April 13 2017

Thirty years ago, I arrived in the U.S. in pursuit of what was touted as “the best medical education in the world.” I landed in an unfamiliar Baltimore, Maryland, to attend Johns Hopkins School of Medicine, and little did I know, the city, not the school, would radically change my life trajectory. 

The contrast between Baltimore and my hometown of Montreal, Canada, was jarring. While Montreal is rich with high-quality housing and public transportation—not to mention sprawling parks and public art—Baltimore is a city of soul-riveting inequality. 

Canada’s wealth of public art, social services and community resources reflects its strong social compact—a profound commitment the government makes to protect and support all citizens. The promise of the American Dream is America’s version of a social compact: the idea that through hard work and dedication, everyone will have a fair shot at success. To fulfill the promise of the American Dream, America’s social compact promises help along the way through access to a good education, safe and affordable housing, and a social safety net that helps people meet basic needs when times get rough. 

Across the nation, our social compact is steadily eroding, leaving many of us without the basic tools needed to achieve the American Dream. 

There are many visible signs of the broken dream: growing homelessness in our communities, people struggling in low wage jobs, unaffordable health care and low high school graduation rates. All of these cumulative stressors, that working families across the nation face, are lowering our life expectancy and making people sick with preventable chronic health issues or with despair. Our fraying social compact is driving a public health crisis. 

Healthy, affordable housing, neighborhood parks, libraries, community centers and safe jobs that pay livable wages are essential to good health. With the future of public funding for community programs at stake, now more than ever before, we need a new social compact reaffirming our commitment to an inclusive society in which all Americans have access to these opportunities and high-quality community resources. 

Our new social compact must recognize the responsibility of government to serve the wellbeing of people, and promote a fair and inclusive society for all Americans.

At the California Endowment, we recognize health is inextricably linked to the communities in which we live, and that inequalities in health result from policies that decision makers have created. For the first time, whites are dying prematurely in California’s rural north and Central Valley. In rural California and across the U.S., working-class whites are struggling with opioid addiction, suicide and despair in the face of stagnant wages, unemployment and high poverty rates—conditions all too familiar to underserved communities of color. 

If we’re not vigilant about defending the progress we’ve made to help expand opportunities for all Americans, it can quickly slip away. Our social compact is something you have to fight for every day. That’s why the California Endowment’s Building Healthy Communities (BHC) initiative is investing in the power of people by bolstering community organizing efforts in communities with the largest health disparities in California. Half way into our 10-year, $1 billion initiative, we have won more than 100 local health-in-all policy victories in our 14 focus communities. 

From youth in Boyle Heights advocating for their city to invest in youth services instead of incarceration, to eastern Coachella Valley residents speaking out about the need for safe drinking water for all, Building Healthy Communities members are strengthening the way that government, community programs and systems work together. By encouraging civic participation, BHC is revitalizing democracy and, together, we are building community power to ensure that conditions where people live, work, learn and play actively promote health and equity. In short, we are rebuilding our tattered social compact.

The American social compact is too valuable to be neglected or forgotten. It’s why, thirty years ago, I found myself laying down roots in a new homeland that would offer opportunities for me, and my future family, to grow and thrive—and to work towards a society that truly reflects the American Dream. By recommitting to our shared values of inclusion and dignity for all with a new social compact, we as a society can curb this public health crisis and progress towards a brighter, healthier tomorrow.


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