As a family medicine resident physician who practices primary care, it is my responsibility to be the first doctor a patient, their family, and their community may visit for any undifferentiated issue. No other field of medicine increases the life expectancy and the quality of life in a community as much as primary care, which provides more meaning to me than can be qualified. My objective is for people to healthily be able to reach their life goals, but also to prevent emergencies and hospital visits. Like a firefighter, I stop smolders from becoming forest fires. It should not come as any surprise that I am always looking for fires, and believe me, there wafts something acrid in the air.

The rules for this existence are quite simple: If you eat well, stay hydrated, do not ingest poison, exercise and get outside often, get restful sleep, find meaning in your life, have shelter, and are surrounded by well-intentioned folks, you will be protected from a vast majority of chronic diseases. Unfortunately, these are challenging tasks today, which create further and further challenges that have health, economic, political, and ecological consequences. Every day, I am guaranteed to see heart disease, COPD, obesity, diabetes, depression, dementia, kidney disease, cirrhosis, stroke, and infectious diseases raise their sordid heads, only for me to strike them like a game of Whac-A-Mole. The problem with this analogy is that a human being is my gameboard, who certainly does not like having unpleasant moles pop up for me to smash with my medical mallet.

I believe most diseases are largely caused by the style of life we have, and not so much the lifestyle we are commonly told. We often underestimate the society and culture we are anchored to and cannot see the forest for the trees. Social determinants of health are exactly that, and recall that ZIP codes are one of the best predictors of life expectancy! Most patients have an idea that to improve their health means better diet, exercise, sleep, and social networks. However, working a back-breaking or totally sedentary job, in food deserts and regions prone to heatstroke, smog, car danger, air pollution, and partisan politics makes this difficult. Our capitalist society says there are only two kinds of people: winners and losers. Feel united yet? The removal of third spaces from our lives does not help either, nor does war and senseless violence. However, I believe most patients in some way or form know the location of the Fountain of Youth but just not how to get there. They do not need another person to tell them to change their habits; they need someone to advocate for a change in their habitat.

It is not far-reaching to think that animals should live in the environment they are closely adapted for. Emperor penguins belong on Antarctica, not in Pittsburgh. Why are we expected to be any different? It begs the question: What are we adapted for? Homo sapiens evolved around 300,000 years ago in the savannas of Africa as small-banded, egalitarian hunter-gatherers. Our bodies are adapted to scavenge together across open grasslands, with eyes suitable to gaze far across plains, but also to be able to see closely in trichromatic vision for the observation of fruits, nuts, tubers, plants, and small animals. Speaking of dinner, the structure of our teeth and gastrointestinal tract is geared towards an omnivorous diet of much greater variety than what we consume today, which allowed us to remain healthy and be flexible during migrations and seasonal fluctuations. Importantly, our upright posture, arched feet, large glutes, and long legs mean we should be moving, constantly. For example, we historically hunted animals to exhaustion via endurance running and intermittent long-distance runs, long before guns and abattoirs. Alone, a human could not survive a bout with most animals our size and greater, but together as a group, we hunted mammoths to extinction. It is this need for teamwork that evolved our language, intelligence, and our diverse set of personalities, forming small intricate social networks that are meant for cooperation and protection.

If you do not believe me, hear this: We are sicker than our prehistoric ancestors. No doubt have infant mortality and complications from congenital syndromes improved today due to modern medicine and vaccinations; this is an incredible feat and a positive for our species. However, health outcomes in regard to survivorship and comorbidities have not improved and have even worsened in the general population. Diseases we worry about today, such as heart disease, cancer, type 2 diabetes, obesity, psychiatric disorders, pandemics, and more are primarily diseases of civilization as some scholars have referred to them, and rarely occur in hunter-gatherers based on current data we have of prehistoric and contemporary hunter-gatherer populations.

Our lives now are different, but the source of our well-being is the same. Our day-to-day should be aligned then with our needs, but right now, civilization generally promotes the opposite for its own gain. It does not surprise me, nor should you, that we are sicker in a world we are destroying to make into something we are not even adapted for. Over the last few thousands of years as modern society has evolved its own appetite, it has culminated into more wars, gender inequality, depression and psychosis, disease, dissatisfaction, mass extinction, and climate destruction than over the previous 200,000 years combined. This is the fire I warned about earlier, figuratively and literally.

I am not at all a believer in the myth of the noble savage (our ancestors led very difficult, harsh lives), but I cannot ignore the value I believe this perspective brings to my patients. The answer, our future, to this question belongs to the past. If at this point I have persuaded you to think and act more like the hunter-gatherer you are, fantastic, but I must state the obvious: You probably would not survive as one today, and the world we have left is not sufficient to be one anymore. The world is dying as more regions become inhospitable because of our actions to keep civilization alive, leaving us to exist in prisons of our own creation. In the spaces we exist in now, we must reprioritize the needs we have developed since prehistory, and not the needs of a myopic, hyperindividualistic, hypercapitalist, utilitarian civilization. This includes not only reframing health and food systems, but also community, culture, resource consumption, technology, habitation, infrastructure, economics, governance, education, communication, sexual relationships, and more.

For me, small practices I implemented from this thought experiment have been gardening and having a portion of my annual food intake be that which I have grown myself, shopping locally, bartering, brewing kombucha, composting food scraps, community walks, biking to work, being involved in a local ecology book club, camping, practicing mindfulness, restricting screen time, thrifting rather than buying, minimizing electricity consumption and being mindful of my carbon footprint, writing to my representatives, opening my home to others, and offering these ideas and thoughts to my patients, colleagues, and strangers. I am sure many of you already do some of these activities and more, so now it is just about getting others excited and helping them feasibly start. One of my joys in my medical practice has been reframing the health narrative and normalizing conversations around nature and our ancestry to our everyday lives and public health discourse. That way, it becomes apparent that water quality, biodiversity, climate change, community-supported agriculture, waste management, screen time, green spaces, rest, social engagement, walkability, and more are all part of a larger campaign towards a livable and healthier world.

If we work to restore the wildness of the world, we awaken the wildness within ourselves. I invite you to consider your needs, not just as modern humans navigating a hyperindustrialized society, but as descendants of small, cooperative hunter-gatherer bands, and to act in ways that honor both your health and the habitat that sustains it. In doing so, we can turn the fires that we face into sparks of renewal for ourselves and the generations to come

Max Goodman is a family medicine resident.