‘This Is Not New’
Less than 18 months into the Trump administration, public health advocates say that the administration’s policies have already had a dire impact on the nation’s health. During that period, there have been cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP), threats regarding funding for Planned Parenthood, rollbacks of numerous environmental regulations, and repeated efforts to repeal the Obama administration’s Affordable Care Act.
But when Mary Travis Bassett, commissioner of the New York City Department of Health and Mental Hygiene, addressed an audience of students, academics, and activists about the health effects of the Trump era thus far at the Dean’s Symposium, “The Trump Administration and the Health of the Public,” she had a simple message: None of this is new.
“The long, bloodstained legacy of white supremacy in this country … did not start with the current president, but reaches back beyond our founding as a nation,” Bassett said.
She was the keynote speaker at the daylong symposium, which brought together public health scholars, journalists, thought leaders, and other public health professionals to dissect the health effects of Trump-era policies. The nonpartisan event was cosponsored by The Lancet Commission on Public Policy and Health in the Trump Era.
White supremacy, Bassett explained, is “a built-in logic, an entitlement that undergirds all of our social and economic systems.” But she argued that white supremacy in the Trump administration goes beyond explicit racism, lurking in implicit biases.
As an example, she pointed to Trump’s approach to the opioid epidemic. “Trump, while talking in coded language about the burden of opioids on the white population, has been vilifying the sources of drugs,” she told the audience. “He said that 90 percent of heroin in America comes from south of the border. He had ICE agents come on the stage with him while he talked about the idea that there should be a death penalty for drug dealers—who are all coded Latino.”
Other speakers also dissected the implicit racism behind the president’s policies. The revival of the War on Drugs signals a return to the policies that have overcrowded the nation’s prisons while disproportionately targeting communities of color, said Lello Tesema, director of population health at Los Angeles County Correctional Health Services. “The best way to avoid the harms of jails is to keep people out of them in the first place,” she said. Instead, she noted, the Trump administration has already rolled back Obama-era guidelines to close all private prisons, a profit-generating move Tesema tied to mass incarceration’s “legacy of slavery and the subsequent commodification of black bodies in the Jim Crow era.”
Joia Mukherjee, associate professor of medicine at Harvard Medical School and chief medical officer of the non-profit Partners In Health, argued that Trump’s reference to “shithole countries” was not a shocking aberration but part of the neoliberal tradition of extracting massive amounts of resources from countries and then grumbling about them being “failed” and “dependent” on aid. “This is not new,” she said, “but in the light of increased racism and increased privatization, this is becoming even more problematic.”
The post-Hurricane Maria situation in Puerto Rico is a result of that same neoliberal exploitation, said Olveen Carrasquillo, professor of medicine and public health sciences at the University of Miami Miller School of Medicine. Decades of American infrastructure monopolies, capped Medicaid block grants, and predatory lending had devastated the island long before the hurricane landed, Carrasquillo said, and the “disaster capitalism” of the Trump administration’s effort to rebuild will continue the “downward spiral” of the territory.
It is unclear whether the Trump administration is trying to repeat history or is ignorant of it, said Michael E. Bird, national consultant on Native American/Alaska Native Communities for the AARP. Going forward with the Dakota Access Pipeline along Standing Rock Sioux land, and recent federal efforts to dictate how tribes should run their healthcare systems, are examples of the administration “undermining tribal sovereignty,” Bird said, a backslide in the relationship between the United States government and the tribes.
A central question among speakers and panelists was how better to convey the harms of the Trump administration’s policies to the public at large, especially in the current “fake news” climate. “Data needs to be supplemented with stories,” said Altaf Saadi, an immigration researcher and National Clinical Scholars fellow at the University of California, Los Angeles. As an example, she cited the case of Rosa Maria, a 10-year-old girl with cerebral palsy who was detained by border patrol when her parents brought her to the hospital: “It was because of national media that she was ultimately freed.”
But Zinzi Bailey, assistant scientist at the Jay Weiss Institute for Health Equity in the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, cautioned that individual stories do not always work. “In police shootings of unarmed black men, there’s always a narrative that comes out around each of these individuals” to suggest they were not innocent, she said. She argued instead for the use of history to contextualize current health threats—for example, putting racial health disparities into the context of centuries of oppression.
Despite the dire concerns expressed about the immediate and long-term impacts of Trump’s policies, some speakers highlighted areas of hope, including the new era of progressivism demonstrated by the Black Lives Matter and the March for Our Lives movements. The worst outcome, many participants agreed, would be for the public health community to grow discouraged or recalcitrant in the face of so many threats.
“We have a duty to play a role in the changes our country needs,” said David Himmelstein, distinguished professor at the School of Urban Public Health at Hunter College. And he reminded the audience that the country’s political winds are always shifting.
“Pendulums swing both ways,” he said.