that didn’t pickup Medicaid, a lot of people are going to suffer.
Now you may argue, in good faith: “I thought vasectomies are on the up and up!” And they are! Which is great.
But did you know Obamacare doesn’t require coverage for vasectomies?
Good news: Just this week, CVS and Walgreens said they’d apply to sell abortion pills — with a prescription — under a new FDA rule that’ll allow them to do so for the first time. The pills won’t be available in states that prohibit them, but it’s…something, if nowhere near enough.
Elections matter. Electing young, progressive people to every level of office who are not old white male lawyers matters. 2023 isn’t a sexy, national election year, but in states like Virginia, women’s health is on the line once again.
Thanks to racism, climate impacts, COVID, inequality, social media, Dobbs and more, mental health support is in high demand and the opportunity is there to build a real-life support structure — no, not Instagram-ready online mental health startups. Sure, some folks have gotten help, and I admire the concept, but the general execution — glossy predatory Instagram ads for incapable contractors — hurts more than it helps.
I think a new generation of intentional, swiss-army knife or “generalist” community health clinics can go a long way here, coupled with the reinforcement of so many existing clinics doing essential work in neighborhoods across the country.
So many young folks and COVID-era frontline workers are suffering, and we have a mandate to support them. Pair local wastewater monitoring with healthier lifestyle opportunities like paid leave and cooler city blocks or more robust public transportation and more plentiful, cheaper housing. Add clinics that provide checkups, prescription management, family planning, immunizations, substance abuse counseling, and talk therapy and we can drive up baselines of health across a complicated, calcified country, reinforcing families, cities, and economies.
These aren’t new ideas. They’re in practice the world over, and it’s on us to come together to enact them in more places, to help more people.
But in 2023, coming together may be the most difficult hurdle to overcome.
Trust is what suffers when it feels like the world is collapsing in around you.
We were born into in an objectively prosperous and healthy time, but that’s actually a key piece of our polycrisis: no matter the problem in your life, it’s often the difference between expectations and reality that crushes you.
Doomscrolling an algorithm driven by popularity and populated by people the world over means actively telling your brain that everything is bad everywhere, all of the time, and it masks a world on the cusp of great change.
Simultaneously, the glaring absence of local news removes our ability to “touch grass” — to be connected IRL, to feel the change immediately around us, and to understand where we may be most needed, and most effective.
Make no mistake: You have, on average, more agency than almost anyone that’s ever been born. INI exists to help you understand how to use it, at home and far abroad. You and I together have helped write and drive support for local policy, have sent precious PPE to health workers in India, supported independent journalists in Ukraine, reduced food waste in California and volunteered for hurricane relief in Florida, among so many others.
These places are home to many of you, and foreign to others.
Discerning where you’re needed and what you can meaningfully contribute, in combination with folks around you, isn’t a cure-all for what ails you, or us. Even with wild privilege, this game is draining.
But action compounds. Look around you. The sum is greater than the parts, and that includes you. We are so much better off than centuries before but better off doesn't mean it's good enough, especially when so much is at stake.
Measurable action across cities and continents can take you and all of us a very long way, rebuilding trust in one another, and in our ability to build a better today and tomorrow, for everyone.