The Lancet Commission on Public Policy and Health in the Trump Era has just come out with an assessment of Donald Trump’s impact on the health of Americans while he was U.S. President. And, spoiler alert, it wasn’t positive.
That’s assuming that you find many more deaths to be a negative health impact. According to the report, Trump’s policies or lack thereof contributed to the deaths of around 461,000 Americans in 2018 alone. And the next year, 2019, about 22,000 deaths resulted from Trump’s dismantling of environmental protection measures, based on the Commission’s analyses. Then there was 2020, when 40% of Covid-19-related deaths in the U.S. could have been prevented had the U.S. only had the same Covid-19 death rates as those of other Group of Seven (G7) nations, namely Canada, France, Germany, Italy, Japan, and the United Kingdom.
Of course, these numbers are not exact. It’s not as if the Commission members used a time machine made out of a DeLorean or the quantum realm to jump back in time, installed something else in Trump’s place as U.S. President such as a cinder block, and then observed what happened in an alternate reality. Time travel is not a thing yet. Plus, it would have been difficult to fit all 33 members of the Commission into a DeLorean. Moreover, The Lancet probably didn’t have those suits that the Avengers wore for each of the clinical medicine, public health, epidemiology, health policy, community medicine, economics, nutrition, law, and political experts from the U.S., U.K., and Canada who comprised the Commission.
Instead, the Commission, which was formed in April 2017, determined how many fewer deaths the U.S. would have had if the U.S. had had death rates comparable to those of other G7 countries. This graphic from The Lancet illustrates the growing gap between the U.S. and the rest of the G7 over the past four decades:
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Yes, you heard that correctly: over the past four decades. Now Trump was U.S. President for only four years, which is about 146 Scaramuccis, although it may have felt longer. So you may be wondering whether this story is not just about Trump. But more on that later.
The Commission also catalogued the Trump Administration’s many actions that could have affected human health, ranging from a trillion-dollar tax cut for corporations and high-income individuals followed by cuts in food subsidy and health care programs to repealing environmental regulations to actions that left 2.3 million fewer people in the U.S. insured. Here’s a graphic from The Lancet that depicts how the percentage of uninsured Americans has changed over the past four decades and before:
There’s that “four decades” mention again. Again, could this story possibly be about more than Trump? As they say in cliffhangers and bagpipe playing, stay tuned.
Trump certainly did plenty to affect health during his term in office. For example, his Administration repeatedly subverted and weakened many science and health initiatives, including the federal governments pandemic preparedness capabilities before ding-ding-ding the Covid-19 coronavirus pandemic. Oh, and then there was that whole putting kids in cages thing.
The Commission identified how different changes under Trump may have led to more deaths. Some associations are easier to demonstrate. Others such as Trump’s stoking racism, xenophobia are more complex. Remember how Trump kept referring to the Covid-19 coronavirus as the “kung-flu” and the “China virus?” Well, as I have described previously for Forbes and the Milken Institute, 2020 saw a jump in hate incidents against Asian Americans. Who knows what that will subsequently lead to over time? And what will be the full impact of Trump referring to African countries as bleep-hole countries where bleep is a word that rhymes with hypocrite? Or what about his tweeting that Representatives Alexandria Ocasio-Cortez (D-NY), Ayanna Pressley (D-MA), Ilhan Omar (D-MN), and Rashida Tlaib (D-MI) should “go back” to their countries even though they are Americans? Well, stand back and stand by, because portraying persons of color as bleep hole or not Americans can just make the racism in the U.S. even worse.
Speaking of bleep-hole, the following figure from The Lancet presents some statistics about the bleep-hole situation near the end of the Trump administration:
However, before you blame everything on Trump and say now that he’s gone you can party like it’s 1999, the Commission also offered an important warning. It wasn’t as if 1999 or any year after the 1980’s was so great for the U.S. The Lancet Commission’s analyses deemed Trump more a product of what has been a four-decade downward spiral than the cause of a more recent downturn. To say that Trump caused all of the ills of the past four years may be giving Trump too much credit. After all, this was the guy who called Thailand “Thigh-land”, wondered about injecting disinfectants to treat Covid-19, said “nobody knew that healthcare could be so complicated,” and called a hurricane “one of the wettest we’ve ever seen, from the standpoint of water.”
Back in 1989, Billy Joel first told us, “We Didn’t Start the Fire.” Similarly, Trump didn’t really seem to start too much himself. Rather, the Commission’s report stated that “many Trump policies, including tax cuts and deregulation that benefit the wealthy and corporations, austerity for the poor, and privatization of Medicare, emulate” those of Ronald Reagan’s while he was U.S. President in the 1980’s. Trump’s policies may have been about as innovative as used underwear.
The report described how Reagan’s policies “reversed New Deal and civil rights-era advances in economic and racial equality. Subsequently, inequality widened, with many people in the USA being denied the benefits of economic growth.” Reagan’s policies were “anti-government” and “wealth-concentrating,” in the report’s words.
“Our country experienced very steady improvements in the U.S. with the New Deal and then Civil Rights,” explained Steffie Woolhandler, MD, who co-chaired the Commission and is a Distinguished Professor at the City University of New York (CUNY) at Hunter College. “But in the 1980’s, policies took a turn. Inequality started growing. Back then, health care costs were in the middle of the G7 pack but they since have been soaring. Unlike other higher income countries, we never got close to the Universal coverage, which is a disgrace.”
Woolhandler pointed out that such trends have had their dire effects. For example, U.S. life expectancy was pretty similar to other high-income nations back in 1980 but by 2018 trailed the G7 average by 3·4 years. She called this an “embarrassing statistic. It isn’t just one disease like diabetes or the opioid epidemic. It’s all of the above. So much of this is linked to lack of life opportunities.”
The Covid-19 pandemic only exploited and exposed these concerning trends. The report indicated that “cuts in funding for public health agencies led to the loss of 50,000 front line staff vital to fighting epidemics between 2008 and 2016. The fragmented and profit-oriented health-care system was ill-prepared to prioritize and coordinate pandemic response.” A lot of other existing problems reared their ugly heads such as food insecurity, lack of access to healthcare, and worse conditions for communities of color. Meanwhile, in the words of the Report, Trump “augmented the flow of public funds through private insurers, who now derive most of their revenues from government programs, raise Medicare’s costs by an estimated $24 billion annually, and have garnered record profits during the Covid-19 pandemic.” So if you have been lying in bed at night awake and worrying about the health of insurance companies during the pandemic, don’t.
Trump also seemed to exploit these trends to rise to Presidency, according to Kevin Grumbach, MD, another member of the Commission and the Hellman Endowed Professor of Family and Community Medicine at the University of California, San Francisco. He pointed out the “widening inequalities and collapsing economic opportunities and the link between worsening economic status and worsening health status. These led to anger and the resulting anti-democratic situations.” As the following graphic from The Lancet shows, Trump gained electoral votes in counties where life expectancy trends have been worse since the 1980’s:
And what was the reward for going for Trump in the 2016 election? Well, “life expectancy in the pro-Trump counties was 2 years shorter than in counties where he was defeated.” Isn’t that like paying for massage and getting a punch in the face instead?
How did Trump garner such support? As the Report described, “The Commission concludes that Trump exploited low- and middle-income white people’s anger over their deteriorating life prospects to mobilize racial animus and xenophobia; he then enlisted their support for policies that benefit wealthy individuals and corporations and threaten the health of most Americans, including Trump’s supporters.” Yep, when all else fails, blame things on minorities and immigrants, the very groups that don’t seem to have much resources or power as whole. That can be a bit like blaming your cat whenever something falls apart in your house.
All of this suggests that MAGGOT (Make America Go Get Over Trump) alone won’t be the cure to America’s ills. “Reverse everything that Trump did is not going to be enough,” said Grunbach. “We have to deal with what already was the situation in the U.S., such as income and racial inequality.” He added, “as long as we have deep rooted racism, we will keep getting into the cycle of racism being used to get lower income white people to support politicians who end up cutting the programs that they actually need.” This ironic paradox is what Grunbach called the “Tragedy of the Trump era. Low income people who could benefit from tackling inequality ended up voting for Trump and supporting a tax cut for the wealthy.” The report mentioned that the states that Trump had taken during the 2016 and 2020 election actually had the worst jumps in pollution and deaths from environmental and occupational causes.
This suggests that the “prosperity” that the U.S. seemed to enjoy since the 1980’s has been a bit like an attorney using a cat filter on Zoom, not what it seems:
Measures like how the stock market is doing or how many different ways you can take selfies are not really good measures of the economy. That can be akin to using Instagram posts to measure someone’s state of health. “People may worry about their 401K’s growing,” said Woolhandler. “But are they living long long enough to enjoy this.” Both she and Grunbach indicated that simply returning to pre-Trump times would not be enough.
“The U.S. approach to health has been bad for health and bad for democracy,” said Grunbach. “This has been sowing opportunities for divisiveness. We have to fix our structural problems and confront our 400 year history of racism. Otherwise, it will come back to bite us.”
Consider 2020 and Trump to be a wake up call. The U.S. is sick in many ways, very sick. And it may take doctors to steer the country in the right direction. “The health of the population is our lane,” Woolhandler emphasized. “If people don’t have enough food to eat or have enough resources, they come to us for help. However, there is only so much we can do if policy makers don’t create the conditions for a healthy population.” In the end, you can’t advance as a society when the population is not well because health ultimately trumps everything.