UNDERSTANDING INTENDED MEANING

Let’ break the sentence to derive the intended meaning, identifying the errors along the way:

We generally tend to look at health
like it is a national issue primarily with no international ramifications,
and how wrong we are.

ERRORS:
1. “Like” is used to indicate comparison. However, no comparison is being drawn here. The idea is to convey that we look at health in a certain manner.
2. “Primarily” is a modifier implying “mainly”. So, this segment seems to be saying that “health is a national issue mainly with no international consequences”. The placement of “primarily” is such that it could be implying “health is a national issue primarily” or it could be implying “primarily with no international ramifications”. This placement creates lack of clear meaning.

INTENDED MEANING
• We generally tend to look at health in a certain manner. That manner implies that we think:
o Health is a mainly a national issue and it does not have any international consequences.
• We are really wrong in thinking so.

ANSWER CHOICE ELIMINATION
Choices B and C have errors similar to those in Choice A and can be eliminated.

Choice D Analysis:
We generally tend to look at health as if it is primarily a national issue with no international ramifications, and how wrong we are.

"As if" correctly points out the manner in which we look at health.
"Primarily" now clearly modifies the verb "is".

Logical
Clear
Per the intended meaning
Correct Choice.


Choice E Analysis:
We generally tend to look at health as if it primarily is a national issue with no international ramifications, and how wrong we are.

• The verb modifier “primarily” in awkwardly placed between the subject “it” and the verb “is”. This construction is not accepted.
Incorrect Choice.
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can an expert provide an explanation as to why option E seems awkward ? ,

my understanding is that - 'It primarily is an issue' , there should be a comma after 'It' .