In the US, where public health is not a political priority, the catalyst for policy change promoting healthier living will be fiscal. The government cannot afford the current trajectory of healthcare spending, which will eventually force changes in housing, food, and community planning.

NYC's ban on smoking in bars, initially met with widespread criticism, became a popular and accepted norm. This shows that effective public health leadership sometimes involves implementing policies that are unpopular at first but create long-term societal benefits.

The fastest, cheapest path to drug approval involves showing a small survival benefit in terminally ill patients. This economic reality disincentivizes the longer, more complex trials required for early-stage treatments that could offer a cure.

The traditional medical ethos prevents interventions on non-sick patients. This conservative approach may be irrational when low-risk therapies could add decades of healthy life, challenging the fundamental definition of when a doctor should act.

When a public health intervention successfully prevents a crisis, the lack of a negative outcome makes the initial action seem like an unnecessary overreaction. This paradox makes it difficult to justify and maintain funding for preventative measures whose success is invisible.

Chronic illnesses like cancer, heart disease, and Alzheimer's typically develop over two decades before symptoms appear. This long "runway" is a massive, underutilized opportunity to identify high-risk individuals and intervene, yet medicine typically focuses on treatment only after a disease is established.

The current healthcare model is backwards. It's more cost-effective to proactively get comprehensive diagnostics like blood work done twice a year than to rely on multiple, expensive doctor visits after symptoms appear. This preventative approach catches diseases earlier and reduces overall system costs.

Preventing a problem, like malaria, is often more effective than curing it, but it creates a marketing challenge. It's difficult to tell a compelling story about a child who *didn't* get sick. This "identifiable victim" bias means funds often flow to less effective but more narratively satisfying interventions.

Reactive healthcare systems like US Medicare are financially unsustainable against an aging population, with projections for insolvency by 2035. The only viable path forward is a government-led pivot from reactive disease treatment to proactive, preventative longevity technologies to manage costs and improve healthspan.