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Keisha Bentley-Edwards and colleagues argue that systemic racism and economic inequality are at the root of disparity in covid-19 outcomes and suggest how to distribute resources more equitably. The story of covid-19 in the United States is one of many systemic failures to protect its residents from preventable illness and death. Racist stereotypes about disease susceptibility1 were subsequently discredited by the data.2 Covid-19 brought the US to a sobering standoff with race, a social construct that through systemic racism materializes as disparate outcomes (box 1).3 Once testing became ava...

Katherine LeMasters and Lauren Brinkley-Rubinstein raise concerns about the lack of sustained change in prison health transparency after covid-19 and implications for future public health crises People in the jails and prisons across the United States are often housed in abysmal and unlawful conditions that have dire consequences for health.1 From poorly designed built environments (eg, lack of air conditioning, overcrowded dorms) to stressful and unpredictable living quarters, to a lack of quality and timely healthcare, time spent in incarceration worsens peoples’ health.23 In fact, the Ame...

Michelle Mello and colleagues argue that state legal reforms have generally exacerbated rather than improved weaknesses in US emergency powers revealed by covid-19, jeopardizing future responses Covid-19 related mortality in the US was higher than in every western European country.1 Compared with its closest neighbour, Canada, also a federated country with a decentralised health system, the US fared far worse.2 With over 1.1 million dead at the end of 2023,3 leaders and academics have begun a painful postmortem. What went wrong, and what can be done to make authorities in the US better equippe...

Chelsea Cipriano , Kushal Kadakia , and Dave Chokshi argue that the US must end its collective amnesia about public health disasters and act collaboratively to strengthen services Throughout American history, leaders have stood up in the aftermath of disasters and committed to honoring the past by investing for the future. For example, the Space Shuttle Columbia disaster in 2003 led NASA to overhaul its safety culture and attracted new partnerships that are paving the way to America’s return to the Moon.1 Likewise, after a multistate blackout that same year, the North American Electric Relia...

As the United States enters an election year with huge international stakes, it is easy to be pessimistic that the value of continued US leadership in global health, including pandemic preparedness, will be the subject of prominent debate in the 2024 elections. Geopolitical crises in Ukraine, Israel-Palestine, and China-Taiwan dominate attention and policy. Climate, debt overhang, food insecurity, and humanitarian crises compete for attention. The flagship President’s Emergency Plan for AIDS Relief (PEPFAR) has lost prominence. President Biden has said little on the campaign trail about the ...