Do Better Better #15: Overwhelm The System

How we're beating lung cancer (and what it means for air pollution)

We’ve made enormous strides in the journey against lung cancer. 

In 1999, there were 55 lung cancer deaths in America per every 100,000 people. In 2017, that number was down to 37. This is in part a second order effect of less smoking: in 1999, 23% of American adults smoked. Just 13% of adults do, today.

But we’ve still got a long way to go -- over 140,000 people still die every year from lung cancer, more than breast, prostate, and colon cancers combined, and lung cancer still has the worst 5-year survival rate (19%) of the top five cancers.

Most frustrating: the vast majority of new cases still come back to smoking. Meanwhile, a growing share of new cases (especially among women) are “never-smokers”, which means we have to dig deeper for causes: other environmental exposures, family histories, genetics.

But we have undoubtedly made progress. We’re smoking less and lung cancer deaths are down. But why? How did we get here?

The answer lies in a combination more research, better and different treatments, expanded testing, legal decisions, craving relief products, advertising regulations, indoor smoking regulations, taxes, and public messaging.

We have made progress against this particular evil not because we have done one of those things, but because we have done all of these things. 

Living now, in a more volatile and connected world, Doing Better Better means not only deciding what to focus on by identifying your values and skills, not only asking what the commitment really looks like, not only dialing the problems down to first principles, not only attacking the symptoms, not only attacking the root causes, but doing all of it

If the issues of our time — like the air pollution that kills over 8 million people every year — are systemic, then we are forced to Overload the System.


I get two frequent questions with regard to the Action Steps we recommend in the weekly newsletter.

First: “Why have you recommended X twice this month?” and second: “Why recommend X when it’s not the big sexy action?”

My answer is always the same: it’s never about one specific Action Step. It’s about helping you take action most effectively, and for us, preparing to do so often results in identifying a particular Action Step that’s worth repeating because it’s so effective, while also making sure we’re attacking the problem from all sides -- from legislation to volunteering, donating to voting, reading to writing.

Just as our response to lung cancer and smoking have been manifold and more effective in the aggregate, so too must we approach problems like air pollution and hunger by Overloading the System.

Issues requiring us to fight on all fronts are myriad, from lung cancer to air pollution, from COVID vaccines to food deserts, from the designated hitter to Dre vs Diddy (give us the Verzuz you cowards).

Let’s look to the 30 million-ish Americans who’ve gone hungry since the pandemic began. 

Of course we can use first principles to discover that this country does a poor job of providing clean food, water, and air; and of course we should thus focus on electing people who will approach these issues differently, and then holding their feet to the fire once elected. Systemic change is the long-term goal. 

But in the meantime, we also need to feed 30 million Americans, like right now, and supporting reputable organizations like Feeding America and World Central Kitchen will help do so. 

Speaking of WCK, let’s talk about natural disaster relief. Of course we need to use our votes to elect people in our districts and states who will go to Washington and legislate the country into a transition economy (another wide-ranging set of tasks), and of course we need to support and activate with groups like Sunrise who have successfully pushed those same policymakers into action. 

But in the meantime, there’s a hell of a lot of folks suffering from an increasing number of wildfires, hurricanes, and flooding, and someone needs to feed them.

Consider even new technologies like carbon capture. Is it unproven? Unscaled? Far-fetched? A drop in the bucket? Absolutely.

But we’ve messed this place up pretty bad, and while the number one goal is to stop burning everything all of the time, that’s going to take a while, and if we really want to get back to a safe place, we need to support and scale both natural carbon capture solutions, like coastal mangroves and Tongass, but also throw private and public money at potential technological solutions. 

Groups like Drawdown have illustrated exactly how many different approaches we can and must take to slow and one day reverse the climate crisis. There is no single silver bullet, no one piece of legislation or NGO that’s going to get it done.

To tackle COVID, we can upgrade our masks and tests, we can socially distance, we can develop vaccines and genomic sequencing for the viruses we have now, we can build messaging campaigns, and we can commit to rebuilding our research and monitoring infrastructure so we’re better prepared for the next one.

To tackle air pollution, we can regulate the hell out of ICE automobiles, especially in high-exposure areas, construction and agriculture sources, factories, and fossil fuel production facilities, improving myriad health outcomes in one fell swoop.

To tackle sea level rise, well, quite a bit of it’s just baked in. That’s the reality. But some of us can avoid buying real estate in places like Miami, New York, and Charleston, while all of us can lobby for just frontline transitions for those who can’t afford to escape sea level rise on their own.

To enable fairer elections, we can vote now, more than ever, despite the suppression, up and down the ballot, while we consider a future run ourselves, while we call and write to pass common sense bills like HR1 and HR4 that will make voting more inclusive, while considering globally successful examples of ranked choice voting for the elections themselves.



Eliminating smoking is obviously the ultimate 80/20 move for lung cancer, like how requiring seat belts helped fewer people fly through windshields. It’s already working.

Getting any further will require (even more) lawsuits and legislation. But we can also support the research scientists, doctors, and patients of today. And that all-encompassing mindset is how we have to approach the systemic issues of the 21st century.

And once you find an issue or issues that fit your values, you can use resources like Important, Not Important to build your own portfolio of Action Steps, to Overwhelm the System.

We’re in a new era. Data-driven activism has never been easier or more effective (cough cough), and -- even if only for about eighteen months -- we have the political numbers to do more than we ever have on a comprehensive issue like climate. Solar panels alone won’t do it. Carbon pricing won’t do it, new transmission lines won’t do it. 

We can and must walk and chew gum at the same time. We can attack root causes and ease symptoms.

To paraphrase author, editor, and friend of the pod Bina Venkataraman, we can all work to be better ancestors, while lending a hand to those in need, today. We can Do Better Better.

— Quinn

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