Long before the COVID-19 pandemic, it was clear that the US approach to public health was failing.

Around 40% of deaths in the country are due to five leading causes of preventable illness. A third of Americans avoid regular doctor visits because it’s too expensive. Nearly 25% of Americans struggle to afford prescription medication, with the number rising to half for people in poor health. Two-thirds of bankruptcy cases in the US stem from medical bills

These outcomes are all due to policy choices — specifically a private health care system, sky-high drug prices, and minimal public health funding. The COVID-19 pandemic only underscored the extent to which ordinary citizens are often on their own when facing health problems. 

The US isn’t alone. Globally, around half of the world’s population lacks access to essential health services and 100 million people get pushed into extreme poverty annually due to medical costs, according to the World Health Organization. Meanwhile, the inequitable distribution of COVID-19 vaccines showed how rich countries immediately hoarded doses that could supply their populations several times over, while poorer countries had little to no access to them.  

These are all examples of existing and long-held inequalities, highlighting the systemic barriers to true health justice and financing for the world’s most marginalized populations.  

Governments and world leaders need to step up and invest in better, more equitable health financing. But in the absence of adequate state support, mutual aid and community support can fill in the gaps of care and weave together missing threads in the social safety net, according to Mia Birdsong, the author of How We Show Up: Reclaiming Family, Friendship, and Community

Family, friends, neighbors, and wider communities can pool resources, organize networks of assistance, and develop a recovery plan that would otherwise be missing. 

For Birdsong, the possibilities of this alternative model came into full view when she received a colon cancer diagnosis last year. She experienced a broader and more-encompassing form of mutual aid than the standard support you’d receive from loved ones. And considering a fifth of Americans experience chronic social isolation, many people lack even this baseline of help. 

“We are all going to face some crisis in our lives, and to build community is a kind of disaster preparedness,” she told Global Citizen. “I have a bin full of non-perishable food and water in my basement, which will be great if we have an earthquake. But the disaster preparedness of building a really great community benefits you all the time. And then when shit goes down, they’re there for you.” 

In an interview with Global Citizen, Birdsong explained how her community showed up for her as she battled cancer and how their efforts are already inspiring similar mutual aid elsewhere. 

Excerpted from a larger interview, the conversation has been lightly edited for clarity, and shows the remarkable potential of mutual aid. 

Mia Birdsong: If I get COVID, I don’t want my government bringing me soup. You know it’s going to come too late, it’s going to be cold. What you really need, I’ve learned, is your own micro infrastructure and systems of support. 

At the end of last July, I got diagnosed with colon cancer. Things moved very quickly. I had to have surgery and really aggressive chemo for three months. 

Because I felt like I learned the lessons of how to ask for help and how nourishing it is for the people who love you to be given the opportunity to help, I was very open about what was happening to me.

Immediately, a group of my friends set up a squad. They set up a meal train for my family to be fed, handled all the communication for all the communities I have. They created spreadsheets with all these tools and resources. There were people outside the hospital singing when I had surgery. I had a squad of people who would text me when I was having chemo and feeling terrible, who would set up times to make sure I took a walk when I didn’t want to move, who would come with me to walk, even if it was just a block.

When you get something that deeply compromises your immune system during a pandemic, you can’t have multiple people around you. It was just my husband taking care of me in our home. But it was extraordinary. People paid to have my house cleaned regularly. People didn't just bring me soup, they brought nutritive broth that they researched. 

A lot of people go through cancer and the only practitioner they’re dealing with is the primary doctor. Because I’ve had loved ones who’ve had cancer, we were able to get an acupuncturist and nutritionist on board right away who knew how to mitigate the experience of chemotherapy and think of recovery after the treatment. 

I had so many resources. They set up a joy fund for me, and I was only allowed to spend it on things that brought me joy. I had a friend who set up an errand squad for things like if I needed weed. My son is in this amazing homeschool collective, and they were on a trip to the Grand Canyon and he was the only one without a parent, and I wanted to send him a care package, and I had a friend who got me his favorite candy. 

People showed up for me in really extraordinary ways, filling gaps in our health care system. I went to a health care provider’s nutrition course who told me to eat fruits and vegetables, and I was like, are you kidding me? I need an actual nutritionist who works with cancer patients, and someone who I know had that connection. But if you don’t have that, you’re on your own. My community filled in the gaps in the infrastructure that exists. But then they did the things that the government wouldn’t do, too. 

That was utterly amazing. I wish everyone can experience that kind of depth and longevity and love and commitment. I don't want people to have cancer, but it was such a gift to be able to be held by my community. 

I’m responsible for building community, but one person doesn’t build community alone. I have all these people in my life who responded to my call for help and it means we have this amazing web. And the tools and care squad that they created have been shared with other communities and people who care. 

What my community modeled is being replicated in other places. That kind of support and mutual aid and abundance is what all of us need to be a part of. Because inevitably, we are all going to face some crisis in our lives, and to build community is a kind of disaster preparedness. 

I have a bin full of non-perishable food and water in my basement, which will be great if we have an earthquake. But the disaster preparedness of building a really great community benefits you all the time. And then when shit goes down, they’re there for you. 

Global Citizen Asks

Defeat Poverty

How Mutual Aid Can Fill in the Gaps of Health Care

By Joe McCarthy