Intended for healthcare professionals


Report highlights “devastating impacts” of Trump on every aspect of US health

BMJ 2021; 372 doi: (Published 12 February 2021) Cite this as: BMJ 2021;372:n439

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  1. Janice Hopkins Tanne
  1. New York, USA

US health status worsened dramatically under President Trump when compared with the other G7 countries, a major study from the Lancet Commission1 has concluded.

If the US had death rates equivalent to Canada, France, Germany, Italy, Japan, and the UK, some 461 000 fewer Americans would have died in 2018, and 40% of US deaths during 2020 from covid-19—around 188 000 people—would have been averted, the study estimated. As of 10 February, the US had 27.3 million cases of covid-19, with 471,00 deaths.2

The US had a poorly managed covid-19 pandemic, excess deaths from all causes, shortened life expectancy, high maternal mortality, and disparities in many measures of health, the study found.

US life expectancy was similar to other G7 countries in 1980, but by 2018 was 3.4 years shorter.

“Americans’ health was deteriorating even as our economy was booming,” said Steffie Woolhandler, who co-chaired the commission with David Himmelstein. Both are affiliated with the City University of New York and Harvard.

David Blumenthal, a co-author of comments on the report, told The BMJ he was not surprised by the US figures. The Commonwealth Fund, which he heads, compares the US and 10 other wealthy countries every three years and has reported similar results. The US’s results are related to underlying social and political causes, said Blumenthal, who was not involved in the Lancet Commission report.3

Richard Horton, the Lancet’s editor in chief, said, “The pandemic has shown how woefully inadequate the country’s healthcare and public health system has been in protecting the nation’s health. The covid-19 pandemic has exploited existing health and social inequalities and nowhere is this more apparent than in the US.”

The US’s health problems go back at least 40 years but they worsened during Trump’s tenure, the report said. Trump’s trillion dollar tax cut benefited wealthy people and corporations, but “opened a budget hole that served as justification for cuts to food and housing subsidies that prevent malnutrition and homelessness for millions.” Some 2.3 million people lost health insurance, which is often tied to their jobs, even before the pandemic. Since then millions more have lost jobs and insurance.

“The social divides of racism and xenophobia affect health directly and indirectly. Trump’s adoption of white supremacy incites low income white people to blame their plight on low income people of colour and is singularly harmful and tragic. He gained his largest electoral margins in 2016 in counties with the worst economic and mortality trends and proceeded as president to dismantle social and environmental protections that would benefit those communities,” the report said.

The report proposes major restructuring of US society and healthcare to solve these problems.

The report said that Trump:

  • · Politicised and repudiated science, leaving the US unprepared for the covid-19 pandemic

  • · Eviscerated environmental regulation, hastening global warming

  • · Incited racial, nativist, and religious hatred, provoking religious and police violence

  • · Denied refuge to immigrants fleeing violence and oppression

  • · Undermined health insurance coverage

  • · Weakened food assistance programmes

  • · Curtailed reproductive rights

  • · Undermined global health cooperation and started trade wars

  • · Shifted resources from social programmes to military spending and tax benefits for corporations and the wealthy

  • · Subverted democracy both nationally and internationally

Even before Trump, damaging policies posed a threat to health in the US, the report said.

Progress on racial equity in education, housing, income, and policing halted or was reversed during Trump’s time. Deaths from substance abuse increased. Although the 2010 Affordable Care Act increased the number covered by health insurance, market based changes commercialised healthcare and increased costs so that even many insured people could not afford care. About 30 million Americans remain uninsured.

Cuts to funding led to the loss of about 50 000 public health jobs before the pandemic.

The report calls on the Biden administration to cancel Trump’s actions and to tackle the problems that existed before Trump’s presidency by:

  • · Raising taxes on high earners and using the money to improve social, educational, and health programmes and tackle environmental problems

  • · Move against structural racism and police violence

  • · Replace means tested health programmes with national health insurance

  • · Restore the federal government’s role in delivering health and social services rather than channelling funds through private firms

  • · Redirect public investments to domestic and global fairness and environmental protection

  • · Reform US campaign financing and reinforce voting, immigration, and labour rights.

But Blumenthal and Margaret Hamburg, the former Food and Drug Administration commissioner, now with the Nuclear Threat Initiative, said these goals face powerful obstacles and US voters’ resistance to change.

“Health professionals might be more effective in promoting healthcare improvement in the US by participating in voter registration and mobilisation in the southern states than by any amount of reframing or coalition building,” they wrote. “Healthcare reform in the US requires political activism of the most basic kind, something that is far beyond the comfort zone of many health professionals.”