It has been nearly 100 days since President Trump assumed the office of the presidency, and the landscape of public health appears unrecognizable compared to what existed before. Through a series of executive orders, policy proposals and administrative changes, the entire U.S. healthcare landscape has been reshaped. Here is a deeper look at how public health has profoundly been affected by President Trump.
The most obvious change is the massive reduction in workforce at the U.S. Department of Health and Human Services. 10,000 jobs were cut, and an additional 10,000 health workers took early retirement or voluntary separation offers from the Trump administration, slashing the agency from 82,000 to 62,000 workers.
The downsizing included thousands of critical workers at the FDA, CDC and NIH, as well as hundreds of indispensable employees at the CMS. Among the employees laid off at the CDC were those responsible for the detection and surveillance of important diseases such as the bird flu and measles. Also among those laid off at the CDC included many who worked for the Epidemic Intelligence Service, a highly specialized training program geared towards developing future public health “detectives” that gained formal training in detecting and combating public health threats. Without these essential healthcare workers, who is going to safeguard the health of Americans and how will we prepare for future health threats such as the bird flu?
The effects on public health go well beyond just the layoff of workers. Essential health programs have been completely shut down and terminated. As an example, consider the Office on Smoking and Health, which has historically been responsible for running smoking reduction campaigns, identifying trends in tobacco use and preventing smoking use at the national level. As of April 1st, the office has been shut down, threatening decades of progress in smoking cessation.
Smoking is the number one preventable cause of death and disease in America. Since the Office on Smoking and Health was established 25 years ago, smoking among high school students has decreased from 28% to 1.4%. This type of progress does not happen in a vacuum, but by the concerted effort of federal programs that now do not exist. Smoking is also a major public health threat directly linked to a dozen of cancers as well as chronic diseases like stroke, heart attacks and obstructive lung disease. The closure of such programs does nothing other than dismantle our public health infrastructure that has sought to improve the health of all Americans.
Perhaps even more troubling is the effect some of the Trump administration’s policies have had and will have on our most vulnerable populations. In an executive order, Trump terminated the Health Equity Advisory Committee for Medicare and Medicaid Services, which has provided a much needed voice to address systemic barriers that people of color face in accessing health.
In addition, access to affordable healthcare could be threatened for millions of Americans. Among those laid off at the HHS were caseworkers that work at the CMS that assist Affordable Care Act consumers when they can’t be helped by call center personnel. With less personnel assisting ACA consumers, the more than 24 million Americans enrolled in the ACA could face significant hurdles in enrolling or accessing their health benefits. Remember, many of these 24 million Americans are low-income individuals that otherwise cannot afford high quality healthcare. Shouldn’t the government be removing, as opposed to placing hurdles on these vulnerable individuals in gaining the best healthcare they can get?
It is not just vulnerable individuals in America that are suffering, but also those all around the world. The Trump administration has directly affected the health of millions worldwide, since billions of dollars in foreign aid will not reach millions of low-income individuals across the globe from USAID cuts. Lack of funding to countries that cannot afford important preventive measures has affected so many with deadly diseases including HIV, malaria and TB. As an example, because many PEPFAR programs have been eliminated, about 500,000 children will die in Africa in the next five years. These children lack the resources to receive HIV medications and rely predominantly on America for life-saving aid.
Public health only thrives when funds and resources are invested in its infrastructure. Successes in healthcare can only be achieved when all people are prioritized, including the most vulnerable such as people of color and low-income communities. Cutting billions of dollars for life-saving interventions across the globe, laying off critical healthcare workers and gutting essential preventive programs in the U.S. will never make America healthy again.
