Imagine Doing Better

Why Policies Backfire and How Prevention Thinking Can Change Everything

Paul J. Fleming

• Publisher: Johns Hopkins University Press
• Year: 2025
• eBook ISBN: 9781421452876
• Topic: Medicine
• Subtopic: Health Policy

A bold vision for reimagining harmful public policies through prevention.

Public policies in the United States are built on certain assumptions: that long-term prison sentences deter crime, that corporate profits benefit everyone, that police are the best way to ensure safety, and that meritocracy ensures equal opportunity. Yet, as public health expert Paul J. Fleming reveals, mountains of evidence show that many of these widely accepted policies cause harm, perpetuate inequities, and even lead to premature death.

In Imagine Doing Better, Fleming offers a bold vision for change that's rooted in public health principles of prevention—addressing problems at their root before they occur. Combining rigorous research, historical analysis, and compelling narratives, he examines the deep flaws in policies governing health care, education, justice, and the environment. Fleming unpacks how these systems were built, why harmful assumptions persist, and how they can be reimagined to promote equity, sustainability, and human dignity. Fleming challenges readers to rethink entrenched ideas by exploring thought-provoking questions like "Are prisons a good investment?" and "Is education a ladder or a sieve?". He highlights how budgets and policies reflect moral choices, and he provides frameworks for advocacy and policymaking grounded in evidence and fairness.

Fleming paints a hopeful—yet urgent—picture of what's possible when societies invest in solutions that prioritize human dignity, equity, and sustainability. Accessible and inspiring, Imagine Doing Better offers a hopeful roadmap to a future where all communities have the resources and opportunities to thrive.

Table of contents

• Cover
• Title Page
• Copyright Page
• Dedication
• Contents
• Preface: What Will Our Great-Great-Great-Great-Great Grandchildren Say?
• Part I: Imagination
• Part II: Reflection
• Part III: Action
• Epilogue: 2225
• Acknowledgments
• Appendix
• References
• Index