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Previous chapters examined how medical providers and the health care financing system have contributed to health inequities that Black people and disabled people in the United States encounter. But having health insurance and getting to see an unbiased, high quality doctor are not necessarily the most important contributors to promoting health and health equity, either for individuals or at the population level. More important are other determinants of health. These include individual behaviors like smoking, diet, and exercise and –critically – the social and physical environments that shape individual conduct.1 To give one example: neighborhood safety and availability of parks or playgrounds nearby influence a person’s ability to exercise conveniently and safely. Healthy behavior takes some individual initiative, but that initiative is far more likely when social and physical environments make healthy options available and easy to choose.2
Chapter 9 revisits the republican conception of the citizen, a conception that has been largely muted in modern society in favor of the liberal and ethno-nationalist ideas. In recent years there has been an effort to “revive” republicanism as an alternative to both the consumerism and individualism of liberal citizenship and the unreflective jingoism of ethnic nationalism. Scholars like Michael Sandel have drawn upon the republican tradition of city-state citizenship to call for a renewed commitment to a republican urban citizenship. In this vision, the city would have the means to buffet itself against the forces of global capitalism and the disruptions of gentrification, and its public places – its parks, schools and libraries – would be sites of civic activity where strangers could mingle without being judged either by their identity or their wallet. Unfortunately, however, the republican concern with protecting the city from the world leads it down the path to a quasi-nationalist xenophobia, in which outsiders are ostracized and scapegoated.
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