New Report Details the Damage to Americans' Health Caused by Trump Administration's Policies

By Linda Carroll

February 16, 2021

NEW YORK (Reuters Health) - A new study explores the impact of the Trump administration's policies on public health and potential ways to counteract the damage.

The report by The Lancet Commission on Public Policy and Health in the Trump Era estimates that 461,000 fewer Americans would have died in 2018 and 40% of U.S. deaths from COVID-19 during 2020 would have been averted if the U.S. death rates had been in line with those of the other G7 nations--Canada, France, Germany, Italy, Japan and the United Kingdom.

The Commission's analysis also estimates the impact of the administration's rollbacks of environmental protections at 22,000 deaths in 2019 alone.

"The main message from this report is that Trump committed crimes against health in America," said commission co-chair David Himmelstein, a distinguished professor of public health at Hunter College of the City University of New York, a lecturer at the Harvard Medical School and a primary care doctor. "But those aren't the only problems with health in America. There have been failures of policy over the last 40 years that undermined health and paved the way for Trump."

The commission traces the beginning of the trend back to about 1980 when U.S. life expectancy began trailing that of other high-income countries. This was when President Ronald Reagan initiated anti-government, wealth-concentrating policies that reversed many of the advances of the New Deal and the Civil Rights eras.

Many of the Trump administration's policies--including tax cuts and deregulation that benefit the wealthy and corporations, austerity when it comes to the poor, and privatization of Medicare--follow in the footsteps of the Reagan administration, the commission concluded.

Moreover, cuts in funding for public health agencies between 2008 and 2016--which led to the loss of 500,000 front line workers vital to fighting pandemics--along with the increasingly fragmented and profit-oriented health care system left America especially vulnerable to the SARS-CoV-2 pandemic, according to the report.

Minorities and the poor may have felt the impact of the Trump administration policies most acutely. When Trump took office there were 28 million U.S. residents who were uninsured. While he was president, another 2.3 million were added to that, with coverage losses concentrated in minority communities and among children (726,000 children became uninsured during his term in office).

The longest lasting effects may come from Trump's acceleration of global warming through his encouragement of the use of fossil fuels and his withdrawal from the Paris Climate Agreement, the commission notes.

"Prior to Trump, environmental and occupational health protections had been pretty steadily improving, Himmelstein said. "He tried to roll back 104 separate environmental policies and succeeded in more than 80. The number of deaths due to environmental and occupational causes rose because of that, reversing years of steady progress."

The commission argues that widespread reform is needed to put American health back on track. Biden has been heading in the right direction, Himmelstein said.

"He's already done something to make it better," he added. "He's taken action on some of the worst anti-immigrant Trump policies, reversed several environmental policies, rejoined the World Health Organization and has put together a competent COVID-19 response. It's a substantial upgrade. We've stopped digging the hole and now we have to start filling it in."

Himmelstein recommends some steps for the government to take: affordable healthcare for all, comprehensive immigration reform, the Green New Deal. "Those would be initial good steps," he said. "But we need much more."

The "sweeping" new report spotlights the many ways Trump administration policies harmed Americans' health, said Dr. Albert Wu, an internist and a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

"Trump policies caused budget cuts to vital public health functions, increased numbers of people without health insurance, and weakened the social safety net," Dr. Wu said in an email. "Trump's policies were particularly harmful to people of color, and disparities in health have increased over the past four years. Ironically, they also impacted the health of low and middle income whites that included his supporters."

"They say if you don't have your health you don't have anything - the US has been left with significantly less than it had four ago," Dr. Wu said. "We need to take urgent action if we are to succeed individually and as a nation in the coming years. A return to science-based policy and universal health coverage would be a good place to start."

SOURCE: The Lancet, online February 10, 2021.