In her compelling account of the 2016 US Presidential election (What Happened, Simon and Schuster), Hillary Clinton invokes a powerful metaphor to express her concerns for the health of America's democracy. She argues that a body politic needs a strong immune system to survive. The elements of that immune protection are facts and reason. But “our immune system had been slowly eroded over years”. Democratic institutions of “the greatest country in the world” became vulnerable to attack. Americans must “heal our democracy”. Yet the prospects for repair seem poor: “I'm worried about our democracy at home…I'm worried about the future of democracy around the world.” With “epidemics” of despair, guns, and substance use, it seems impossible to deny that America has a “broken political system”. This view, from someone who has served her country for over a generation, should surely be taken seriously. Some critics have interpreted Clinton's book as a bitter parting shot against those who defeated her. They are mistaken. Her analysis is a disturbing autopsy on the state of America today. What Happened is an urgent plea directed not only to those concerned about America's capacity to survive, but also to all who are anxious about protecting America's international contributions to human health.

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Clinton doesn't exonerate herself from America's existential crisis. She writes frankly about her own “shortcomings” and “mistakes.” She accepts that she “failed to connect” with working class voters. “I take responsibility”, she states plainly. But the pathologies of America are multiple and metastasising. America has lost its ability to base policy on sound evidence. Instead, the country has developed a zero-sum politics of resentment—your unjust gain is my intolerable loss. Truth has given way to spectacle. A war is being waged against mainstream sources of reliable information. “Billionaires, powerful corporations, and special interests” have corrupted political debate. Sexism and misogyny thrive. Cultural dis-ease is pervasive, based on fears about race, class, immigration, religion, gender, sexual orientation, and economic exclusion. America is now victim to violations of its sovereignty through an organised campaign of cyberwarfare. An important pillar of American democracy—a free and independent press—now suffers from “moral decay”. Reporters “often seemed bored” by the substance of the 2016 election. They focused on the pugilistics of the contest, not the arguments of candidates. There was a “decline of serious reporting on policy”. Most media organisations ignored “the danger staring us in the face”. She is nothing less than exasperated by the “absurdity of it all”.

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The present state of America was predicted. The French writer Jean Baudrillard conjured the idea of a Fourth World in his 1986 travelogue, America. The Fourth World was one in which “entire swathes of the population are falling into oblivion, being totally abandoned…entire social groups are being laid waste from the inside…society has forgotten them”. Baudrillard was the 20th century's de Tocqueville. But his vision was not a paean to democracy in America. It was a dystopian warning. The policies of successive governments—he was writing at the time of Ronald Reagan—have been “desocialising, disenfranchising, and ejecting”. The “American prophecy” was “the grand prospect of utopia on earth combined with world power”. That prophecy lay in tatters. Baudrillard saw America as “the only remaining primitive society”, one that enjoyed a “superficial diversity” yet lacked a past through which it could reflect on its own predicament. He described an Astral America, a civilisation with “the obsessive desire for survival (and not for life)”. America is “the crisis of an achieved utopia, confronted with the problem of its duration and permanence”. The gravest danger? “The anti-utopia of unreason.” His words uncannily define America today. Hillary Clinton has a “creeping dread” about the future of her country. Global health has emerged as an important force in international diplomacy and development. America has been a leader in global health. But the future for global health is threatened by a closing of the American mind. As the current US administration turns its back on the world, as it seeks to corrode institutions that have enhanced human lives, now is a moment to engage even more energetically with America and protect its role in global affairs. The ice that is freezing America will thaw. But the country's winter will last some years to come.

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Article Info Publication History Identification DOI: https://doi.org/10.1016/S0140-6736(17)32589-8 Copyright © 2017 Elsevier Ltd. All rights reserved. ScienceDirect Access this article on ScienceDirect