After three years in Australia, I made a trip back to the USA to have Thanksgiving with my aging parents. Since Australians are prone to long holidays; my wife extended this through Christmas and travel involved five air segments as well as driving about 1300 miles (2092 km) from Miami Beach to Indianapolis.
What were my impressions, after being away so long and hearing about the US only through media? The first thing that struck me - transportation infrastructure - miles and miles of concrete and asphalt. Six and eight lane freeways (3-4 in each direction) are common; not just around cities, but linking all the cities. In colder areas, freezing, thawing, and heavy use means continual maintenance, but nearly everywhere additional lanes were being built; interchanges expanded - not just on interstate highways but suburban roads. There are a handful of cities in the US that have good public transit systems, but outside of that, the highway is king, and sprawl is an economic imperative. The miles of asphalt represent not only a huge investment, but an entire ecosystem of interrelated employment - construction workers, truck drivers, diesel mechanics, auto sales, and restaurants and hotels along every freeway interchange. Rail may be the most efficient means of moving cargo, but building highways and cars creates more jobs. There has been much talk of the self-driving car and the self-driving truck; there has been little talk of replacing asphalt with rail or some other alternative. The current thinking seems to be of continuance of independent, programmable units travelling on the existing asphalt substrate and "driving" jobs may be eliminated, but the maintenance infrastructure employment will remain intact for some time. Los Angeles is frequently cited as the first US city to be built after the private automobile became the dominant means of travel, but every major city in the US has had neighborhoods razed to accommodate high-speed travel or new suburbs built to accommodate commuting by private automobile (strange that word, and the private vehicle is only now on the verge of truly becoming an auto-mobile).
The second of my impressions, and one that I looked forward to considering the Thanksgiving holiday: food. Critics, my wife included and myself to a lesser degree, lament the widespread prevalence of processed food with added salt, sugar, or fat being the primary enticing ingredients. The typical American's health shows the effects of this. However, I grew up in a Midwest where winter fruits and vegetables consisted of carrots, cabbage, or something frozen and subsequently mushy. From that perspective, modern processed food is an improvement, and of course even better, fresh produce from around the globe. The "eat local" movement decries the waste of energy spent shipping food, a large percentage of which subsequently spoils, but in temperate winters, fresh fruits and vegetables are a modern luxury. Still, most consumption is of processed food, or restaurant fast food, with a priority for taste and convenience over nutritional value. One change I've seen, especially in the Midwest, is a proliferation of fast food chains and families (including my nearly 80 year-old parents) relying on fast food restaurants as a primary food source. In the larger picture, crop subsidies and a low minimum wage or even illegal sub-minimum wage has contributed to this inexpensive convenience, and in families with two working parents, convenience is seen as essential. As my mother's health declines, cooking is more of a challenge. The question from a health perspective: can nutrition compete with salt, sugar, and fat?
Related to the food infrastructure: health care. There is widespread discussion regarding the inefficiencies of health care in the United States. One factor becoming more apparent that is rarely part of the discussion: overcapacity. In Indianapolis (and more recently in San Francisco), competition among hospitals is spurring overbuilding and overcapacity. My perspective is that much of US healthcare operates on what might be considered a predatory model. While food sales are increased by the addition of sugar, salt, and fat, the health care system can make more money performing heart surgery or gastric bypass operations (or selling related pharmaceuticals) than it can make, under the current system, in any sort of preventive care or admonishment. It seems there will always be more money and desperation in prolonging life than in preventive care. Fertility clinics, virility, and plastic surgery are also cash cows. While much of the developed world wrestles with how to add capacity and innovation to their health care systems, the US has capacity and innovation in abundance, but most of it is geared towards cashing in on trends rather than improving overall health. Mind you, the motivation towards greater individual income is present in all systems, it just plays out differently when taxpayer funding and union working conditions are larger factors than insurance, pharmaceutical, and institutional profit.
Another topic and impressions: guns and gun violence. But there's enough in that one for a separate post.
