Why the Trump administration will be bad for Americans’ health

Donald Trump will take office promising to “Make America Healthy Again,” even as mounting evidence links the president-elect’s conservative policy agenda to poorer health.

Public health scientists see Republican-led states, some of which have the worst health outcomes in the developed world, and Trump’s record as warning signs for the future.

“We looked at the policies other countries had adopted that helped their populations live longer, healthier lives,” said Dr. Steven Woolf, a public health researcher and family physician at Virginia Commonwealth University.

Those policies often included universal health care, education support, gun violence prevention and laws reducing smoking — many of which are opposed by the Trump administration or opposed by Republican state leaders.

“One of the immediate takeaways from the election is that the policy agenda is now even more questionable – essentially a political non-starter,” Woolf said. “The bigger concern over all of this is that we are likely to see the announcement of a range of new policies that will further endanger health.”

The ominous future envisioned by researchers highlights the gap between what decades of research show are the leading causes of ill health and the belief in alternative medicine (and sometimes outright quackery) supported by one of Trump’s top advisers, Robert F Kennedy Jr.

Kennedy, a longtime vaccine skeptic and former independent presidential candidate, laid out his policy agenda on social media two weeks agotelling his supporters that he “provides stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean food, sunshine, exercise, nutraceuticals and anything else that promotes human health that cannot be patented by Pharma ” would promote. .

Without getting into the details of that list – some of which are active harmful – the focus contrasts with what public health scientists see as the most effective ways to improve the nation’s health, from getting health insurance for all to improving STD detection and diagnosis programs to increase tobacco taxes.

The US South provides one of the clearest examples of this evidence being ignored. This old conservative stronghold has done just that among the highest diabetes, obesity, infant mortality, maternal mortality, sexually transmitted diseases, cancer and self-reported poor health in the country, and sometimes in the developed world.

If West Virginia were a nation, it would have the worst rate of preventable deaths of any country in the 38 member states of the OECD, a group of highly developed democracies. With 416 preventable deaths per 100,000 inhabitants, the state’s rate is comparable to that of Latvia, Lithuania and Hungary, according to a Commonwealth Fund Analysis using data from 2018.

The South, as a region, also has the highest number of people without health insurance less than having a high school education and living in poverty – all of these are associated with poorer physical and mental health behaviorally health outcomes.

“The U.S. is not doing a good job protecting the health and well-being of its citizens,” said Reginald Williams II, vice president of international health policy at the Commonwealth Fund.

Researchers trace the beginnings of one decades of decline in America’s health care system and the growing gap between states relative to the Reagan era, when the administration cut funding to the Department of Health and Human Services (HHS) and the public health insurance program Medicaid, effectively eliminating many public health programs. States were expected to fill this gap, leaving some states to fare better than others, with poorer national health compared to similarly wealthy countries.

“Now you have some states that are performing better, like Massachusetts and Connecticut, and you have some states that are performing quite poorly, like Mississippi and West Virginia,” Williams said. “But if you look at even the best-performing states in the US, they still rank below other advanced economies.”

In other words, the concerns driving Kennedy’s promises are legitimate: the profits and corporate influence are real. But the Republican Party has a track record of rolling back regulations that protect health occupational health and safety standards – and to oppose those who protect health – such as reducing cigarettes, alcohol, junk food or pollution.

These in turn are what researchers call the “political determinants of health.” And a growing body of research, including a study recently published Krieger’s Septembershows how the conservative policy agenda is associated with poor health outcomes.

“It is the living conditions, the air we breathe, the temperature of the planet, the nature of the qualities of the ecosystems in which we live – that are fundamental to understanding public health,” says Nancy Krieger, professor of epidemiology at Harvard University. Chan School of Public Health.

This area of ​​research has grown significantly following the Covid-19 pandemic, as the hardest-hit populations shifted from the poor and people of color to more early in the outbreak prosperous, white and conservative states where Republicans oppose masks and vaccines.

“So there is one part (of the political determinants of health) – what is the policy of the health insurance system?” Krieger said.

For example, Republican-led South Dakota has taken steps to limit insurance coverage during this election cycle. There, voters approved a measure to add work requirements to Medicaid, the public health insurance program for low-income Americans.

The American Cancer Society called that change “dangerous and life-threatening,” and one that goes against research that “shows time and time again that access to health insurance is a major determinant of surviving a cancer diagnosis.” The measure still needs approval from the Centers for Medicare and Medicaid (CMS), which it will likely receive in a new Trump administration.

“On the other hand,” Krieger said, there are proposals from Trump’s supporters to dismantle the “regulatory state.” Trump supporters are “very keen to push for environmental regulations and occupational health protections — those kinds of things that really matter,” she said.

That would include policies such as ending an effort by the Food and Drug Administration (FDA) to ban menthol cigarettes, which are now considered dead in the water by supporters and opponents alike. Lawyers believed the ban would reduce predatory marketing against black youth. Black men have the highest rates of developing and dying from lung cancer in the country.

Taken together, these types of changes make it “very unlikely that there will be a healthier nation” during the second Trump term, Krieger said.

The Guardian contacted A potential choice for Trump’s health and human services department, former Louisiana Governor Bobby Jindal, through the Trump-centric America First Policy Institute. The think tank did not respond to an interview request.