‘There’s No Way Through This but Forward’.
‘There’s No Way Through This but Forward’
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No matter your political leanings, policy preferences, or preferred candidates, the presidential re-election of Donald Trump presents serious challenges for the health of the public on a local, national, and global scale. Trump’s Cabinet nominations thus far have provided a clear window into the direction his administration hopes to take on a number of health issues. Below, members of the SPH community share what a second Trump administration means to them personally and to the public health issues that matters most to them—and how we can remain optimistic and embrace opportunities to make progress towards a safer and healthier world.
A second Trump presidency could very well be the end of public health as we know it.
Trump has expressed support for legislative efforts to repeal the Affordable Care Act (ACA), even with only “concepts of a plan” for how he might replace it. Because he is likely to inherit a GOP-controlled Senate (albeit one without a filibuster-proof supermajority) and (perhaps) a Republican majority in the House of Representatives, Trump is in position to take action on long-held Republican priorities; such as eliminating the federal government’s ability to negotiate prescription drug prices under the Inflation Reduction Act (IRA).
Trump may also take action to fundamentally reshape the federal health bureaucracy. For example, Trump suggested entrusting (and has now nominated) science skeptics like Robert F. Kennedy Jr.—to make key decisions about who will staff the Department of Health and Human Services, in exchange for his political support on the campaign trail. The authors of Project 2025—made up of Trump campaign and administration alumni (and who may once again find themselves in positions of power in the Executive Branch)—have also proposed converting previously non-partisan scientific posts into political appointments. Who receives funding for scientific research, and whether some forms of science are prohibited in government scientific agencies, could all be influenced by the actions and preferences of political appointees.
Cruelest of all, Trump can take executive action to roll back protections for some of the most marginalized groups in American society. That includes gender-affirming care for transgender people, the enforcement of once-dormant federal statutes (like the Comstock Act) that could limit the availability of contraceptive care, appointing justices to federal courts who seek to roll back reproductive health services (as he did often in his first term), and may even consider signing a federal abortion ban into law.
A Trump presidency, for me, removes the “public” from “public health.” I think it’s entirely possible that, for some of us, day-to-day life doesn’t feel much different. But if the second Trump administration follows through on its campaign promises, it will split the public into several groups: a privileged few who will enjoy access to high quality health care, vs. many others—including some of the most marginalized members of society—will struggle to get the care they need.
This is a truly dark time for public health in America. But, there’s no way through this but forward.
I draw optimism from the possibility that those of us here at BUSPH will do the hard work to fight for a truly public public health; to change the way people think with our research; teach others about the value of a truly public health; and do what we can to fight for science in every aspect of our personal, professional, and political lives.
There has been something almost otherworldly about living in Massachusetts during this election. I live about an hour north of Boston, and we are experiencing wildfires throughout our area. As the news unrolled over the course of Tuesday night and into Wednesday, and even further along in the week with the news of a complete Trump sweep of the swing states, Trump winning the popular vote, the continued Republican control of the Senate, and new control of the House, I was smelling smoke: when I woke up, when I went to bed, inside my house, outside my house. This constant dread and anxiety coursed through me: the world is on fire, and it’s coming closer and closer.
Public health, and perhaps particularly academic public health, is going to face vigorous assault in the coming years. We are going to need all our collective wisdom and our collective energy to resist anti-science attacks on our work. We’ve been here before: public health has faced apathy and disregard for human life many times before. Sometimes we’ve been complicit. We were here for the “crack epidemic” of the 1980s, the zealous mass incarceration of African Americans, the condemnation of Black mothers. We’ve witnessed and (sometimes) fought back against apathy towards those dying from HIV, we’ve worked within and outside the systems as Clinton and his appointees disregarded human rights and autonomy for poor women and families. What we do next is up to us. I think looking back and learning from history—all of it—the triumphs, the mediocre, and the shameful chapters, will help us forge a new path.
As advocates for public health, you and I must remain vigilant and proactive. We must engage in grassroots efforts, support local initiatives, and hold leaders accountable to push for a more equitable healthcare system.
I’m worried. Under a Trump administration, we may see policies that prioritize deregulation. President Trump could limit the powers of regulatory agencies such as the Environmental Protection Agency (EPA), the Food and Drug Administration (FDA), and the Occupational Safety and Health Administration (OSHA) to enforce existing laws. Already, there is talk about dismantling the Centers for Disease Control & Prevention. What’s more, I am afraid that legitimate, science-based decision making will be pushed to the side. For instance, the discussion about eliminating fluoride is frightening, and may be only just the start. Each action could undermine efforts to protect vulnerable populations and expand healthcare access.
What do I want from the new administration? Of course, my list includes addressing health disparities, ensuring equitable health access, and renewed focus on climate change. But, more simply, I want the new administration to be honest and tell the truth, fight for justice, and lead with compassion.
As advocates for public health, you and I must remain vigilant and proactive. We must engage in grassroots efforts, support local initiatives, and hold leaders accountable to push for a more equitable healthcare system. The election results are disheartening, but our commitment to these values should remain strong. These values will fuel our advocacy for a healthier nation for everyone.
The Presidential election results matter for public health matters at every level of government. Though he cannot change laws by himself, the President has power to direct policy, and he also has influence over leadership at the federal and state levels.
Looking at the bigger picture, under the next Trump administration we can expect shifts in regulation of healthcare, health insurance coverage, and access to all kinds of care, whether addressing reproductive health care, the practice of medicine across the nation, or public health more broadly. Such change is likely to occur through several different legal paths. These will include the President’s policy preferences, which are expressed through executive orders and appointments of cabinet-level and other presidential appointees that lead policy through federal agencies. Changes in policy and personnel will have ripple effects, such as revoking regulations and reversing ongoing litigation positions. In addition, the President can suggest policies to Congress that may become law, though Congress has not been especially productive in recent years (with the exception of relief bills during COVID). If the Senate maintains current filibuster rules, then the Republican majorities still need Democrats to agree to major laws or nothing except budget reconciliation bills (which address taxing and spending only) will get through Congress.
Because all of these paths to legal and policy change are both likely and important for public health, I am paying close attention to the names floated for leadership in the Department of Health and Human Services and its sub-agencies (the Centers for Medicare and Medicaid Services, CDC, FDA, NIH, and the others that are sometimes called “line agencies.”). The current HHS Secretary nominee, RFK Jr., has many ideas that are far outside the public health, medical, and scientific mainstream. His misinformation and disinformation become more potent with the bully pulpit the Secretary has. On the other hand, the Secretary cannot single handedly dismantle FDA or other agencies’ sub-departments, though he does lead policy within HHS. It is important to keep in mind that the Secretary of HHS is a political appointee whose job is often perceived to be more politics than policy work.
Yet, the Secretary of HHS has power over the agency that is responsible for health insurance and health care access of more than 40 percent of the US population. And it is predictable that actions the first Trump administration initiated, like work requirements in Medicaid, will swiftly recur. For another example, an HHS Secretary who wants to end health insurance market protections under the Affordable Care Act could do so by reducing spending on advertising for open enrollment on the exchanges (which occurred from 2017-2020), and would predictably reduce health insurance coverage and therefore access to preventive and other kinds of medical care—such a move would reduce access to basic, effective public health measures like contraception, even though the GOP proclaimed support for contraception in its 2024 Platform. The HHS Secretary also could revoke the Biden administration’s letter to hospitals explaining that the Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals to provide medical emergency care that includes abortions even in states that criminalized abortions (which would possibly end the Idaho v. U.S. case over EMTALA). Likewise, a new FDA Commissioner could revisit protocols for mifepristone use, which could limit access to medication abortion (that accounts for more than 60 percent of abortions nationwide post-Dobbs). The Secretary of HHS might also seek to revisit the ACA’s health care civil rights rule, Section 1557, which prevents discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, gender identity, and sex characteristics), in covered health programs or activities. The first Trump administration asserted Section 1557 only protected women from sex-based discrimination, but the Biden administration issued rules earlier this year that extend 1557 protections to LGBTQ+ populations as well as preventing discrimination based on pregnancy or abortion. We can expect these regulations, or their enforcement, to change as well.
The reality of disability rights is that they will impact everyone at some point in their life—to age is to become disabled.
I cannot help but fear for the state of disability rights after these election results. Many Americans point to Trump’s mocking of disabled journalist Serg Kovaleski on the campaign trail as an indication of his character, but his administration’s hostility towards disabled people runs much deeper. In 2017, a Republican-controlled Congress passed several attempts to repeal and replace the Affordable Care Act (ACA). Infighting among Republicans ultimately ended this attempt, but much of the fighting centered around how many wanted a complete repeal. With Trump’s advisors telling Axios that the former president took too long to get things moving in his first term, there will no doubt be swift and catastrophic damage to our healthcare system, with the disabled community bearing the brunt of the burden.
The ACA is a landmark piece of legislation that not only lowered insurance costs for millions of Americans—it also allowed many Americans to actually qualify for insurance. Prior to the ACA, insurance companies could deny people coverage due to preexisting conditions- anything from diabetes to a previous cancer diagnosis could make someone ineligible. If a complete repeal of the ACA is on the horizon, it would have disastrous consequences—according to Avalere, over a hundred million Americans, or a third of this country’s population, could be at risk of losing their health insurance. According to a Congressional Budget Office report, social security expenditures would decrease by billions, but only due to earlier mortality across the US. While initial ACA repeal and replace attempts were widely unpopular with the American public (per Vox News, approval rates polled under 20 percent), the Senate Republicans only failed to pass one repeal attempt by one vote (that vote was Senator John McCain). With ACA subsidies set to expire in 2025, it is highly likely that we will begin to see the destruction of the already weak foundations of our healthcare system. I fear for the outward malice towards not just disabled Americans, but the average American person, that will be on display with this incoming administration.
The reality of disability rights is that they will impact everyone at some point in their life—to age is to become disabled. And for many disabled people, strong communities are what allow us to thrive- in the wake of this election, I’ve seen many nondisabled people come to similar conclusions for themselves. While the pressure from the top will be immense, the things that impact us the most in our day to day lives will center around local politics. For everyone who is feeling rage, anger, and sadness after this election, I am with you. But we cannot allow those feelings to make us apathetic towards the world around us. It is only with each other that we will survive the storm to come.
The well-being of immigrant families in the US is an area of major concern in a second Trump Administration; more than one in four children in the US has at least one immigrant parent.
A high-profile and very real cause for alarm includes his plans to conduct mass deportation. Aside from the huge amount of resources an action like that would require, draining funds from other needed programs, the human and health impact would be enormous. Additionally, threats to end Temporary Protected Status and humanitarian parole for groups such as Haitians and Venezuelans—who are here legally and unable to return to their countries due to unrest and safety issues—means that these and other groups would be pushed ‘out of status’ and thus become vulnerable to deportation. We already know what happens after these kinds of raids and deportations. It is not just the people who are deported who are affected, but also those in their communities who are left with residual stress and uncertainty, and children separated from parents. Prior actions like this have resulted in spikes in preterm births in areas where raids have happened, as well as major psychological and material harm to children.
Less visible than an immigration raid is the weaponization of the social environment and the bureaucratic state undertaken in the last Trump administration and is likely to happen again this time. The increase in hostility toward immigrants—dehumanizing language and false stories such as those circulated during this year’s campaign—lead to an atmosphere of fear, including among those who would not be at risk of deportation (e.g. naturalized citizens).
Plans have already been put forth to rescind eligibility for public supports for mixed status families, where one or more household members are US citizens and others are immigrants, whether documented or undocumented. There has also been discussion of (re)expanding the definition of public charge, a designation that blocks immigrants from adjusting their status to become legal permanent residents (and therefore get on the path to citizenship) if they receive help from particular public resources. Other potential changes include unraveling Deferred Action for Child Arrivals (DACA)—many of whom are now adults with their own young families—in part by the dry but dangerous process of eliminating staff time needed to review and process renewals.
The combination of an atmosphere of fear and these kinds of targeted bureaucratic policy changes will lead again to a chilling effect, scaring people away from accessing vital resources for health. Because the policy changes are complex, seemingly boring or benign, and often not debated publicly in Congress, it is harder to rally public support to oppose them. Yet because these changes are surgically precise in denying resources to millions of immigrant families at once, it is imperative to shed light on these actions and communicate compellingly the harm they cause in order to protect the health and well-being of our immigrant neighbors.
What I’ve learned in movement work is that the systems and structures that founded this country—White supremacy, patriarchy, capitalism—hurt us all, even though some benefit mightily from them.
More than a week out since the election was called, we are starting to see President-elect Trump’s cabinet choices roll in, each one more seemingly devastating for public health than the last. As a queer woman and parent of a transgender teenage son, being in our country feels shaky right now. While my other identities keep me safer—a white person born in the US, first and foremost—it feels unsettling in public spaces.
I traveled to the Midwest this week and couldn’t help wondering which souls I passed in the airport were part of the majority of people that voted against queer and trans people. It was easy to stay divided in my mind—“us vs them.” Yet, I know that is not the answer, nor what my soul craves. As a public health practitioner it’s always been about caring for the health and well-being of everyone. The truth is, it’s hard to move forward knowing so many are actively working to remove access to both our healthcare and basic human rights.
So how do we go on, individually and collectively? I learned in 12 Step programs that “hurt people hurt people.” I find that pithy slogan quite profound. What I’ve learned in movement work is that the systems and structures that founded this country—White supremacy, patriarchy, capitalism—hurt us all, even though some benefit mightily from them. Acting on those hurt feelings—generation after generation—is bound to hurt others, on both sides of the aisle.
While we have to fight for the lives of those in real danger right now, first and foremost, I know the other piece of the work, especially as a White woman, is to stop writing people off based on their political affiliation and adopt a beginner’s mindset: Be curious and listen more. It is going to take a radically different approach to create a radically different world. If you’re up for thinking and behaving radically in the weeks and months to come, regardless of who you voted for, let’s talk. I’ll be ready to listen.
I am proud of the seven states, including my home state of Arizona, who all passed measures to protect abortion access. However, the re-election of President Trump is deeply disheartening. I fear that his administration will further restrict access to reproductive health services—such as abortion, contraception, and IVF—leading to an increase in maternal and infant mortality rates and compromising individuals’ autonomy. Additionally, I fear there will be increased harm toward marginalized communities, including people of color, immigrants, and LGBTQIA+ individuals, which would threaten their ability to live happy and healthy lives. I hope the administration does not pursue a national abortion or contraception ban or reinstate the domestic gag rule, although I fear these are real possibilities.
My career ahead of me will be challenging, but it’s worth doing because I was taught to fight for the health of all.
Tuesday night, I sat in front of my TV, obsessively checking my phone with my partner trying to calm me. I had so much hope in a late Blue wave to get past the red mirage. As midnight rolled around and Pennsylvania turned red, my electoral math could no longer calm me. I knew we would lose. I had friends reach out asking for me to reaffirm their hope in a Harris win – I felt like I was lying to them, failing them. I had to go to bed and pray to be proven wrong. When I saw the news Wednesday morning, I laid in bed catatonic and silent. Nothing will ever compare to the void of hope I felt. Mourning the future is so much more frightening than mourning the past.
I am fearful for the state of the nation following a second Trump administration. Trump-era Supreme Court appointees are my primary concern since I’m afraid that Justices Alito and/or Thomas may resign to usher in younger Justices and uphold the strong Conservative majority hellbent on overturning public health regulation precedent. On top of that, the Republican-led Congress makes me fear for the kinds of legislation that will be passed in the next two years. Trump’s agency appointee announcements have only deepened these concerns since conspiracy theorists are now poised to run federal agencies or act as Attorney General.
Since the results came out, I feel stuck on what to feel and do. My fear only deepens, but so too does my passion. This is our reality that we must practice within. As a public health professional, it’s my job to contribute and preserve public health. My career ahead of me will be challenging, but it’s worth doing because I was taught to fight for the health of all.
The power now lies with state and local governments to take the lead and build from the groundwork that has been laid.
The next four years are likely to be extremely challenging for climate policy and environmental justice. The next administration promises to restore “U.S. energy dominance,” remove restrictions on oil & gas drilling, “make the US the global leader of AI” and “kill” or “cancel” many EPA regulations, all while somehow “protecting access to clean air and water”. Since the world’s still largely fossil-fuel-based energy system is responsible for around 75 percent of the greenhouse gas emissions causing climate change and has a health burden of 6.7 to 9 million deaths, or about 1 out of 5 of all deaths worldwide, continuing to support the energy system that got us here will only make these impacts worse.
In 2016, the last time this happened, states and local governments became the new climate and environmental justice leaders. They proposed and enacted policies to reduce greenhouse gas emissions and protect vulnerable communities from environmental hazards. Now, state and local governments will have to take up this mantle of climate leadership again, hopefully with an even greater focus on environmental justice this time. The Inflation Reduction Act of 2022, the Bipartisan Infrastructure Law of 2021, and the Justice40 initiative of 2021 laid the groundwork for an energy transition that protects health, climate, and environmental justice. These policies boosted deployment of renewable energy technologies that hold promise to usher in a new era of energy that is abundant and healthy, and provided policy guidance that could have ensured that this deployment made progress toward righting the many environmental wrongs of the fossil-fuel based energy system. The power now lies with state and local governments to take the lead and build from the groundwork that has been laid.
As a psychiatric nurse, I have seen the drastic impacts that access to care have on health outcomes in the population I serve. Many of my patients rely on programs such as Medicaid to affordably receive treatment and preventive care for both physical and mental health concerns, so the results of the election are alarming to me. I worry that future changes in policy will leave many of the people I care for without proper health insurance coverage and cause them to wait for care until they are in dire condition. Additionally, as a Texan, I have a lot of fear surrounding the health of my friends and family that still live within the state. The politicization of private health issues, such as reproductive care, has led to the death of some pregnant individuals seeking life-saving care during miscarriages despite there being tangible medical care that could have been provided. The current strict abortion policies in some states have left health care providers in a difficult position of whether they can provide care, and future attacks on reproductive health can further complicate this issue.
Since the election, I have been asking myself “What is next for public health workers?” It is easy to point fingers and try to assign blame. However, I believe as current and future public health leaders, we have an obligation to connect with others no matter their political beliefs and background. We need to strive to be understanding and find creative new ways to protect the health of those in our communities by going back to the basics of the public health model and assessing what people want from their health system. This is going to be a challenging time for all of us given the potential threats to environmental health, access to reproductive care, federal health programs, and LGBTQIA+ care needs. However, we need to foster connections over these issues, strive to fight misinformation, and continue to take care of ourselves while doing this difficult work. I don’t know what is next, but I am grateful to be in a field alongside others that are deeply focused on bettering the lives of individuals and the communities they live in.
Let me be clear—environmental regulations save lives, including those of pregnant people.
As an epidemiologist, I often think about earth-shaking events in a counterfactual framework. That is, what would I be feeling or thinking in the world where the opposite decision was made? Here, we have two very clear paths that could have happened: a Trump presidency (the real outcome) or a Harris presidency (the counterfactual). My work is at the intersection of the energy sector and reproductive health, both of which are under attack. My team and I are going to spend the next four years generating epidemiological evidence that will facilitate health-protective policy decisions. However, it remains unclear what data can affect change in this upcoming administration.
We already know who the incoming president intends to run the Environmental Protection Agency: someone who has open plans to undo a wide range of environmental regulations under the guise of promoting economic prosperity. Policies in favor of the oil and gas industry will be camouflaged in energy independence language. Programs to reverse our path towards electric vehicle adoption will be disguised as promoting American manufacturing. Their agenda will make the path for a healthy energy transition away from fossil fuels even more difficult than it would’ve been in an ideal political climate. The shift to cleaner energy has switched from lofty goal to pragmatic necessity for the U.S. I’d be remiss if I didn’t acknowledge that the counterfactual Harris administration was not flawless on the energy sector. Her campaign very definitively stated that a policy banning fracking, which could have protected health in communities that host this industry, was not on the table. However, a counterfactual world with a Harris administration would likely put public health closer to the forefront of our energy policy decisions, in stark contrast to the impending Trump administration.
For reproductive health, the counterfactual Harris administration would certainly be better for people with uteruses across the entire country. The often-touted “abortion care is healthcare” barely scratches the surface of what I am worried about in the upcoming Trump administration, a sentiment already expressed by many leaders in this research space. I am particularly worried about pregnant people who are exposed to polluting industries (e.g., oil and gas extraction) or emissions sources (e.g., traffic congestion). We already know that these exposures increase the risk of pregnancy complications in many contexts, and this “double jeopardy” of environmental hazards and inadequate reproductive healthcare may be particularly deleterious at the population level. Let me be clear—environmental regulations save lives, including those of pregnant people.