Why the Trump administration will be bad for Americans’ health

Donald Trump will take office with a pledge to “make America healthy again”, as evidence mounts that the president-elect’s policy is more health-conscious. .

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

Dr Steven Woolf, a population health researcher and family physician at Virginia Commonwealth University said: “We looked at policies that other countries have adopted that allow their citizens to live longer and healthier lives. “

Those policies often included universal health care, support for education, gun violence prevention and anti-smoking laws — many of which are opposed by the Trump administration or opposed by leaders. of the country of the Republic.

“One of the immediate takeaways from the election is that policy is becoming more questionable – it’s not really a political establishment,” Woolf said. “Now, the biggest issue surrounding all of this is that we may see the announcement of new policies that will put health even more at risk.”

The alarming future described by the researchers highlights the difference between what decades of research shows is the main cause of health and faith in alternative medicine (and sometimes outright manipulation). supported by one of Trump’s key advisers, Robert F Kennedy Jr.

Kennedy, a long-time vaccine skeptic and independent presidential candidate, laid out his plan on social media two weeks ago, telling supporters he would promote “stem cells, raw milk, hyperbaric therapy, chelating agents, ivermectin, hydroxychloroquine, vitamins, clean. food, sunlight, exercise, nutrition and anything that improves human health and it cannot be patented by Pharma”.

Without going into the minutia of that list – some of which is dangerous – the focus is instead on what public health scientists see as the most effective ways to improve public health, from access to health insurance to improving programs for tracking and testing sexually transmitted diseases. increasing tobacco taxes.

South America paints one of the strongest examples of ignoring this evidence. This long-standing practice has among the highest rates of diabetes, obesity, infant mortality, maternal mortality, and sexually transmitted diseases. sexuality, cancer and self-reported ill health in society, and sometimes in developed countries.

If West Virginia were a nation, it would have the worst preventable death rate of any country in the 38-member OECD, the group of most advanced democracies. At 416 preventable deaths per 100,000 people, the state’s rate is on par with Latvia, Lithuania and Hungary, according to a Commonwealth Fund analysis that used 2018 data.

The South as a region also has the highest rates of people lacking health insurance, having a high school education and living in poverty – all of which are associated with the worst outcomes. of physical and behavioral health.

“The US is not doing well in protecting the health and well-being of its citizens,” said Reginald Williams II, vice president for international health policy at the Commonwealth Fund.

Researchers trace the beginning of the decades-long decline in US health and the widening gap between states 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 – in fact. ending many public health programs. Countries were expected to fill the gap, which led to some countries performing better than others, with worse overall health compared to wealthier countries.

“Well, you have states that do well like Massachusetts and Connecticut, and you have some states that do poorly like Mississippi and West Virginia,” Williams said. “But if you look at the best performing countries in America they are still below the rest of the developed economies.”

In other words, the skepticism driving Kennedy’s promises is correct: business profits and influence are real. But the Republican party has a record of reducing laws that protect health – such as occupational health and safety standards – and opposing those that protect health – such as bans on cigarettes, alcohol, junk food nutrition or pollution.

These, in turn, are what the researchers call “the political effects of health”. And a growing body of research, including a study published recently in September by Krieger, shows how the policy of care is related to negative health outcomes.

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after the news release

“It’s the quality of life, the air we breathe, the temperature of the planet, the nature of the characteristics of the environment we live in – it’s important to understand population health,” said Nancy Krieger, professor of epidemiology. Harvard’s TH. Chan school of public health.

This area of ​​research grew exponentially after the Covid-19 pandemic, as the population affected by the crisis moved from poor people and people of color at the beginning of the crisis to wealthier countries. white and disadvantaged where Republicans opposed masks and vaccinations.

“So there’s one part [of political determinants of health] – What are the policies of the health insurance system? said Krieger.

For example, Republican-led South Dakota took measures to block insurance coverage this election cycle. There, voters approved a measure to increase work requirements for Medicaid, the health insurance program for low-income Americans.

The American Cancer Society has called the change “dangerous and life-threatening”, and contradicts research that “consistently shows that access to health insurance is an important factor in survival after a cancer diagnosis. “. The move still needs approval from the Centers for Medicare and Medicaid (CMS), which is likely to be part of the new Trump administration.

“On the other hand”, Krieger said, are the proposals of Trump’s supporters to dismantle the “state of order”. Trump supporters are “passionate about environmental regulations and occupational health and safety – the kinds of things that are very important”, he said.

That would include policies such as ending the Food and Drug Administration’s (FDA) efforts to ban menthol cigarettes, which are now considered dead in the water by supporters and opponents. Proponents believed that the ban would reduce inadvertent advertising to Black youth. Black men have the highest rates of lung cancer in the country.

Taken together, these kinds of changes make it “impossible to have a healthy society” during Trump’s second term, Krieger said.

The Guardian reached out to a potential pick for Trump’s health and human services department, former Louisiana governor Bobby Jindal, through Trump’s America First Policy Center. The thinktank did not respond to a request for comment.