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The Trump Effect on Public Health

December 14/2016

On January 20, 2017, Donald Trump will take office as the 45th President of the United States. If he delivers on the alarming promises he made throughout his campaign, not only will the health of Americans be adversely affected by the so-called “Trump effect,” but so will the health of Canadians and populations worldwide.

A number of U of T scholars have shared their insights on the election and its impact on a wide range of issues, including Canada’s role, gender, race and the markets. I invite you to read more here, and I would now like to add my views from a public health perspective.

While there is no way to know for sure how reactionary the United States government will become under a Trump administration, every signal we have been seeing in the days following the election indicate that challenging times lie ahead, especially for us in public health. What we do know from his choice of cabinet members, such as a climate change denialist and oil industry ally to lead the Environmental Protection Agency, and a physician who has been leading efforts to repeal the Affordable Care Act to be secretary of health and human services, is that it would be wise to prepare or at least brace ourselves for change in these areas.

By nature, public health lies at the crossroads of many social, economic and political movements, and if Trump’s promises come to fruition, systems that directly or indirectly promote public health in the United States will be significantly emasculated. Further to this systemic impact, the shocking displays of discrimination and violence that have emanated from the Trump campaign signal an assault on values of human rights and dignity that are core to public health, with effects that appear to be trickling up to Canada.

Ironically, the U.S. election results have been attributed to a common thread: a deep-seated sense of disenfranchisement and of growing inequities, particularly among the white middle or working class. These disparities are likely to be worsened by policies the Trump administration seems likely to pursue.

For this and many other reasons, we cannot waiver on our attention to the School’s core values and principles of equity and social responsibility, as well as ethics and responsiveness. It is crucial that we as a Faculty come together, regardless of our political views, around our shared values. At times like this I am proud to work with fellow researchers and teachers who share these core principles, including promoting the inherent dignity and social justice of every human being, and engaging with our communities in a way that is respectful of diverse perspectives, values and cultural framings.

Like many members of our community, I have close ties with the U.S., including family, friends, colleagues and collaborators whom I will continue to support and help resist the politicization of public health and health systems, not only as it relates to research and training, but also how it impacts implementation and the many policies that affect population health. Given that universities are sanctuaries for diversity of opinions and the freedom to express those opinions, I also encourage all members of the U of T community to defend these principles today and in the times ahead.

It may not be all bad news. Our colleague, Stanley Zlotkin who is Chief of Sick Kids’ Centre for Global Child Health, reminds us of a reason to be optimistic in his December 1, 2016 message in which he explains the Obama administration’s efforts to eliminate hunger and malnutrition globally are unlikely to be undone.  The Republican Congress supported the Global Food Security Act, which builds resilience in farmers, helping them deal with sudden shocks like drought and food price spikes and targets nutrition interventions targeted at children.

Trump’s declaration that he intends to invest in infrastructure carries the promise of improving resources that are critical to public health, such as safer roads and better water quality. My hope is that the realities of Trump’s administration are more reflective of bipartisanship and that public health remains strong and continues to grow and thrive in the U.S. and globally.

During these times of social, economic, and political instability, I am inspired by Richard Horton’s recent commentary in The Lancet, The case against (and for) public health. He reminds us that historically, it was immense societal pressure that resulted in the public health revolution of the 19th century. The coming years will push us once more to innovate and advocate, and I think DLSPH is well-poised to do so.