In Twenty Years of Life, Suzanne Bohan exposes the disturbing flip side of the American dream: your health is largely determined by your zip code. The strain of living in a poor neighborhood, with sub-par schools, lack of parks, fear of violence, few to no healthy food options, and the stress of unpaid bills is literally taking years off people’s lives. The difference in life expectancy between wealthy and distressed neighborhoods can be as much as twenty years. Bohan chronicles a bold experiment to challenge this inequity. The California Endowment, one of the nation’s largest health foundations, is upending the old-school, top-down charity model and investing $1 billion over ten years to help distressed communities advocate for their own interests. This new approach to community change draws on the latent political power of residents and is driving reform both locally and in the state’s legislative chambers. If it can work in fourteen of California’s most challenging and diverse communities, it has the potential to work anywhere in the country. Bohan introduces us to former street shooters with official government jobs; kids who convinced their city council members to build skate parks; students and parents who demanded fairer school discipline policies to keep kids in the classroom; urban farmers who pushed for permits to produce and sell their food; and a Native American tribe that revived its traditional forest management practices. Told with compassion and insight, their stories will fundamentally change how we think about the root causes of disease and the prospects for healing.