In 2016, life expectancy at birth in the United States fell for the second year in a row, driven by obesity, suicides, the opioid crisis, and inaccessible health care. Now, more than ever, public health needs political commitment and respect for science.
Sadly, politics trumps health, emboldened by a President who prioritises rich over poor and corporations over healthy communities. Here are six ways the Trump Administration undermines public health:
President Trump constantly casts doubt on science. He suggested childhood vaccines cause autism (untrue) and cast aside the scientific consensus that humans accelerate climate change, withdrawing from the Paris Agreement.
Alarmingly, his Administration instructed the nation’s public health agency – the Centers for Disease Control and Prevention (CDC) – not to use seven words: diversity, transgender, vulnerable, foetus, entitlement, evidence-based and science-based.
Yielding to the National Rifle Association, Congress virtually forbids CDC from conducting firearms research.
If the Trump Administration is committed to one big idea, it is gutting health regulations developed under former President Obama. Agriculture Secretary Sonny Perdue reversed Obama-era rules for healthy school lunches, saying, “It doesn’t do any good if nutritious meals wind up in the trash can.”
He also delayed plans to reduce the amount of salt in school lunches, even though 92 percent of children exceed the maximum recommended salt intake. The Food and Drug Administration (FDA) delayed new rules requiring ‘added sugars’ be included in nutrition labels until 2020, caving to food companies.
The Environmental Protection Agency (EPA) rolled back 76 Obama-era environmental protection rules. Vitally, the EPA reversed greenhouse gas and fuel economy rules, handing car companies a victory. To limit reproductive rights, the Department of Health and Human Services (HHS) rescinded Obama-era guidance that prevented states from de-funding health facilities offering family planning services, including abortions.
Congress tried unsuccessfully to repeal the Affordable Care Act (ACA) 70 times, but ‘Obamacare’ has still been badly damaged. Congress is set to repeal the requirement that health insurers offer “essential health benefits” including emergency, maternity/paediatric, mental health, drug-addiction, and preventive/wellness services.
Trump’s 2017 budget gave corporations a massive tax reduction and repealed the ACA’s individual mandate to buy health insurance. Trump now wants to rescind the employer mandate, which requires large organisations to offer health plans to employees.
Perhaps most cruelly, states can now opt-out of the ACA’s proposed expansion of Medicaid – the federal-state health program for low-income and disabled persons. The President has also given states permission to require Medicaid recipients work or lose their health cover.
Pre-emption is the ultimate deregulatory tool masquerading as legal doctrine. Pre-emption allows higher levels of government to block the actions of lower levels of government – its effect is to prevent cities (or even states) from protecting their residents’ health.
Federal pre-emption shields food companies from consumer protection lawsuits, while state-level legislation prohibits municipal taxes on sugary drinks. The ‘Protection of Lawful Commerce in Arms Act’ protects firearms companies and dealers from liability for crimes committed with their inherently dangerous weapons. By law, the Consumer Product Safety Commission cannot regulate two products: firearms and tobacco.
Earlier this year, the Trump Administration released its 2019 budget, which included savage cuts to the National Institute of Health, CDC, and foreign health assistance. Congress baulked at cutting funding for health research and foreign aid, but CDC expects to be hit hard and is already pulling expert staff from low-income countries in preparation.
Also facing huge cuts is the ACA’s Public Health Prevention Fund, which supports CDC and state health departments for vital health protection, and the Global Health Security Agenda, which funds emergency preparedness (think Ebola, Zika, Influenza).
What may be worse than all this “unhealthy” policy is Trump’s flouting of American values – of justice and equity, human rights, and rules-based international norms and institutions.
Last month, the US withdrew from the UN Human Rights Council and froze all funding for Palestinian refugees. The Trump administration threatened trade sanctions against Ecuador for sponsoring a World Health Assembly resolution promoting the health benefits of breast feeding – until, ironically, Russia stepped in. The President also reversed Obama’s immigration policy of letting ‘dreamers’ stay in America – people who arrived as infants and have no other home. He separated mothers from babies at the southern border.
The saddest part of Trump’s policies is that they hit the vulnerable hardest, perhaps further reducing life expectancy and imperilling America’s already fragile safety net. Every day, the President of the country that gave birth to human rights and multilateralism shows disdain for global norms and institutions. America was once “great”. To make America great again, its leaders need to demonstrate moral authority.
This article was authored by Professor Lawrence Gostin, director of the WHO Collaborating Center on National and Global Health Law, Linda and Timothy O'Neill Professor of Global Health Law at Georgetown University Law School, Faculty Director of the O’Neill Institute for National and Global Health Law and Visiting Professor at the University of Sydney Law School, and Professor Roger Magnusson, Professor of Health Law and Governance at Sydney Law School and Adjunct Professor of Law at Georgetown University.
Professor Gostin and Professor Magnusson were featured speakers at a free seminar 'Public Health Law and Health Leadership in the United States: What can Australia learn?' at the University of Sydney Law School on Thursday 19 July from 6pm, co-presented by the University of Sydney Law School and the United States Studies Centre.
Sydney Law School offers a Master of Health Law and Graduate Diploma in Health Law that includes units of study in medical law, public health law, mental health law and global health law and governance. It is open to both legally qualified candidates as well as those without a law degree.
Find out more about health law study and units on offer in 2018, including 'Law, Business and Healthy Lifestyles' delivered by Professor Magnussen and 'Global Health Law' delivered by Professor Gostin.
Top image: Demonstrators march through downtown Philadelphia in 2017 in protest against a proposed repeal of the Affordable Care Act. Image: MB298/Wikimedia Commons.