Born Paul Francis in 1977 in Miami, Florida, Sage Francis spent most of his youth in Providence, Rhode Island. Interested in the poetic side of rap, Francis had been rhyming since age eight, later winning the Superbowl Battle in Boston in 1999 and the Scribble Jam in Cincinnati in 2000 and 2001 (the last under the name of his "metal" alter ego, Xaul Zan). After graduating from Dean College in Massachusetts with an A.A. in communications and from the University of Rhode Island-Kingston with a B.A. in journalism (where he started the now-defunct group Art Official Intelligence), Francis worked on releasing his solo records.
Always an outspoken and political rapper and a strict vegetarian, he started the Sick Of series in 2000 on his independent Strange Famous Records with Still Sick...Urine Trouble, and continued with Sick of Waiting Tables (2001), Sick of Waging War (from 2002, and containing the single "Makeshift Patriot," recorded exactly one month after the September 11 attacks on New York), and Sickly Business (2004). He also released one album on Anticon in 2002, Personal Journals, and was signed in 2004 as the first rap artist on Epitaph Records, which issued his highly anticipated A Healthy Distrust in 2005. Two years later he was working with composer/trumpeter Mark Isham on the soundtrack for Pride and Glory starring Edward Norton. Two tracks from these session ended up on Francis' own 2007 full-length, Human the Death Dance.