At what point shall we expect the approach of danger? By what means shall we fortify against it? Shall we expect some transatlantic military giant to step the Ocean and crush us at a blow? Never! All the armies of Europe, Asia, and Africa combined, with all the treasure of the earth (our own excepted) in their military chest; with a Buonaparte for a commander, could not by force, take a drink from the Ohio, or make a track on the Blue Ridge, in a trial of a thousand years. At what point then is the approach of danger to be expected? I answer, if it ever reach us, it must spring up amongst us. It cannot come from abroad. If destruction be our lot, we must ourselves be its author and finisher. As a nation of freemen, we must live through all time, or die by suicide.
—Abraham Lincoln, Lyceum Address, January 27, 1838
Master Sgt. Mike Landsberry served tours in Kuwait and Afghanistan as a member of the Air National Guard. At home in Nevada, he worked as a high school math teacher and sports coach. Chris Kyle was a Navy SEAL sniper and decorated Iraq War veteran who had 160 confirmed kills of Iraqi insurgents—the most in U.S. military history. When Kyle returned home, he set up an organization to help troubled vets and wrote a best-selling memoir, American Sniper, which was adapted into an Oscar-nominated film, directed by Clint Eastwood. Patrick Zamarripa enlisted in the Navy less than one month before 9/11 and saw combat during three tours in Iraq. When he left the service, he joined the Dallas Police Department. What did all three of these men have in common? They survived fighting the war on terrorism in Iraq and Afghanistan—but they could not survive America’s deadly gun culture.
When a young student came to school armed with a Ruger nine-millimeter semiautomatic handgun that had been stored in his family’s unlocked kitchen cupboard, Landsberry leapt into action. Relying on his military training, he tried to calm the young gunman and disarm him. But the twelve-year-old boy, who claimed he had been a victim of bullying, could not be reasoned with: he shot and killed Landsberry before shooting himself in the head in front of his classmates.1
Kyle, along with his friend Chris Littlefield, was trying to help a tormented former Marine corporal, Eddie Ray Routh, who suffered from posttraumatic stress disorder. Kyle and Littlefield brought him to a gun range, but Routh turned his weapon on the two men.2 Zamarripa, who had recently begun an assignment as a bike officer in downtown Dallas, was killed when a gunman opened fire at the end of a peaceful Black Lives Matter protest. They are just three of the more than thirty-eight thousand Americans who die every year from gun homicides, accidents, or suicides.
The tragic and senseless deaths of these men highlight one of the great ironies in the way Americans think about threats and, in turn, national security. American politicians and a news media that adheres to an “if it bleeds, it leads” mind-set focus inordinately on violence that is random and rare and that can be blamed on “others,” such as jihadists or terrorists. Far less attention is paid to nonterrorist acts of violence and systemic harms that occur on a daily basis in the United States—and cause far greater suffering. Even less attention is paid to the silent killers: noncommunicable diseases such as heart disease, respiratory illnesses, cancer, and diabetes that take hundreds of thousands of lives every year and are largely preventable.
Today the dominant “national security” narrative emphasizes the number of ships in the Navy and soldiers in the Army, as well as the perceived seriousness of overseas threats. The actual dangers all around us, which not only put our lives at risk but undermine our basic standard of living, barely register.
In 1983, the eminent international relations scholar Richard Ullman made the persuasive—and all too rarely heard—argument that discussions of national security would be more useful if they addressed “human security.” Ullman argued that the greatest challenges to national security are twofold: those actions that threaten “drastically and over relatively brief span[s] of time to degrade the quality of life for the inhabitants of the state” and those that dramatically “narrow” the range of policy choices available to the government or state to private nongovernment entities (persons, groups, corporations).”3 Limiting policy choices and undermining quality of life may not seem like pressing national security issues, but they go to the heart of how national power is built and retained. A country in which its citizens see their wages go down, their health get worse, their children receive a subpar education, and the infrastructure around them crumble can hardly feel secure—no matter how effective its armed forces may be or how many nuclear-tipped missiles it deploys.
Ullman’s notion of an expansive view of national security is not merely the navel-gazing of an Ivory Tower–ensconced academic. It reflects the sentiments of the architects of America’s post–World War II hegemony. Defense secretary James Forrestal, who is generally credited with coining the expression “national security,” made clear that the term should take into account “our whole potential for war, our mines, industry, manpower, research, and all the activities that go into normal civilian life.” He argued that the best weapon the United States had against communism was its economic leadership, and “the only way in which a durable peace can be created is by world-wide restoration of economic activity and international trade.”4
The Eisenhower administration adopted this view, incorporating virtually every element of national power—from scientific research and transportation to education and military technology—into discussions of national security. Investments in these areas, from the National Highway System and the National Defense Education Act to the National Science Foundation and the Advanced Research Projects Agency (ARPA, later renamed DARPA for “Defense”), laid the foundation for America’s technological and economic dominance over the Soviet Union during the Cold War. Indeed, DARPA is credited with funding and supporting the precursor to the internet.
Since then, America’s political leaders have continued to make a fundamental link between economic power and national security as well as the quality of life for the American people. George H. W. Bush’s National Security Strategy in 1993 noted, “Our national security requirements must be viewed in the context of our overall national well-being.”5 President Obama’s 2010 National Security Strategy took a similar position: “Our national security begins at home. What takes place within our borders has always been the source of our strength, and this is even truer in an age of interconnection.”6 However, these words have rarely been translated into concrete action. Instead, it is the military inputs of national power rather than investments at home that receive predominant attention.
Thinking about national security in a broader manner would transform how we talk about foreign policy. It would mean prioritizing the physical protection of the American people, which would include their immediate safety, their health outcomes, their social and economic opportunities, and to quote the nation’s founding document, their “pursuit of happiness.” To do so would also mean focusing on the primarily domestic, human-induced behaviors or negligence that needlessly kill and injure millions of Americans each year. Indeed, the greatest threat to Americans does not originate in the Middle East or the South China Sea or the Hindu Kush but rather in communities and neighborhoods across the United States.
Near-Term Harms
The most pressing risk that Americans face has nothing to do with radical Islamic terrorism, allegedly “existential” threats from Russia or China, or even America’s standing in the world. Rather, it is something that is overwhelmingly under their control: how they take care of themselves.
There are four specific behaviors that put Americans in the greatest danger: smoking, drinking, unhealthy diets, and lack of exercise. These risk factors directly increase the chances of being diagnosed with and dying from a noncommunicable disease (NCD), which includes cancers, respiratory illnesses, diabetes, and cardiovascular diseases. In all, NCDs take 2.3 million lives every year (and account for 90 percent of all deaths within the United States).7 This preventable carnage costs the country $330 billion each year in health expenditures and lost productivity and makes life for the afflicted progressively worse.8 These illnesses restrict normal daily activities, keep people home-bound, and make workers far less productive. They send health care costs skyrocketing and heighten anxiety and depression, particularly among family members and even the unborn, as NCDs alter the genes passed on to future generations as children of parents with NCDs are more likely to suffer from the diseases as well.
The striking tragedy of NCDs is that, unlike communicable diseases such as polio and many cancers, chronic diseases are essentially self-inflicted. The behavior and lifestyle choices that Americans make on a daily basis determine how vulnerable they will be to these illnesses.
When surveyed, Americans believe that they make about fifteen food and beverage choices every day, but in reality, it is more than two hundred.9 When those choices include large portions of red meat, salt, and fat, it contributes to heart disease, cancer, and strokes. Or consider simply what people drink with each meal. Sugary beverages—such as soda, energy drinks, or sweetened iced tea—contribute directly to cardiovascular diseases (heart attacks and strokes), cancers, and diabetes that are estimated to kill over twenty-five thousand Americans every year.10 Recent studies even suggest a link between such drinks and dementia.11
While every country with access to unhealthy foods, alcohol, and tobacco is confronted by the challenge of NCDs, the problem is particularly acute in the United States. According to a comprehensive 2013 report by the Institute of Medicine and the National Research Council, ominously titled Shorter Lives, Poorer Health, the United States—compared to other developed countries—ranks near the bottom on a host of health metrics.12 These include infant mortality rates and low birth weight, as well as diabetes, heart disease, and chronic lung disease. More recent studies have found that children in the United States are three times more likely to be born dangerously premature and 76 percent more likely to die in the first year of life than are kids in other developed nations. For those who make it past the first year of life, they are 57 percent more likely to die before they reach the age of twenty. These declining health outcomes mean that since 1961, more than six hundred thousand American children have needlessly died.13
A big part of the problem—and there is really no nice way to say this—is that America needs to go on a diet.
Today, around 40 percent of Americans are considered obese.14 That is more than double the average of all Organization for Economic Co-operation and Development (OECD) countries—the thirty-five-member club of advanced, democratic nations. Among children, the obesity rate stands at 18.5 percent—a 34 percent increase from just fifteen years earlier.15 In all, more than two-thirds of American adults—and 31 percent of children—are overweight.16 This problem has gotten steadily worse. In 1990, not one state in America had an obesity rate above 15 percent. By 2016, not one state had a rate below 22 percent, forty-six states were above 25 percent, and twenty-five states had a rate higher than 30 percent.17 This rapid increase in the size of Americans has also led to a corresponding rise in the prevalence of hypertension, diabetes, and heart disease. It is small wonder that in 2016 life expectancy in the United States (78.6 years) declined for the second consecutive year—the first time that happened in the United States since a particularly virulent flu epidemic in 1962–1963.18
The consequences of America having a population so severely overweight go far beyond mortality. Obesity-related medical costs in the United States are estimated to run as high as $315 billion a year.19 Obese children miss more days of school and have lower grade point averages than do their peers who are not overweight.20 Obese workers are less productive, are more likely to be absent from work, and produce an estimated $70 billion annual drain on the economy.21 They make less money, have greater economic anxiety and higher health care costs, and are also more likely to suffer from depression.22 Not surprisingly, being overweight is the leading medical reason that otherwise-eligible recruits are turned away from military service, as one in four young adults are deemed ineligible.23 Retired generals and admirals have in recent years described this epidemic as a national security priority, because it shrinks the pool of potential soldiers and sailors.24 But this is a good example of how America’s national security discussions tend to miss the forest for the trees. A smaller pool of military recruits is problematic, but it pales in comparison to the far more consequential health and economic implications—and the vast societal costs—of a national population that is so overweight. Indeed, if there is one thing that Washington could do to make Americans safer, extend their lives, reduce their anxiety, and improve the nation’s economic performance, it would be to encourage and incentivize them to eat healthier.
Along the same lines, drug interdiction has been considered a national security issue for nearly four decades. President George H. W. Bush’s 1990 National Security Strategy stated that the “international traffic in illicit drugs constitutes a major threat to our national security and to the security of other nations.”25 Less focus, however, has been given to the national security implications of drug use in America.
In recent years, America’s problem with drugs has become a national catastrophe. In 2016, more than seventy-two thousand Americans died from a drug overdose—far more than the number of American soldiers killed in Vietnam and approximately twenty-four times the number of people killed on 9/11. Drugs now kill nearly as many Americans as guns and cars combined and are the third biggest killer in the United States.26 The major reason for this startling increase in mortality rates is the increasing popularity and prescription of opioids and highly addictive prescription pharmaceuticals like hydrocodone and oxycodone. Indeed, two-thirds of overdose fatalities in 2016, or forty-two thousand deaths, were from opioids. That represents a 28 percent increase from just the previous year. As addicts get hooked, they begin to seek out bigger and better highs, and that means drugs like heroin and synthetic opioids like fentanyl, the latter of which killed twenty thousand Americans in 2016—a 540 percent increase in just three years.27 One 2015 White House estimate put the economic costs of America’s opioid crisis at $504 billion, or 2.8 percent of GDP—and the situation has worsened since.28 Moreover, like NCDs, drug addiction alters the genes that are passed down to a user’s sons and daughters. This matters because scientists estimate that genetic factors account for as much as 50 percent of a person’s vulnerability to addiction.29
As this carnage has unfolded, annual federal drug-control spending has grown by 16 percent from 2013 to 2018, even as the Obama administration shifted the federal government’s focus toward treatment and prevention and away from law enforcement and interdiction.30 This suggests that despite the ever-worsening dangers of drug use—and the heightened media attention to the issue—the country has not adequately grasped its severity or fully adopted an agenda of prevention and recovery.
Beyond food, drink, and drugs, the most significant near-term harm to Americans—and one that is exceptional compared to other developed nations—comes from guns. The direct human costs of America’s loose gun laws and the easy availability of weapons are staggering. In the past decade, more Americans have died in their homes and communities from gun violence than all the Americans who died fighting fascism in World War II.31 More American civilians have died from gunfire since 1968 (1.5 million), than were killed in every war fought by the United States since 1775 (1.01 million).32 While firearm deaths have fallen nationally—along with all major violent crimes over the past quarter century—38,658 Americans are killed and more than 80,000 are injured every year by guns.33 The societal acceptance of guns, along with the ease with which Americans can purchase and carry them, means that one American is killed every fifteen minutes by a firearm. Here again, America is an inauspicious global leader. Of all the children killed by gunfire in developed countries between 1961 and 2010, 91 percent of them lived in the United States.34
Americans are painfully familiar with the mass shootings at Columbine, Sandy Hook, Orlando, and Parkland, as well as gang-related violence in Chicago. But the majority of gun deaths occur when Americans turn a weapon on themselves. Suicides in America have increased by 47 percent over the past fifteen years to nearly forty-five thousand a year in 2016, with almost half the result of a firearm.35 Many of these deaths are easily avoidable. Suicide attempts are frequently not actual attempts to end one’s life but instead are a proverbial cry for help. Indeed, when a person tries to take his or her own life by poisoning or drug overdose, the effort is fatal only about 2 percent of the time. When a gun is used, the fatality rate rises to 85 percent. Moreover, suicide is generally an impulsive decision. A majority of attempts take place almost immediately after someone has decided to take his or her life—and the chances that these attempts will end in tragedy are exponentially heightened by the presence of a firearm. Indeed, more than 90 percent of those who survive a suicide attempt will not try to harm themselves in the future.36 Not surprisingly, a 2014 Annals of Internal Medicine study found that people with access to guns are more than three times more likely to kill themselves than those who do not have access to guns.37
What about the argument often promoted by the National Rifle Association (NRA) and gun advocates that firearms “protect” Americans from criminals and terrorists?38 In reality, the opposite is true. Rather than serving as protection from “bad guys,” having a gun at home doubles the chances that somebody connected to the gun owner will be killed—either by suicide, homicide, or accident. Most of the eleven thousand gun homicides that occur each year in the United States are committed by a family member, acquaintance, or friend, not a rampaging stranger.39 The FBI has deemed only between two and three hundred of these shootings to have been “justifiable homicides.”40
Then there are the most needless and negligent gun deaths, such as the two-year-old who found his mother’s handgun in her purse and accidentally shot her to death while they were shopping at a Walmart in Idaho, or the eleven-year-old who was killed by her two-year-old brother after he picked up a .357-caliber handgun in their Philadelphia home, or the four toddlers who shot and killed themselves in the span of one week in April 2016. From 2015 to 2017, a child died every other day from an accidental shooting.41 Even more remarkably—and this could truly only happen in America—in 2015 and 2016 at least one toddler every single week fired a gun that killed or wounded someone.42 In fact, a toddler with a gun killed more Americans in 2015 than were killed in terrorist incidents. Every single one of these deaths was preventable and is the direct result of an adult leaving a loaded gun where a curious child can find it, rather than in a locked vault or with tamper-proof trigger locks.43
Beyond the senseless loss of life and the emotional devastation that comes from gun violence, there are the tremendous and underappreciated socioeconomic costs. A joint investigation by the economist Ted Miller and journalists from Mother Jones in 2015 estimated the annual price tag of gun violence in America to be at least $229 billion in medical costs, lost economic productivity, and diminished quality of life in the communities where violence occurs. The cumulative human and economic toll posed by firearms is a form of armed violence that is originating at home, not from terrorists abroad. There are precautionary approaches that could reduce this carnage, but pro-gun advocates and a national security mind-set that is seemingly inured to this constant drumbeat of violence and focuses instead, almost exclusively, on foreign threats have repeatedly stymied them.
Finally, there is a vast category of accidental deaths in the United States that, with minimal investment, could easily be prevented. More than thirty-five hundred people unintentionally drown each year in bathtubs, lakes, and pools, the latter of which mostly can be prevented with swimming lessons, four-sided fences, and adult supervision.44 Eighty die from carbon monoxide poisoning, also preventable with twenty-dollar CO monitors and having heating systems annually checked by a technician, which costs about seventy-five dollars.45 Around thirty people die every year from being crushed to death by televisions or furniture (80 percent of whom are under eight years old).46 These are tragedies that can be easily prevented simply by anchoring flat-screen TVs and large pieces of furniture to walls, which is relatively inexpensive to do.47 The number of deaths from these causes may seem small, but less than twenty people were killed by terrorism in the United States in 2017—and yet the United States spends billions every year to keep Americans safe from such attacks.48
Systemic Harms and Diminished Opportunities
Of course, when politicians and pundits talk about the risks from terrorism, their concerns generally run deeper than just lives lost. They claim that America’s very way of life, its freedoms, and its liberties will be at risk if the terrorists have their way. In a 2017 speech, White House Chief of Staff John Kelly claimed, “We are under attack every single day . . . from people who hate us, hate our freedoms, hate our laws, hate our values, hate the way we simply live our lives.”49 His boss, President Trump, has gone even further. After a terrorist attack in Egypt in May 2017, he declared, “Terrorists are engaged in a war against civilization—it is up to all who value life to confront & defeat this evil.”50
But if that frame is applied to domestic threats that are not terrorism related, Americans’ quality of life, political freedoms, economic opportunities, and social mobility are constantly being undercut by structural inequalities and systematic harms that receive far less attention.
These reduced opportunities directly impact America’s actual national security and the country’s ability to project power and influence globally. A great power like the United States that cannot ensure a safe environment for its citizens, severely underinvests in critical infrastructure, has a poorly educated citizenry compared to other advanced countries, fails to encourage economic growth and social mobility, and is wracked by partisanship and policy paralysis is one less capable of supporting international institutions, deterring interstate wars, and above all, competing effectively in global markets. In addition, the image of domestic political unrest and politicians trafficking in xenophobia diminishes the United States as a democratic, pluralistic example for the rest of the world. The foundation of U.S. power is the strength and well-being of its environment, education system, economy, and political institutions. When these are allowed to deteriorate, Americans suffer at home, and U.S. influence is undermined overseas. It is impossible to talk about national security today without talking about these domestic sources of American power—and they are increasingly rotting.51
Infrastructure
In the summer of 2015, national attention was drawn to Flint, Michigan, as city residents turned on their water faucets and were greeted by streams of brownish, smelly water. The failure to properly treat the city’s drinking water with the corrosion-inhibiting compound orthophosphate had caused lead from aging pipes to contaminate the city’s water supply. Further tests showed that lead levels in many of the city’s homes were far above normal for clean drinking water. In some cases, the amount of lead in Flint homes was more than twice what the Environmental Protection Agency (EPA) considers to be “toxic waste.”52 Civil and criminal lawsuits were filed, and a federal investigation and congressional inquiry were launched. The Flint situation, though an extreme example, is emblematic of a much-larger public health problem: water is being delivered to millions of homes across the United States via lead pipes. As a result, there is the distinct possibility of multiple Flint-like crises. In fact, according to data compiled by the EPA, forty-one states have unacceptable lead levels in their drinking water.53
Inadequate infrastructure also takes an estimated $27 billion toll on American businesses every year—which gets passed along to consumers in the form of higher prices for everyday goods.54 Then there is the direct human cost. When pavement conditions are allowed to deteriorate and when streets crack and potholes form, Americans are more likely to die in car crashes.55 Here again, the United States dangerously lags behind its wealthy counterparts: 40 percent more Americans die when they get in a traffic accident than their European counterparts do.56
America’s rail and subway transit badly trails that of other developed nations. The Northeast corridor, which has a GDP equivalent to the fifth-largest economy in the world and is responsible for one out of every five jobs in the United States, still lacks consistent high-speed rail service. Much of the essential equipment that keeps this vital transit artery functioning—including the key rail tunnels that connect New York and New Jersey—is more than a century old and in constant danger of breakdown. In three of the major metropolitan centers in the Northeast—Boston, New York, and Washington, DC—the subway systems are chronically delayed, which weakens economic productivity and increases anxiety and frustration among commuters. Indeed, New York City has been judged to have the “worst on-time performance of any major rapid transit system in the world.”57
America’s waterways are badly deteriorating too. Poorly functioning locks and dams cause needless hours of delay for farmers and manufacturers taking their products to market. On a one-hundred-mile passage of the Ohio River, more than 150 million tons of soybeans, wheat, scrap metal, and other assorted items travel through 1920s-era infrastructure, which adds on more than $640 million in additional transportation costs.58 According to a report by the American Society of Civil Engineers, by the year 2020, 70 percent of dams in the United States will be more than fifty years old, and more than two thousand dams are considered “high-hazard” and in need of repair. The cost of repairing all these aging dams could run as high as $60 billion.59
It is not as if the policy steps required to roll back this decay and rebuild critical infrastructure are unknown. There is widespread bipartisan agreement that Congress and local governments should fund new building and repairs by issuing bonds; and with long-term interest rates at historically low levels, it has never been cheaper to make these necessary investments. The longer the United States waits to make these improvements, the greater economic dislocation it will lead to today and the more expensive repair costs will be down the road. In the interim, Americans will suffer, and U.S. economic performance will be further weakened relative to other advanced countries. While America’s economic rivals move forward with the kind of infrastructure ventures that are essential in a modern twenty-first-century economy, the United States will find itself falling further and further behind. A country unwilling and unable to sustain the foundational elements of national economic power cannot remain an economic powerhouse forever.
Education
It is hard to think of a more important driver of economic competitiveness than a well-educated workforce. Indeed, there is a rule of thumb among economists that a one-year increase in any country’s average level of schooling corresponds with a 3 to 4 percent increase in long-term economic growth.60 Yet, here again, America trails the rest of the developing world—and badly so. America’s second-class schools, particularly primary and secondary, are inadequately educating the next generation of young people, who will struggle to compete with workers in other developed countries. Indeed, in global rankings last done in 2015, compared to thirty-four other advanced OECD countries, the United States was twentieth in reading skills, nineteenth in science, and thirty-first in math.61 According to the National Assessment of Educational Progress, in 2015 average math scores for fourth and eighth graders declined for the first time in twenty-five years. The study found that just a quarter of twelfth graders were proficient or advanced in math. Only 22 percent of the same students reached the same level in science.62 This record of failure is happening at the same time that America’s federal, state, and local governments spend more money per student than practically any other country in the world.63
America’s poor educational outcomes are also influenced by its high (and increasing) rate of income inequality and low rate of social mobility. In 2014, only 30 percent of twenty-five- to sixty-four-year-olds had attained a higher level of education than their parents had, which is a key indicator of upward mobility. This rate is one of the lowest levels among OECD countries.64 One particularly alarming OECD survey found that when it comes to literacy, math, and technical skills, “American adults lag well behind their counterparts in most other developed countries in the mathematical and technical skills needed for a modern workplace.” Young adults ranked worse in the survey, though even middle-aged Americans are “barely better than middle of the pack in skills.”65 Cumulatively, this indicates that Americans preparing to enter the workforce are not receiving the kind of education or learning the type of skills that will ensure they have greater economic success than their parents did. One of the core principles of the “American Dream” has long been that children will do better economically than their parents. Today in America that is no longer true.
Economic Inequality and Social Mobility
These troubling education numbers have a dangerous ripple effect on the quality of life for millions of people. Americans who cannot find good-paying jobs to care for their families and who have little prospect for social mobility are at greater risk of being afflicted by a host of social ills. They are more likely to live in unstable homes, to suffer from depression and anxiety, and to fall victim to drug and alcohol addiction. It is no exaggeration to say that this lack of opportunity is killing Americans.
In 2016, Princeton University economists Angus Deaton and Anne Case began studying the death rates of forty-five- to fifty-four-year-old groups in the developed world. They made a harrowing discovery: while such rates were falling for nearly all other groups, they unexpectedly rose for white men and women living in the United States. The most marked increases were experienced by those who had a high school education or less, and the causes of death spoke to a larger sense of hopelessness: drug overdoses, suicide, and chronic liver diseases and cirrhosis tied to alcoholism. Had the white mortality rate continued declining at the same pace that it had during the 1980s, nearly half a million deaths would have been avoided between 1999 and 2013. As Deaton and Case observed, “This figure is comparable to the number of deaths caused by the AIDS epidemic in America.”66
While the cause of this turn of events is hotly debated, it hardly seems coincidental that this unfolding horror is happening at the same time that the social safety net has frayed, obesity rates have increased, wage growth has stagnated, and the nation’s schools have underperformed. Many Americans, it seems, have lost faith in the idea that they can move up the rungs of the country’s economic ladder.
A 2016 McKinsey Global Institute report offered compelling evidence that these perceptions are well founded. The report found that between 2005 and 2014, real incomes in the United States stagnated or fell for 81 percent of all households.67 The United States has one of the highest national poverty rates in the world and the second-highest child poverty rate among OECD countries, and by some estimates, approximately half of all Americans between the ages of twenty-five and sixty will find themselves at some point living at or below the poverty line. Even as the U.S. economy has steadily grown since 2000, wage growth has not kept up, and household income has declined. Jobs in low-wage, low-skill occupations are plentiful, while those in middle-wage business have shrunk. Part of this is a result of automation and certainly also the de-unionization of the American workforce, which has made it harder for workers to fight for higher wages and better benefits.68
Whatever the reasons, it should hardly come as a surprise that a 2017 poll found that more than half of adults believed that the next generation of Americans would be worse off financially.69
Ironically, while it is middle-aged whites who have seen the most dramatic shift in death rates, black and Hispanic households are in far worse shape. According to a 2017 analysis of Federal Reserve data, the median wealth for white families in 2016 was $171,000, compared to $20,600 for Hispanics and just $17,100 for blacks.70 After the Great Recession, this racial disparity only became more severe: while median wealth of white households increased by 2.4 percent from 2010 to 2013, that of black and Hispanic households fell 33.7 percent and 14.3 percent, respectively.71
Not surprisingly, America lags behind other developed countries in social mobility. A 2014 study that measured the probability of somebody ascending from the bottom fifth income level to the top fifth over his or her lifetime found that a Danish child is 35 percent more likely to do so than an American child and that a Canadian child is 55 percent more likely. The authors note accurately and depressingly, “the chances of achieving the ‘American Dream’ are considerably higher for children in Denmark and Canada than those in the United States.”72
For people at the top of the economic ladder, however, things have been quite different. Since the 1970s, wealthy Americans have become increasingly richer, more secure, and more disconnected from the vast majority of Americans. In 2014, the top 1 percent of all households—slightly more than one million homes—earned 20.2 percent of all the income earned in America, which is the highest percentage since the Great Depression.73 To put it more starkly, the top 1 percent earns twenty-five times more than the bottom 99 percent.74 In modern America, the rich are getting richer, the middle class is treading water, and the poor have little hope of fully escaping poverty.
While Americans seem largely inured to the extraordinary want in their own country, others are taking notice. In the fall of 2017, Philip Alston, the United Nations special rapporteur on extreme poverty and human rights, spent two weeks touring the United States and in a harrowing report concluded that “the United States is one of the world’s richest, most powerful and technologically innovative countries; but neither its wealth nor its power nor its technology is being harnessed to address the situation in which forty million people continue to live in poverty.”75
Political Paralysis
All this data might beg an obvious question: what does this have to do with national security? The answer is that there is a growing body of economic research that suggests widening income gaps negatively affect economic performance and productivity, which are the foundations of national power. Economists at the International Monetary Fund have found that in countries with greater income inequality, that inequality is “robustly associated” with longer growth spells.76 In other words, the less inequality, the more likely a country is to sustain its economic growth. But one does not need a raft of statistics to see the dangers of an ever-widening chasm between the rich and poor and ever-diminishing opportunities for advancement. When workers lose hope that they can get to a place of economic security and get out of the cycle of living paycheck to paycheck, it is inevitable that their morale will suffer and Americans will be more likely to make poor economic decisions—or be too afraid to start a new business and become entrepreneurs.
As was evident in the 2016 campaign and the election of President Donald Trump, “economic anxiety” can lead Americans to embrace political scapegoating and demagoguery that further frays the nation’s already-tattered social fabric. An economic system that puts so much power into the hands of so few and a political system that allows the wealthiest Americans to have the greatest access to political leaders also ensure that those groups’ interests will receive the greatest focus and attention in the halls of government.
Of course, there is no requirement that the federal government should be so uninterested in the myriad signs of national decline. Yet it is hardly debatable that many of the domestic threats, risks, and systemic harms just documented have been allowed to worsen simply because of the apathy and negligence of America’s elected leaders. In an increasingly polarized political environment where compromise has become associated with capitulation, political gridlock is one of the biggest reasons for Americans to be concerned about their country’s decline. With the Republican Party wedded to an ideological position that rejects nearly any federal initiative to improve educational outcomes, guarantee health care access, or strengthen the social safety net—and indeed prefers to slash such programs—there is little near-term hope for tackling these challenges. The 2017 passage of a massive $1.5 trillion tax cut that delivers disproportionate benefits to the nation’s wealthiest citizens and substantially increases the nation’s budget deficit will make it that much harder to tackle the country’s numerous domestic challenges. The most likely outcome from the vats of red ink projected to result from the legislation will be calls for spending cuts, particularly for social insurance programs like Social Security, Medicare, and Medicaid that represent a large percentage of federal spending.
Washington’s political paralysis and toxic partisanship themselves also pose a more direct national security challenge to Americans. Research shows that political instability inhibits cross-border flows into the developing world, scaring off investors and tourists alike. According to the Political Conflict Index (PCI), which was developed by the Federal Reserve Bank of Philadelphia, for years there was little change in political disagreement between Republicans and Democrats. Suddenly, in 2010, partisan conflict increased more than 50 percent, spiking during a federal government shutdown at the end of 2013. This post-2010 increase in political discord, say PCI researchers, resulted in a 25 percent decrease in foreign direct investment into the United States.77
Gridlock also hits Americans in their pocketbooks. In October 2013, when Congress failed to meet a deadline to pass spending legislation, the government shut down for seventeen days, resulting in a 0.3 percent dip in GDP growth and the loss of 120,000 private-sector jobs.78 The shutdown came after two years of congressionally created fiscal crises that undermined consumer confidence and cost the economy almost a million jobs.79 By way of comparison, the attacks on the World Trade Center cost New York City 146,100 jobs.80 In other words, deep ideological divisions in Washington, DC, have wrought far greater economic damage than the terrorist attacks on 9/11 did.
It’s Not All Bad . . .
All of this sounds pretty bad, right? But not all hope should be lost: if Congress and state legislatures wanted to adequately address national security challenges at home, the roadmap to doing so is readily available. We know how commonsense prevention works and have repeatedly seen that when proper attention is paid and resources allocated, millions of lives can be saved. Heart disease, for example, may still be the leading cause of death in the United States, but it kills far fewer Americans (1.6 for every 1,000 Americans today) than it did at its peak (5 per 1,000 in 1969).81 While the reasons for this life-saving decline are complex, it is generally understood that better treatments, the adoption of preventive tools including public education campaigns, and the collapse of smoking rates have each played key roles.82
Tobacco is the most statistically significant risk factor for an NCD and has prematurely killed twenty-one million Americans in the past half century. It remains the leading preventable cause of death within the United States (and throughout the world).83 Yet smoking in the United States has fallen by more than half since 1980—from 33 percent of adults then to just 15 percent in 2016.84 This did not happen by chance but instead is the result of simple and relatively inexpensive smoking prevention and cessation programs.
For example, when cities and states began raising the price of cigarettes by putting new taxes on each pack, it contributed to a significant drop-off in smoking rates.85 According to one recent study, a one-dollar price hike on cigarettes was associated with a 20 percent increase in people quitting smoking and a 35 percent reduction in the average number of cigarettes smoked each day by the heaviest smokers. Other studies find that creating smoke-free buildings, banning smoking in restaurants and bars, and public education programs warning about the significant dangers of tobacco usage have a modest impact as well.86
The result is a virtual collapse in the number of respiratory and cancer deaths from smoking. This has single-handedly saved more than eight million Americans’ lives since 1964—or 167,000 people per year. The quality of life for countless others who have quit smoking has been dramatically improved. No longer are they poisoning family members with secondhand smoke, and their health care costs have almost certainly declined.87 The success in reducing smoking rates shows that when a public health challenge is prioritized, the impact can be dramatic—and often at a minimal cost.
Similar progress has also been made in reducing automobile deaths, the number of which has fallen dramatically in the past forty years. Seat-belt laws, mandated air bags, vehicle designs that prioritize safety, and reduced drunk-driving rates have saved countless lives. Since 1975, the number of people killed in car accidents has fallen by half, from 20.6 deaths per 100,000 then to 11.6 per 100,000 in 2016.88
Nonetheless, thirty-seven thousand people are killed every year in car accidents.89 Many of these fatalities are the result of poorly maintained roads or human error, such as texting and drowsiness, and could easily be prevented. In fact, half of drivers and passengers killed on America’s roads die because they were not wearing a seat belt.90 Vehicle deaths could be further reduced with more comprehensive public policy efforts, such as New York City’s “Vision Zero” campaign, which has set a goal of no traffic deaths or serious injuries. This initiative is focused on emphasizing safety over convenience when building roads and intersections, heightening public awareness, and imposing stricter punishments for drunk drivers or speeders. This effort could not be timelier, considering that almost six thousand pedestrians are killed every year on America’s roads—and that number has actually increased an astounding 46 percent since 2009.91
The greatest hope for reducing these deaths, however, is coming from car companies that are developing technologies that can drastically reduce road accidents. This includes sensors that can detect when a car is drifting from its lane and automatically correcting the car’s route, as well as those that can identify an oncoming obstacle, alert the driver, and automatically brake if the driver does not react in time. With the ongoing development of driverless cars, we may even reach a point in our lifetimes when vehicular deaths are practically eliminated.92
Other efforts could be made to immediately prevent needless deaths caused by human misjudgments or mistakes. Every year, for example, medical errors—such as misdiagnosis, overtreatment, or acquired infections in hospitals—kill as many as 250,000 Americans.93 While this figure is not without controversy, due to the difficulty in attributing deaths to such errors, even more conservative estimates of error-associated deaths top 175,000—an astonishingly high number that gets little public attention.94 Hospitals, which should be the safest environments possible, threaten everyone who enters them for treatment. Take one unfortunate patient in Saint Vincent Hospital, outside Boston, who had a perfectly healthy kidney removed because of a patient identification error.95 Significantly reducing this leading cause of death for Americans would come at a fraction of the cost that the government currently spends to fight terrorism. Commonsense measures like checking patients’ full names and birth dates, avoiding diagnostic errors, assuring better hygiene through widespread use of disinfectants, and administering correct medications could save tens of thousands of lives.96 According to a 2016 Journal of the American Medical Association study, 32,000 deaths could be prevented every year simply by encouraging male physicians to adhere to the same clinical guidelines and evidence-based practices as their female counterparts.97 Yet, the past two years, congressional Republicans have tried to repeal the Affordable Care Act (also known as Obamacare), even though this legislation had reduced the number of “hospital-acquired conditions” by 21 percent, saving more than 125,000 lives.98
The goal of this book is to change how Americans think about the world and to fully appreciate the consequences of foreign-threat inflation. Doing so requires broadening the very conception of “national security” by acknowledging that Americans face far more lethal and preventable threats at home. Those dangers diminish not just Americans’ mortality but also their quality of life, opportunities for achievement, and economic productivity. These attributes represent the very foundations of national power, and when they are allowed to weaken, America itself is weakened. The threats, systemic harms, and reduced opportunities documented in this chapter could be far more effectively addressed—and more cheaply—than America’s open-ended seventeen-year (and counting) war on terrorism. What is lacking is the national recognition that these domestic threats are indeed national security threats and as such deserve the political attention and resources to counter them.