We are overlooking the most critical element of public health for Americans: feeling stuck

Tracy Chapman’s “Fast Car,” a ballad about a dead-end life, made the Billboard Hot 100 twice, nearly 40 years apart. As a doctor, I’m not surprised. “Fast Car” is about someone trying desperately to move up in life even as obstacles mount — bleak job, insufficient finances, family obligations, and increasing isolation. The song endures because it validates the experience of millions of Americans.

I hear versions of “Fast Car” every time I set foot in the hospital as a general internist. My patients tell me stories about how, no matter how hard they work, the path to a better future slips farther away. It inevitably comes up as the reason they feel sick. My patients even have a name for their condition: they feel stuck.

The more I listened, the more I realized this wasn’t just an individual problem. We’ve reached our 250th anniversary as a stuck country.

I’ve been documenting what our research group has come to call “stuckness” for a decade. It’s more than poverty, loneliness, or a lack of opportunity. Stuckness emerges when real barriers in our jobs, finances, relationships, health, neighborhoods, and politics coalesce to keep people from having a real shot at success and happiness. It is a feeling and a reality that reinforce each other, robbing us of hope, generating chronic stress, and making it harder to move forward.

» READ MORE: 250 years has taught us that freedom comes only with economic security | Opinion

As one young man, stuck with dwindling job prospects, mounting debt, and few close relationships, said: “I’m not hopeful. I may not make it past the age of 35 if things continue this way.”

It is not a coincidence that the rise in stuckness coincides with our flatlining life expectancy.

My patients are right to identify stuckness as the biggest threat to their health. Yet, our country hasn’t found effective ways to fix it. Part of the issue is that when people tell us they are stuck, we believe it can be solved by self-help books, a positive attitude, or the latest wellness fad.

The bigger issue is that we haven’t really understood the problem.

My colleagues and I at the research nonprofit Opportunity for Health decided to change that. In a recent survey, we asked working-age adults across America whether they felt stuck. We found that more than one in five respondents — representing about 40 million adults — strongly felt stuck. Nearly half of the people taking our survey felt at least somewhat stuck. Stuckness was most common among lower-income Americans, but one out of 10 of the richest or most educated Americans felt stuck, too.

Respondents got stuck because of job or financial challenges, worsening conditions in their neighborhood, social isolation or fraying relationships, or because of a sudden illness or disability. Once any one of these challenges set in, others quickly piled on.

A health problem leads to lost work, creating financial strain that weakens relationships, and the resulting hopelessness and stress further damage health. That cycle helps explain why people who felt strongly stuck were five times more likely to report being in poor health than those who didn’t feel stuck at all.

While our survey covers only a single year — no one had bothered to ask about it before — other data show that stuckness has grown over time.

That tracks with what I hear from my patients. The likelihood that low-income Americans can move up the economic ladder has fallen since at least the 1980s. So has the share of Americans who are able to leave neighborhoods that aren’t working for them in search of new opportunities.

Based on my calculations using economic survey data, the fraction of working-age Americans facing multiple challenges — whether unemployment, a work-limiting disability, low household income, social isolation, or being moored in place — rose from 14% in the late 1980s to 24% today.

Stuckness also shows up more often in our culture. In the more than three decades bookending the appearances of “Fast Car” on the Billboard Hot 100, the share of songs mentioning feeling stuck rose from one out of every 100 to one out of every 20 — and that doesn’t include Chapman’s hit or other songs by Bruce Springsteen or Garth Brooks that describe stuckness without using the term.

It is not a coincidence that the rise in stuckness coincides with our flatlining life expectancy. We are getting sicker despite the trillions of dollars we throw at healthcare. My patients wouldn’t find that surprising: they aren’t asking for more medicines or tests. They just want to get unstuck.

Because stuckness arises from a cascade of factors, solutions must do two things: prevent people from falling into those slumps and help them escape when they do.

That means ensuring that work once again provides a pathway to security through fair wages, ample opportunities to develop new skills, and ensuring that new technologies like AI expand rather than replace human potential.

It means investing in communities that have been left behind, building up local economic capacity and infrastructure so that every corner of America has the basic tools for people to thrive.

It means making healthcare, childcare, paid family leave, and other basic supports reliable foundations that keep temporary setbacks from becoming permanent ones.

Finally, we shouldn’t ignore growing concerns about affordability or the economy. We shouldn’t make it harder for people to access safety net programs like Medicaid and the Supplemental Nutrition Assistance Program (SNAP), as the administration is now doing, because they can help our neighbors escape stuckness.

» READ MORE: Trump’s devastating SNAP cuts are being felt everywhere. Here’s one grandmother’s story | Jenice Armstrong

And we shouldn’t make it harder for people to weigh in at the ballot box to seek the wider changes that will improve their lives on how to get their communities unstuck.

The solutions to stuckness will vary across regions. We will need to argue productively, try, fail, and try again to get it right. One of the most shocking findings from my team’s research is that stuckness touches us all: even richer Americans are less healthy when people in their communities get stuck. There’s a reason for that. When millions get stuck, we collectively become less productive, angrier, and more divided.

Now that our country has turned 250, we face a critical choice. We can keep pouring resources into treating the consequences of stuckness or we can confront its causes.

My patients already understand this distinction. They know that what makes them sick is not simply a disease. It is the growing feeling that no matter how hard they try, their future remains limited and bleak. If we want a healthier America, we need to build a country where effort once again leads somewhere.

Atheendar S. Venkataramani is a physician and professor of medical ethics and health policy at the University of Pennsylvania. He is the founding director of Opportunity for Health and is a senior fellow at the Penn Leonard Davis Institute of Health Economics.