Student Blog: President Donald Trump’s implications for public health

January 20/2017

DLSPH Student Blog

michelle amri

By: Michelle Amri, MPA, PhD student

Today, Donald Trump will become President of the United States of America.

Throughout the presidential election process, Trump became infamous for his voluble election promises. While he did not make many commitments directly referencing public health, many of his pronouncements can provide insight as to what his presidency will mean for public health.

Opportunities

Trump has noted that he will preserve Medicare, Medicaid, and Social Security and veto any proposed cuts to these programs. If kept, this promise will ensure that basic social safety nets are protected, which we know are crucial for public health, given that income is a major social determinant of health.

Trump has also indicated he would like to improve mental health and addictions services, both for the general population and for veterans. Specifically, he mentioned increased funding for drug treatment, especially for those battling heroin and other opioid addictions. For veterans, he has promised to invest more heavily in programs that facilitate their transition back to civilian life, including job training and placement services. He has said that he would increase funding for the treatment of post-traumatic stress disorder, traumatic brain injuries, and mental health issues. These are all long overdue actions that further the area of mental health, which was been underfunded for many years.

Potential Pitfalls

There are some decisions and statements made by Trump that are alarming for public health and in fact, may set the field back a number of years.

One of the major election promises Trump made that directly impacts the health of the public is to repeal the Affordable Care Act (colloquially known as Obamacare), and implement a new plan that would feature, among other things, coverage for pre-existing conditions, and nationwide private health unencumbered by state borders.

It remains to be seen what this will mean for health, as the alternative health care plan from Trump would likely lead to more affordable healthcare, with lower premiums. Several experts have noted that it could also be a danger, as individuals with a low socio-economic status would lose coverage as Obamacare pools expenses and subsidizes plans for those of lower socio-economic status. This can have major implications for health equity.

While Canada ensures the nationwide coverage of “medically necessary services” through the principles outlined in the Canada Health Act, the discourse in the U.S. may ignite further discussions in Canada and perhaps Canadians will vow to never accept the privatization of health services.

Last week, news reports indicated that Trump had asked Robert F. Kennedy Jr. to chair a commission on vaccine safety. Kennedy Jr. is a long-time vaccine skeptic who advocates for parents to not vaccinate their children and has pushed discredited theories regarding the linkages between autism and vaccination. Given Trump’s prior statements that vaccines cause autism and the selection of a vaccine skeptic to chair this commission, this does not portend well for evidence-based decision making. Experts believe that this may lead to a major overhaul on the administration and public policy of vaccinations. Any deviation from the mainstream can have dire effects for public health, as many common and easily preventable diseases may increase in prevalence, such as MMRV (Measles, Mumps, Rubella, Varicella).

Trump has also made it clear he would like to reduce the $18 trillion national debt by “vigorously eliminating waste, fraud, and abuse in the federal government, and ending redundant government programs.” While this seems like a logical goal that most people can support, I have concerns about how this may be executed. Many government programs are difficult to evaluate using a strict cost-benefit analysis. This is particularly true for programs that improve health and well-being over a long-term. These types of programs are designed first and foremost to improve health outcomes, as opposed to reducing health expenditures. A singular focus on reducing costs may have impacts on health programming, such as smoking cessation and/or nutrition programs.

In addition, some government departments are also focused on improving innovation in health by piloting public health programming, for example, through developing public policies, such as nutrition labelling at fast food franchises, or in combination with the social policy sphere (the basic income pilot in Ontario, for example). These programs are pilots and may be unsuccessful. Consequently, they may come across as a waste in tax-payer dollars. This is unfortunate, as the potential benefit to citizens — through improved health and well-being outcomes, the testing of novel ideas that may yield benefits in the future, and an increase in the collection of data — may not occur.

Other areas that are concerning are both the fields of women’s health and international development. Trump has expressed strong opposition to abortion and other female health choices. Trump’s questioning of the United Nation’s value signals that funding may be cut for international development efforts. The U.S contributes 22 per cent of the United Nation’s regular budget. Trump has also threatened to cancel Pepfar, which has been called the best government program and is one of the greatest AIDS relief programs of all time. Any cuts will inevitably have major impacts on the health of the world’s citizens, particularly those in the global south.

Final Thoughts

Trump’s election features opportunities and potential pitfalls for public health. It is expected that the promise to maintain social safety nets, increased investments in addictions treatment and veterans’ health, among others, will be positive public health outcomes from his presidency.

The U.S. president has symbolic powers and inevitably, influences public discourse on healthy lifestyles and behaviours. Trump has eschewed exercise and notes that he exercises by golfing and public speaking. He has previously criticized the Secretary of State John F. Kerry for cycling despite being 73, and Trump is known to subsist on a diet of fast food and soda.

While Trump has discussed some positive opportunities for public health, both his personal actions and his lack of advocacy for evidence-based policy on issues like vaccines and women’s health, set a disappointing tone for public health, which unfortunately, is needed now more than ever.

Banner photo by Gage Skidmore via Flickr.