Health is largely shaped by our physical and social environments, pandemic or not. That is why we see 30 year differences in life expectancy between the most and least affluent zip codes, and why COVID deaths are so disproportionate too 2/10 
Many of the factors underpinning this disparity in health originate "upstream", and outside healthcare. Some are amenable to action at the local authority level. Many however are influenced by decisions nationally, and these longer term decisions did not help in the US 3/10
The US suffered from a long-term erosion of public goods and safety nets, and suffers from severe health inequity. It is that inequity, the poor health outcomes suffered by those with less income and opportunity, that was already driving US life expectancy down 4/10
The inequity, lack of social safety nets, large vulnerable groups, poor workplace protections, and lack of economic security and affordable healthcare made #COVID19 worse, and the consequences of social distancing more acute 5/10 blogs.scientificamerican.com/observations/t…
Underinvesting in these factors made the US population less healthy, less equitable, and more vulnerable to COVID and it's consequences. Reversing that would make for a healthier, more resilient and economically secure population 6/10 onlinelibrary.wiley.com/doi/full/10.11…
The US spent $$$ on disease control, but often in siloed and reactionary ways rather than with longer term strategy. It underinvested in broader public health infrastructure at the expense of health equity and coordination of expertise and data 7/10 milbank.org/quarterly/arti…
The US did what it has always done. Invested in technology and healthcare way, way more than promoting population health and reducing health inequities. Look at the relative spend, and then remember that life expectancy graph 8/10
Setting aside broader functions of @PHE_uk to focus on disease control, or healthcare, ignores the role of the broader determinants of health in the inequity that worsened COVID. Just ask Local Directors of Public Health: 9/10
Tackling health inequity has to be at the heart of whatever comes next, even if your sole focus is ensuring future pandemics don't hit as hard. It can't be an afterthought. We can't buy or treat our way out of it. We need to lay the foundations for health as a public good 10/10
