For most of human history, the majority of people worked to feed the majority of people. Food production was labor-intensive, local, and inseparable from daily life. Survival demanded bodily competence, shared effort, and constant participation. Over the last century, mechanization, industrial agriculture, and global supply chains radically altered that equation. Fewer humans were required to produce food for many more humans, freeing large portions of the population from subsistence labor. This was an extraordinary achievement—and it created a new question society had never faced at scale: what do most people do when their labor is no longer required to meet basic physical needs?
The answer, for a time, was knowledge work. Education became the new ladder, and schooling expanded to prepare people for roles in administration, analysis, management, and abstraction. This transition absorbed generations of workers and produced real prosperity. But unlike food production, knowledge work does not scale indefinitely with population. As systems matured, efficiency increased, roles consolidated, and the number of meaningful ladders began to shrink. The belief that “more education” alone could solve this quietly persisted, even as the number of available rungs failed to keep pace with the number of climbers.
Alongside this shift, another vast human enterprise expanded: healthcare. As fewer people worked to produce food, more people began working to care for sick bodies. Some of this reflected genuine progress—longer lives, better acute care, and expanded diagnostic ability. But the system also grew in ways that normalized chronic illness rather than resolving it. Highly processed, calorie-dense, nutrient-poor food replaced real food for many communities, increasing metabolic and inflammatory disease. The result was a self-reinforcing loop: industrial systems that produced cheap, artificial nourishment also generated the conditions that required lifelong medical management, creating jobs while quietly eroding baseline health.
Over time, health itself became increasingly objectified—measured, categorized, treated, and managed—rather than restored or shared. Many people came to experience their bodies as fragile, their minds as overwhelmed, and their lives as fragmented into appointments, diagnoses, and protocols. At the same time, social structures that once provided meaning and connection—local work, shared movement, small groups, faith communities, and civic rituals—thinned or disappeared. Technology promised connection but often delivered amplification instead, concentrating voice and attention while leaving many feeling unseen and unheard.
We arrive at the present moment with unprecedented material capacity and unprecedented disconnection. Large numbers of people are neither needed to produce basic goods nor invited into meaningful participation. Hope falters not because of laziness or ignorance, but because many lack simple pathways back into shared life—pathways that restore trust in their bodies, confidence in their thinking, and connection with others. The challenge before us is not merely economic or medical, but human: how to rebuild systems where health is socially valuable again, participation is possible without credential or performance, and people can once more walk together, ask questions together, and belong.
Less visibly, healthcare has also come to play another role: it has become one of the few socially legitimate ways to distribute resources, attention, and dignity in a world where fewer people are clearly needed to produce basic goods. In the absence of other widely recognized pathways for contribution, illness—diagnosed, managed, or prevented—quietly became a justification for care, income, and ongoing human presence in large systems. This was not the result of bad intent, but of necessity; something had to absorb displaced usefulness. The consequence, however, is that sickness now confers legitimacy in ways that participation, presence, and steadiness often do not, leaving many people caught between wanting to belong and needing to be unwell to matter.
What may be needed now is not the replacement of healthcare or the invention of another ladder, but the recovery of a different kind of legitimacy—one rooted in participation rather than pathology. Long before modern systems, people mattered because they showed up: they walked together, kept pace with one another, listened, asked questions, hosted space, and sustained shared rhythms of life. These acts did not require credentials or diagnoses, yet they produced resilience, clarity, and belonging. Re-establishing simple, repeatable ways for people to participate bodily and cognitively—without performance, optimization, or medical framing—offers a path back to dignity that does not depend on being sick, exceptional, or economically necessary, but simply human.