In a 49-page study, nearly three dozen experts assembled by The Lancet concluded that U.S. health policies under the Trump administration resulted in an avoidable 461,000 deaths per year — plus an unnecessary four in 10 COVID-19-related deaths — blaming decades of policy failures that were significantly enhanced by the 45th president.
The report, published Thursday in the British medical journal, says that if the U.S. had been on par with the life expectancy rate of other G-7 nations, such as France and Japan, these deaths could have been avoided.
The Lancet Commission on Public Policy and Health in the Trump Era has been compiling data for the report since 2017, the year Donald Trump took office, tracking policy outcomes as far back as the Reagan Era.
“Even before Trump's presidency, the U.S. was falling farther and farther behind other nations in terms of the most important health outcomes, like life expectancy," Sam L. Dickman, a commissioner and one of the report’s authors, told The Academic Times. "Our research shows how Trump's policies exacerbated long-standing health inequality in the U.S.”
The team of 33 commissioners, including 12 people of color and 13 women, was composed of doctors, lawyers, public health and legislative officials, professors, union leaders and economists, among others. All members of the team were from the U.K., Canada or the U.S.
To conduct the research, the commission collected data through published studies, legal documents, news reports and government websites, as well as its own original analyses.
Those analyses included various models, such as one demonstrating the downward trend of insurance coverage since Trump’s election: An additional 2.3 million U.S. residents became uninsured since 2017, including 726,000 children.
That model and others in the study support the report's claim that under the Trump administration’s policies, mortality rates were on the rise.
“The pandemic has exposed some of the glaring gaps that affect the health of millions of Americans, including our high uninsurance rate and the fact that losing your job often means losing your health insurance, too,” said Dickman, an M.D. associated with Planned Parenthood.
According to the commission, troublesome health policies started with former President Ronald Reagan.
Declaring that he essentially ended the New Deal and reversed advances accomplished by the Civil Rights Era, the report says Reagan led the U.S. to adopt neoliberal polices such as lower corporate taxes, social program privatization, including for health programs, and weakened labor protections.
The authors argue that Trump worsened the damaged state of health policy beget by Reagan. He expanded immigration enforcement and domestic policing, they explained, and in a policy aligned with neoliberal politics, simultaneously moved money out of necessary social and health programs. That funding was ultimately added to the defense budget.
Highlighting Trump’s 2021 budget plan, one that the Biden administration is contesting, the report describes the former president's proposed health care-related reductions, such as cutting $1.52 billion from the Emergency Plan for AIDS Relief, as well as one-third of funding for global health and disease control.
The authors emphasize that the latter directly impacts the Centers for Disease Control and Prevention, World Health Organization and other important entities in the fight against COVID-19.
“Massive resources aimed at ending the pandemic can also be invested in developing better health systems to prevent the next pandemic, make sure every American has access to health care and tackle the opioid epidemic,” Dickman said, conveying that health care-related budget cuts should be as limited as possible.
He underscored that bad health outcomes in the U.S. can be traced back to the country’s long history of racial injustice and disinvestment in public health for communities of color, and those living in poverty.
For example, the study shows that prior to the pandemic, Black Americans had a 42% higher mortality rate than non-Hispanic white people. It also suggests that Trump’s hand in harsh immigration policies and housing policies encouraging segregation played a part in growing racial disparities over the last four years, which led to a higher risk of mortality among all people of color.
The report also studied mortality with regard to Trump’s decisions about climate change, reporting that in 2019 alone, his environmental policies contributed to 22,000 excess deaths.
“Trump's policies, like his decision to loosen restrictions on air pollution and pulling out of the Paris climate agreement, contribute to the large mortality gaps between the U.S. and other countries,” Dickman noted.
The commissioners warn that significant reforms are needed to change the trajectory of health outcomes that scientists have been seeing. However, Dickman also commended work by the Biden administration to remedy the ills detailed in the report, even though he believes that the U.S. is late to the game.
“It's great to see Biden's team developing a real nationwide response to the COVID-19 pandemic, which should have been done a year ago,” he said.
The paper, “Public policy and health in the Trump era,” was published Feb. 11 in The Lancet. It was authored by Steffie Woolhandler, Sameer Ahmed, Mary T Bassett, David Bor, Adam Gaffney, Danny McCormick, Juliana E Morris, Joia S Mukherjee, Altaf Saadi and Davida Schiff, Harvard University; David U Himmelstein, Hunter College; Zinzi Bailey and Olveen Carrasquillo, University of Miami; Jacob Bor and Sandro Galea, Boston University; Merlin Chowkwanyun, Columbia University; Samuel L Dickman, Planned Parenthood; Samantha Fisher and Philip J Landrigan, Boston College; Richard N Gottfried, Committee on Health, New York State Assembly; Kevin Grumbach and Helena Hansen, University of California, San Fransisco; Gordon Guyatt, McMaster University; Michael Lighty, National Nurses United; Martin McKee, London School of Hygiene and Tropical Medicine; Alecia McGregor, Tufts University; Reza Mirza, University of Toronto; Marion Nestle, New York University; Linda Prine, Mount Sinai School of Medicine; Martin Shapiro, Weill Cornell Medical College; Lello Tesema, Department of Public Health in Los Angeles County and Atheendar Venkataramani, University of Pennsylvania. Steffie Woolhandler and David U Himmelstein are the co-chairs of the Lancet Commission on Public Policy and Health in the Trump Era.