1. Medical Deserts

Small hospitals were already on life support … and that was before the COVID-19 pandemic hit. Now a whopping 40 percent of America’s rural hospitals are at risk of closure, according to the advocacy group Center for Healthcare Quality and Payment Reform. That continues a decade-long trend, which has already seen 120 health care systems close, leaving many Americans stranded hours away from quality treatment. States that didn’t accept Medicaid expansion as part of the Affordable Care Act were particularly hard-hit.

2. Mental Health Toll

Some 42 percent of American adults reported symptoms of anxiety and depression in December, four times higher than the previous year, according to the Census Bureau. With other studies showing similar findings worldwide, it’s clear that heavy hearts may be here to stay. Young adults living alone were hit nearly twice as hard emotionally as adults 45 and older. Even trying to get a handle on the mass of data is a challenge, as researchers like University of Georgia psychologist Michelle vanDellen mount the biggest pandemic study in the world — featuring surveys of more than 60,000 people across 100-plus countries — to grapple with its effects.

3. Concierge Care

Some are turning to private health care clubs as a result, with memberships costing thousands annually even before tallying the actual cost of treatment. Such groups include Concierge MD LA, which has locations across America, and Sollis Health, which promises quicker emergency care plus “VIP amenities at leading hospitals,” the kind of preferential treatment typically reserved for concerts and strip clubs. While such care may seem problematic in countries with universal health care, it’s especially striking in the United States, where care is not guaranteed. “In that context, it’s easy to feel that there’s something wrong with those with means buying an exceptional level of care for themselves,” Michael Abrams, co-founder of the health care strategy firm Numerof & Associates, tells OZY.

4. Race-Based Outcomes

Even those who shell out for special treatment may still find themselves burned, particularly if they aren’t white. That was what OZY CEO and co-founder Carlos Watson saw when his family thought they were getting his aging mother “the best care” by enrolling her in a concierge program. He was shocked when his mom was suddenly diagnosed with late-stage kidney cancer. “As I later learned, a lot of the symptoms my mom had, if somebody was taking her seriously, were easily observable,” Watson shared recently on a special “Real Talk, Real Change” episode of The Carlos Watson Show exploring health disparities. His experiences match studies showing how minorities, and Black women in particular, receive worse treatment than many white patients — regardless of education or income. If multimillionaire tennis star Serena Williams can almost die after childbirth because her doctors won’t listen to her, who is safe?

The U.S. saw 85,000 overdose deaths from August 2019 to August 2020, according to the most recent CDC tracking data — topping the prior year’s record high by 25 percent. The numbers confirmed the fears of experts who worried COVID-19 closures would drive up drug use, depression and other ailments. The 2016 presidential election and its immediate aftermath saw opioid addiction receive unprecedented media attention, but it’s more recently been overshadowed by other societal problems, including a litany of social justice issues and the pandemic itself. But that doesn’t mean the problem has gone away, as children continue to be born in the throes of withdrawal and parents become sick and unemployable, repeating a cycle of suffering.

6. Getting Healthy

America could decentralize power from large hospital systems to smaller-scale care, particularly in marginalized communities. One such program, Brooklyn-based Cityblock, raised $160 million in Series C funding in December and was valued at $1 billion — showing the promise of localized ambulatory care centers, a model that McKinsey predicts will top 6 percent annual growth the next two years. America could revamp its green card immigration system, particularly by making exceptions for physicians from India, who sit on a decades-long waitlist (one scholar estimated the queue for advanced degree holders at 151 years). Value-based models, otherwise known as “pay if you’re cured,” could incentivize better care and reduce the financial burden, as studies show hospitals with such programs are better equipped financially to combat COVID-19. And maybe robodoctors would be more willing to listen to Black women.

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1. Back-to-Back Tragedy

Mass shootings seemed to experience a lull once COVID-19 lockdowns went into effect. And yet this month saw two high-profile fatal shootings in back-to-back weeks — the killing of eight people, mostly Asian women, in Atlanta, and then 10 more shot dead in a Boulder, Colorado, grocery store — signaling the apparent return of a pandemic of violence.

2. But Was That Decline a Dream?

The feeling of quiet may simply have been a case of out of sight, out of mind. In 2020, the United States suffered 611 mass shootings, in which four or more victims were shot, according to the Gun Violence Archive. That far surpasses 2019’s 417 mass shootings and represents the worst year in the group’s seven-year-old database. Other trackers that define mass shootings more conservatively also recorded an increase. And that’s not even including the larger story on gun deaths: a record 41,000 Americans died from gunshot wounds in 2020, as Washington Post reporter John Woodrow Cox recently pointed out, with many of them coming from firearm suicides. Some argue those should contribute to any accounting for gun violence in America, although others disagree.

3. Trapped at Home

Stay-at-home orders left many stuck with their abusers. While domestic violence organizations prepared for a surge by beefing up their phone lines, many experienced the opposite — some saw more than a 50 percent drop in calls. Unfortunately, experts believe it wasn’t because the need diminished: Instead, victims simply couldn’t reach out for help safely. That troubling trend persisted outside the U.S., including global increases in teen pregnancies (Kenya, for example, saw thousands more unwanted cases) and child marriages, with up to 2.5 million more children at risk, according to one nonprofit.

4. And Abroad

The share of child victims of human trafficking has tripled in the past 15 years, and experts say the pandemic-induced global recession likely exposed many more to further risk. That’s because people who are economically disadvantaged by the pandemic, as the U.N. Office on Drugs and Crime has warned, are more likely to be exploited by criminals. Ebola and other medical crises have also coincided with more children, many of them orphaned by disease, falling prey to traffickers. The prominence of QAnon, which tried to attach itself to legitimate anti-human-trafficking efforts, didn’t help. The conspiracy theories created the odd situation where well-meaning people feared speaking out against human trafficking because it could lump them in with radical conspiracists.

5. Can You Vaccinate Against Violence?

President Joe Biden has called for a federal assault weapons ban and other gun control measures, but the world has seen this script before. Meanwhile, change won’t happen in cities or counties because 45 states have “preemption” laws that severely restrict or don’t allow local leaders or voters to pass more restrictive gun laws. Ending those preemptions, plus following the leads of countries like Australia and New Zealand by instituting gun buybacks and other reduction programs, could make a dent but would be nearly impossible given the political power of conservative American gun owners. On child marriage and sex trafficking, many are providing examples worth modeling. In Pakistan, Hadiqa Bashir, 18, has been knocking door to door, breaking up as many as 15 child marriage arrangements while preparing for a legal career. In India, Hasina Kharbhih has used repatriation and compensation to rescue 72,000 women and children from trafficking across the region.

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1. Rich Get Richer

A stock market that kept on chugging through rising unemployment and disrupted trade routes led to billionaires gaining $1.3 trillion since mid-March 2020 — even as many of them received bailouts for their businesses, exacerbating a perception of “socialism for the rich and capitalism for the rest” at the highest levels of the global economy. From 1975 to 2018, the top 1 percent earned an additional $50 trillion due to less equal wealth distribution (put another way, enough money to give every American $1,144 a month for each of those 43 years). That reality has spurred anger, such as when Kylie Jenner posted on Instagram urging her followers to support a GoFundMe … leading people to ask why Forbes’ highest paid celebrity of 2020 didn’t just foot the bill herself. Perhaps it’s time, as actor Sean Penn lays out in an upcoming episode of The Carlos Watson Show, for a true rethink of the dominance of Big Tech.

2. Self-Centered Countries

Nationalism is selfishness on the state level, with an emphasis on inward-looking policies without regard to how others are affected — and countries were more tempted than ever to go it alone as borders closed or were significantly restricted. As of mid-February, some 75 percent of the 191 million COVID-19 vaccine doses distributed worldwide were in just 10 countries, with affluent governments spending a lot more money on manufacturing and delivering the shots to their own people than on spreading them equitably to poorer nations. With needs already too often unmet and ignored, migrants suffered even more: The United States, for example, ground asylum claims to a halt in 2020 and ramped up border wall efforts. Since former President Donald Trump left office, there has been a trickle of successful asylum claims. Meanwhile there’s a new surge of migrants making the trek, with many incorrectly assuming Biden would open the border. The new administration recently reopened a Trump-era child detention center featuring a “Bienvenidos” welcome banner.

Meanwhile, national despots and strongmen seized on COVID-19 challenges to advance their own agendas while disregarding personal freedoms or rights. In October, the United Nations Human Rights Council complained that COVID-19 shouldn’t be an “excuse” for human rights violations — adding that the pandemic had greatly increased those that were already brewing. That didn’t stop Hungarian Prime Minister Viktor Orbán’s party from ending the legal recognition of transgender people and then proposing a horde of anti-LGBT laws under the thinly veiled guise of COVID restrictions. Meanwhile, Indian Prime Minister Narendra Modi’s authorities have tossed countless Kashmiris in jail, where internet outages amid the pandemic have led to 90 percent of those cases not even beginning trials. China has allegedly continued human rights abuses against the Uyghur minority in Xinjiang, cracked down on Hong Kong and is unapologetically moving toward seizing self-governing Taiwan next.

4. Solving Selfishness

People fight selfishness when they have shared goals, beliefs and backgrounds. So any solution must come from the recapturing of a shared identity. Societies can start by adopting a new idea of citizenship, one that incentivizes the wealthy to willingly spread their gains more equally across society — perhaps through rewarding them with titles and honor, as the ancient Athenians did. While religion can be divisive, it also provides a communal sense that transcends language or ethnicity: Could interfaith solidarity, intentional communities and a DIY spirituality keep the world from adopting Adolf Hitler as its guiding light? Biden has promised to reassert America’s moral authority globally while fighting authoritarianism, although the U.S. will first have to overcome its own recent authoritarian turn and past sins China is all too happy to point out.

One Virginia superintendent described making decisions about education during the pandemic as like “playing a game of 3D chess while standing on one leg in the middle of a hurricane.” In other words: Education is in disarray. Children are falling behind, teachers are stressed and sick, and the non-Ivy League universities are seeing flagging attendance while debts rack up. That will likely lead to increased inequality between the haves and the have-nots in academia.

2. The Widening Gap

Students of color already faced tremendous headwinds compared to their white counterparts, from poorer schools to unequal resources. The pandemic only exacerbated those inequalities, as a McKinsey report found in December. Last fall, students of color were about three to five months behind where experts would expect them to be in math (white students were one to three months behind). Reading levels were a bit better, with students “just” a month and a half behind historical averages. Still, the report was just one in a flood of mounting evidence suggesting that America is leaving its most at-risk students behind in the classroom, which could negatively impact their chances at finding jobs, building wealth and staying healthy down the line.

3. Elevating Education

How do we close the gap? Bilingual platforms like Encantos can expand teaching for the youngest, helping minority students keep pace early. Taking heed from educators like Stacy Johnson, who teaches teachers how to break down racist classroom structures, would also help, as would giving students more say over their curriculum. Artificial intelligence tutors, particularly at reduced or no cost, could help reduce America’s achievement gap and teacher shortages. Gamification is being used by social media and entertainment companies to dominate children’s time, so why not make it educational, too — as Poland did, launching a Minecraft server packed with quizzes that give in-game rewards to the best performers. And micro-schools, which became popular with pod families during the pandemic, could help ease overflowing classrooms in time. Another change that should stay? Free food for kids, a practice that extended the lunchroom into homes during the pandemic and could fight child hunger long term.