The United States spends more on health than any other country in the world, yet we are far from the healthiest. In recent years, our life expectancy has lagged, even declined. We have fallen behind our peer countries on a range of key health indicators, including heart disease, infant mortality and HIV/AIDS. And we face acute health challenges – from obesity, to opioids, to gun violence.

Why is our health so mediocre? The answer is we are not spending on health. We are spending on health care. Health is more than the doctors and medicines we turn to when we are unwell. It is a product of the world around us – the social, economic, and environmental conditions in which we live. Health care helps us when we are sick, but whether or not we get sick in the first place is decided by factors like the air we breathe, the water we drink, our income, neighborhood, schooling and overall social capital. These are the true foundations of health.

I am often asked, if I could choose just one policy intervention to improve health what would it be? The more I reflect on this question, the more convinced I am that the answer is to invest in quality education for all children, with special emphasis on education in early childhood. Education helps us live longer, think better, and be healthier. As graduation season is upon us, here are a few reflections on the central role of education in shaping our physical and mental health. 

Study after study has shown that the higher our education level, the longer we will potentially live and the healthier those years are likely to be. College graduates live almost nine years longer than those who did not graduate from high school. Those years of higher education can also lead to a range of health benefits, including a lower risk of diabetes, heart disease, and obesity. The health effects of education are also intergenerational—the infant mortality rate per 1,000 live births for mothers who did not graduate from high school is close to double that of women who earned college degrees. 

Our health is a public good.

I suspect that statement runs at odds with how most readers think about their health. Is our health not, after all, determined by what we do, what we eat, and how much we exercise? While that is indeed the case, fundamentally, our behaviors are shaped by the world around us, inescapably so. Let me explain.

Public goods are common resources that need to be supported by collective investment. Libraries, parks, highways, national security—these are all examples of public goods, supported by all and accessible to all. The reason they are public goods, rather than individual commodities, is we have decided that they are so fundamental to our wellbeing that they should not be entirely the province of private investment or market forces. Education, for example, benefits everyone—there is no one whose life it does not stand to improve. It is therefore supported by everyone, as a public good.

Last year, Americans borrowed approximately $88 billion to pay for health care. One in four of us skipped medical appointments because of concern about costs. Such statistics reflect a trend that has been going on for decades. In 1970, the U.S. spent $74.6 billion on health. By 2000, this figure had risen to around $1.4 trillion and by 2017 it was $3.5 trillion. Not incidentally, medical debt is now the number one cause of personal bankruptcy in the U.S.

This question — Are we paying too much for health? — has defined much of the health conversation in the U.S. over the years. Unfortunately, it is the wrong question. Here’s the right one: Is our spending making us healthier?

The answer, sadly, is no.

Yesterday, a series of bombings in Sri Lanka killed over 200 people and injured hundreds more, in what police have called coordinated terrorist attacks. While the attacks may be over, their health consequences have only begun. In addition to physical injuries, the survivors of the bombings will be at risk of a range of mental health challenges, from depression to post-traumatic stress disorder (PTSD). They are, sadly, not alone in experiencing this risk. The drivers of trauma are all around us—from natural disasters, to gun violence, to racism, homophobia, and the many forms of interpersonal abuse. The bombings are just the latest reminder that trauma is a ubiquitous human experience that touches millions daily and should be of concern to public health.