I hope you all enjoyed last week’s celebration of our nation’s 250th birthday. As I reflected on this remarkable milestone, I found myself drawn to a book that has given me a new way of thinking about America: American Nations: A History of the Eleven Rival Regional Cultures of North America, by Colin Woodard. Whether or not one agrees with all of its conclusions, the book offers a fascinating framework for understanding the diversity, tensions, and strengths that have defined our country since its founding.
Woodard's central premise is that we, the United States, have never been a single culture, but rather a federation of eleven enduring regional "nations," each founded by different groups of settlers with distinct ideas about religion, liberty, education, commerce, government and community. His work maps these regions down to the county level.
These regional cultures have persisted for centuries, repeatedly coalescing around shared national purposes and then reasserting their distinct identities, a dynamic evident during the American Revolution and Civil War but by no means confined to those defining periods. Remarkably, these eleven distinct cultural entities have proven resilient enough to assimilate successive waves of immigrants, whose descendants generally come to reflect the civic culture of the region in which they settle more than that of their ancestral homelands, even as they enrich those regional cultures with their own traditions.
In many respects, I've had the privilege of living that experience. Growing up in Boston, I absorbed the virtues, and occasional arrogance, of Woodard's Yankeedom, a culture characterized by its reverence for education, civic responsibility, institutional excellence, and the common good, but also by a tendency toward moral certainty and paternalism. That tradition has inspired some of America's greatest reform movements while also inviting periodic accusations of elitism and self-righteousness.
Living in New York exposed me to the cosmopolitan, entrepreneurial culture of New Netherland, with its commercial energy, pluralism, and tolerance. My years in Ohio provided a fascinating intersection of The Midlands’ pluralism, pragmatism, and instinct for compromise with Greater Appalachia's fierce individualism, pugnacious resilience, quick defense of personal honor, and deep skepticism of centralized authority. Now, living in Florida, I have a greater appreciation for the Deep South's traditions of faith, hospitality, close-knit communities, and enduring sense of place, alongside its complex legacy of intolerance.
Woodard's remaining regional cultures — the fiercely independent Left Coast; the vast, resource-rich Far West, whose ethos of self-reliance has been sustained by an equally enduring reliance on federal investment; the Hispanic borderlands of El Norte; and the distinctive histories of New France, Tidewater, and First Nation — further underscore that America's character has always been shaped by multiple founding traditions rather than a single national identity. Each contributes something indispensable, but alone, none fully explains America.
The consequence is a nation that is simultaneously diverse and durable, one whose character is continually renewed without losing its essential continuity. Time and again, Americans have demonstrated a remarkable capacity to rally around shared purposes in moments of challenge, while preserving the regional loyalties, values, and perspectives that make the country so distinctive. These recurring cycles of unity and differentiation can be contentious and frustrating, but they have also been a powerful source of creativity, adaptation, and resilience. To me, that remains the enduring paradox, and perhaps the enduring strength, of the American experience.
Seen through this lens, many of the peculiarities that perplex both Americans and foreign observers become more understandable. We are fiercely individualistic, yet remarkably generous in forming voluntary associations of every kind, from civic organizations and scientific societies to conservation groups and humanitarian charities. Alexis de Tocqueville, the French aristocrat and author of Democracy in America, found this trait especially striking when he visited the United States in 1831. We are among the world's most scientifically innovative societies while remaining one of its most religious. We champion free enterprise yet repeatedly unite behind transformative public-private endeavors, like the rapid development of COVID-19 vaccines. We value local autonomy yet expect national leadership in times of crisis, and we are capable of both extraordinary military resolve and prolonged self-examination before and after exercising power abroad. To outsiders, these qualities often appear contradictory, and to Americans, consistently irritating, but through Woodard's paradigm, they reflect the continuing dialectic among America's founding regional cultures.
What strikes me most, however, is that these eleven original regional cultures remain America's enduring civic foundation. My father's family arrived in Massachusetts in the 1660s, though he was born and raised in Ohio and Florida. My mother was born an Italian citizen and grew up in Puerto Rico and Baltimore. Yet both were unmistakably Boston "Yankees." That story has been repeated millions of times through generations of American families. Successive generations of immigrants have settled within these regional cultures, adopting many of their civic habits and institutions while enriching them with their own languages, cuisines, music, literature, and cultural traditions. The result is not exactly a melting pot, but an evolving civilization whose layers of variation have become its greatest strength. In my view, it is this continual process of cultural assimilation and renewal within these enduring regional traditions that is the source of American dynamism, helping to explain our outsized contributions to business, science, technology, medicine, higher education and the arts, as well as our capacity for both remarkably consistent benevolence and occasional episodes of great cruelty.
My guess is that this is what so many visitors discover when they experience America firsthand. They encounter not one America, but many, or at least eleven, stitched together by an extraordinarily durable constitutional framework born of the remarkable “Enlightenment” vision of our Founders. Even earlier, it was John Winthrop, who hoped his new Puritan society in Massachusetts Bay would become "a city upon a hill," whose example would be visible to the world. Two centuries later, de Tocqueville concluded that America's true genius lay in the character of its people and, as noted, their extraordinary habit of freely associating in pursuit of the common good. If Woodard is right, America's pluralism was embedded in the nation's birth and was the bedrock of our independence. Our continuing success has depended on transforming that intrinsic and, at times contentious, heterogeneity from a source of division into a source of innovation and renewal.
As we celebrate the 250th year of our independence and prepare to begin another academic year, I am reminded that many of the most important advances in medicine, science, and public health emerge when people with different experiences, perspectives, and expertise work together to solve shared problems.
For those of us who educate the next generation of health professionals, this is an essential lesson: progress depends not on uniformity of thought, but on a willingness to question assumptions, engage respectfully with competing ideas, follow the evidence wherever it leads, and remain united by our commitment to improving human health.
I hope that as we pursue distinctive scholarship and vigorous intellectual exchange, USF Health continues to foster an environment where thoughtful people can disagree, learn from one another, and collaborate in service of science, discovery, compassionate care, and the public good.
Thank you for all that you do to contribute to our exchange of ideas and pursuit of learning. I look forward to another season of Making Life Better.