How to Really Make America Great: By Confronting the Forbidden Issues

Ever since I was a little boy whose native country (the Netherlands) was liberated from the Nazis by American and Canadian troops after years of bombing, mass incarcerations, concentration camps, starvation, and general brutality, I have seen the USA as a beacon of hope and sanity in what often appears to be an insane world. Later, perhaps in reaction to the Nazi insanity, I made it my life’s work to understand how people survive horrendous conditions, and how different countries and cultures deal with social opportunities, distribution of power, child rearing, and the delivery of justice. After I emigrated, like for so many of us, the United States became a land of incredible opportunity and generosity. However. with all its abundance, it is also the painful reality that the United States performs much worse than comparable countries in some of the critical areas that define healthy communities: life expectancy, medical care outcomes, educational achievement, social equality, incarceration rates, and support for young families trying to raise children. 

In this context, it was stunning to receive a notification from the National Science Foundation in March 2025, announcing that dozens of subjects including disability, women, minorities, social justice, gender, and trauma had been eliminated from being eligible for federal support, and that grants and programs that include those words would be summarily excluded. This is particularly concerning, because those words denote many of the core issues at the very root of the problems that the United States needs to confront if it is not to lag far behind other economically advanced countries. 

EDUCATION.  Let’s begin with education, where the US currently ranks 36th in the world, and is steadily going down compared with countries like Singapore, China, Finland, South Korea, Taiwan, Japan, Switzerland, Estonia– and yes, Canada. Approaches to education vary a great deal around the world, but what high-performing countries have in common is that they prioritize the funding of public education by ensuring that teachers are well-paid, that schools have modern infrastructure, and that people have equitable access. Given the rich tapestry of educational approaches around the world which produce better results than ours, what can we learn from them? Surely, we will not make progress by abolishing our Department of Education. Without its macro view of public education, how can we possibly learn from other countries if concepts like “culturally appropriate,” “ethnicity”, ‘socioeconomic,” “ identity,” “inequitable,”  ”sense of belonging,” and  “multicultural” have been scrapped from study and intervention? 

LIFE EXPECTANCY. As of 2021, the United States had a life expectancy of 76.4 years, a marked decline from previous years, positioning it well beyond 50^th place among developed nations.  In comparison, life expectancy in countries like Japan and Switzerland exceeds 84 years. Despite spending significantly more on healthcare per capita ¹, the U.S. has higher rates of infant mortality and preventable deaths as compared with these nations. In the U.S., life expectancy differs significantly across racial and ethnic groups: Black mothers face a pregnancy-related death rate more than three times higher than that of white mothers, with approximately 80% of these deaths being preventable. White Americans have much higher life expectancies than Black and Indigenous populations ². Numerous studies show that groups that have experienced chronic poverty, forced displacement, or systemic racism carry lasting health burdens due to prolonged activation of stress hormones. These hormones increase the risk of heart disease, stroke, and immune system dysfunction, and higher rates of chronic diseases (e.g., hypertension, diabetes).  Recent research also demonstrates that these stress hormones can even cause epigenetic changes that affect stress response across generations. General health and Life expectancy are also drastically influenced by exposure to trauma, including physical, sexual and psychological assaults, as well as chronic poverty and environmental adversities.⁴ Adverse Childhood Experiences (ACEs) like abuse, neglect, or witnessing violence have been shown to markedly increase the risk of chronic diseases, mental health issues, and substance abuse. These are urgent public health issues, but how can we even hope to address them when subjects like “health disparity, “equity,” “socioeconomic,” “trauma,” “Black,” and “female,” have been placed on the index of forbidden topics? ^8,9

INCARCERATION. The US holds 21.0% of the world’s prisoners, even though the US represents only around 4.4%of the world’s population¹⁰.  In 2022, the United States had 1,808,100 incarcerated people in adult facilities (prisons and jails), at a rate of 541 per 100,000 population. Adding inmates in U.S. territories, military facilities, US Immigration and Customers Enforcement (ICE) facilities, jails in Indian country, brings the number to 2.42 million inmates. The annual cost of incarceration is at least 81 billion dollars. 2.7 million children in the US have a parent who is in jail, and at least 5 million American kids have experienced having an incarcerated parent. In comparison, in other developed countries, like the Netherlands, the incarceration rate is 65 per 100,000 and in Japan only 36 per 100,000.  It is stunning to learn that the incarceration rate for young black men ages 20 to 39, is nearly 10,000 per 100,000¹¹. To give context, during the racial discrimination of apartheid in South Africa, the prison rate for black male South Africans, was only 851 per 100,000. 

But the problem with U.S. incarceration is not merely a function of numbers. The countries with much lower incarceration rates share a different strategy than that prevailing in the US. They tend to prioritize rehabilitation and reintegration into society, rather than punishment, with the goal of helping inmates to become contributing members of society. Most of these systems strive to maintain prisoners’ humanity, allowing them to participate in activities like voting, attending school, learning new skills, exercising, and seeing their families.  The focus on rehabilitation and reintegration in countries such as Norway and the Netherlands has resulted in low recidivism rates. These countries also have a stronger social welfare system, and provide universal healthcare, affordable education, and robust social services, thereby reducing the economic desperation that often contributes to crime.¹² If the U.S. adopted policies similar to these countries it could significantly reduce its prison population, but this surely will be impossible as long as terms like “at risk, “barrier, “bias, “Black, “discrimination, “race, “mental health, “trauma,” and “social justice” are on the index of forbidden topics.  

ABUSE AND TRAUMA.  While many people associate trauma, and its psychiatric diagnosis, PTSD. with war veterans, trauma is tragically common in civilian populations: studies suggest that 8.4 out of every 1,000 children in the USA are victims of abuse or neglect each year. Parents are the perpetrators in most of these cases, and all in, about 1 in 4 girls and 1 in 20 boys in the U.S. experience sexual abuse during their childhood.  

Child abuse is not just a social or moral issue, but a significant economic burden. The economic consequences of child abuse are vast and affect individuals, families, businesses, and society as a whole: the lifetime cost per victim of child abuse has been estimated to exceed $200,000.¹² The immediate costs include not only medical and mental health care, but also treatment for physical injuries, psychiatric services, maintaining a child welfare system, foster care, child protective services, investigations, case management, police investigations, court proceedings, incarceration of offenders, special education services, and interventions for children suffering from developmental delays and learning difficulties due to trauma. Survivors of child abuse are also more likely to struggle with employment, mental health issues, and lower educational attainment.  They also are more likely to be involved in criminal activities, both as perpetrators and as victims. They are more likely to experience homelessness, welfare dependency, and unemployment.¹³ The Center for Disease Control once estimated that the overall cost of child abuse exceeds that of cancer or heart disease. If we could reduce abuse through early intervention, education, and policy changes it would lead to massive economic savings and a healthier, more productive society.¹⁴

But the recent directive forbids the study of “equal opportunity,” “inequality,” ”trauma,” “disability,” or “injustice.”  This creates a major problem because it has been well established that societies with greater income inequality have higher rates of heart disease, obesity, infant mortality, drug abuse, mental illness– as well as shorter life expectancy. Sadly, rising inequality has recently been linked to increased “deaths of despair” (suicides, drug overdoses, and alcohol-related deaths), particularly in countries like ours with weak social safety nets.¹⁵

So, how do we really Make America Great?

James Heckman won the Nobel Prize for economics in 2000 for his research that showed that investing in early childhood development for disadvantaged children yields high returns in terms of education, employment, and social outcomes.¹³  Home visits, mentorship programs and community-based initiatives significantly helped parents to provide a stimulating, nurturing environment for their children. His research showed that for every $1 invested in high-quality early childhood care, society gains $7–$13 in the form of higher earnings, reduced crime, and lower social service costs. One of Heckman’s most important discoveries was that non-cognitive skills like perseverance, social behavior, motivation, and self-discipline are just as important as IQ and academic skills¹⁴. His studies show that character development in early childhood is crucial for long-term success. Children who develop self-control, social competence, and emotional regulation early in life tend to have better job performance, higher incomes, and lower criminal activity later in life.

Yes, the costs of large-scale programs to address these core components that constitute a civilized society will be high, and improving living conditions, enhancing access to quality education and healthcare, and implementing targeted social support programs to break the cycle of poverty and thereby promote better health outcomes for future generations, is an immense challenge.¹⁵ But if we are to ensure a higher quality of life for all Americans than we currently enjoy, we have no choice but to address precisely the subjects listed in the index of forbidden topics such as: “biases,” “at risk,” “diversity,” “discrimination,” “inequalities,” “ injustice,” “multicultural,” “ socioeconomic,” “prejudice” and “trauma.”   

Bessel A. van der Kolk MD

Founder, Trauma Research Foundation 
Author, #1 best seller, The Body Keeps the Score

1. U.S. Life Expectancy and International Comparison

   • Arias, E., Tejada-Vera, B., Ahmad, F., & Kochanek, K. D. (2022). Provisional Life Expectancy Estimates for 2021. National Center for Health Statistics. This CDC report documents the U.S. life expectancy at 76.4 years in 2021, with lower rankings compared to peer nations6.

2. Disparities in Life Expectancy by Race/Ethnicity

   • Khan, S. S., et al. (2022). Life expectancy by county, race, and ethnicity in the USA, 2000–2019. The Lancet, 399(10341), 1482-1498. This study details racial and ethnic disparities in U.S. life expectancy6.

3. Infant and Maternal Mortality Disparities

   • Petersen, E. E., et al. (2019). Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016. MMWR Morb Mortal Wkly Rep, 68(35), 762–765. Black mothers in the U.S. face pregnancy-related death rates more than three times higher than white mothers6.

4. Impact of Chronic Stress and Racism on Health

   • Williams, D. R., & Mohammed, S. A. (2013). Racism and Health I: Pathways and Scientific Evidence. American Behavioral Scientist, 57(8), 1152–1173. Chronic stress from racism increases risk for chronic diseases.

5. Adverse Childhood Experiences (ACEs) and Health

   • Centers for Disease Control and Prevention. (2019). Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence. CDC research shows ACEs increase risk for chronic disease, mental illness, and substance abuse7.

6. U.S. Education Ranking and International Comparisons

   • Organization for Economic Co-operation and Development (OECD). (2018). PISA 2018 Results. The U.S. ranked 36th in math, 13th in reading, and 18th in science among OECD countries.

7. Link Between Education and Health Outcomes

   • Zajacova, A., & Lawrence, E. M. (2018). The relationship between education and health: Reducing disparities through a contextual approach. Annual Review of Public Health, 39, 273-289. Higher educational attainment is linked to longer, healthier lives4.

8. Impact of Funding Cuts on Research and Social Programs

   • Nature News. (2025). What’s in store for US science as funding bill averts government shutdown. Nature, 617, 237-238. Details recent and pending federal research funding cuts affecting social and health research18.

9. Cuts to Federal Grants for Diversity, Equity, and Inclusion

   • PBS NewsHour. (2025). What happens to health research when ‘women’ and ‘diversity’ are banned words. PBS NewsHour, March 30, 2025. Describes the effects of eliminating federal funding for research on gender, minorities, and social justice8.

10. U.S. Incarceration Rates and International Comparison

    • Sawyer, W., & Wagner, P. (2023). Mass Incarceration: The Whole Pie 2023. Prison Policy Initiative. The U.S. holds about 21% of the world’s prisoners, with an incarceration rate of 541 per 100,000 adults, compared to much lower rates in the Netherlands and Japan3.

11. Racial Disparities in Incarceration

    • The Sentencing Project. (2022). Report on Racial Disparities in Incarceration. Black men aged 20–39 have incarceration rates approaching 10,000 per 100,000.

12. Recidivism and Rehabilitation Approaches

    • Sprick Schuster, S., & Stickle, B. (2023). Research Finds Prison Education Programs Reduce Recidivism. Mackinac Center for Public Policy. Prison education and rehabilitation programs lower recidivism and improve outcomes5.

13. Economic and Social Benefits of Early Childhood Intervention

    • Heckman, J. J., et al. (2016). The Life-cycle Benefits of an Influential Early Childhood Program. Center for the Economics of Human Development. High-quality early childhood programs yield a 7–13% annual return on investment for society121419.

14. Non-cognitive Skills and Long-term Success

    • Stehle, S., & Peters-Burton, E. (2019). Exploring the influence of non-cognitive skills on academic achievement. Frontiers in Education, 4, 1339625. Non-cognitive skills like perseverance and self-control are crucial for educational and life outcomes13.

15. Societal Impact of Inequality

    • Wilkinson, R., & Pickett, K. (2009). The Spirit Level: Why More Equal Societies Almost Always Do Better. Societies with greater income inequality have higher rates of heart disease, obesity, infant mortality, and mental illness.