The Lancet Commission on Public Policy and Health in the Trump Era

Himmelstein DU, Woolhandler S, Cooney R, McKee M, Horton R.. Lancet. 2018 Sep 22;392(10152):993-995. [CrossRef] [PubMed]

The article is lengthy at 49 pages and has no abstract available. The executive summary runs about 2 pages. The key messages listed in the article are below. Links to the executive summary and the whole article are at the end of this summary.

Key messages

• Politicised and repudiated science, leaving the USA unprepared and exposed to the COVID-19 pandemic
• Eviscerated environmental regulation, hastening global warming
• Incited racial, nativist, and religious hatred, provoking vigilante and police violence
• Denied refuge to migrants fleeing violence and oppression, and abused immigrant detainees
• Undermined health coverage
• Weakened food assistance programmes
• Curtailed reproductive rights
• Undermined global cooperation for health, and triggered trade wars
• Shifted resources from social programmes to military spending and tax windfalls for corporations and the wealthy
• Subverted democracy both nationally and internationally
• Although the Trump administration policies posed a uniquely urgent threat to health,
• damaging neoliberal policies predated and abetted his ascendance:
• Life expectancy in the USA has lagged behind other wealthy nations since 1980 and
• began falling in 2014
• The chronically high mortality of Native Americans started rising in 1999, while
• yawning disparities between Black and white people persisted and progress on racial
• equity in other domains (eg, education, housing, income and policing) halted or
• reversed
• Substance abuse deaths greatly increased
• Income and wealth inequality widened
• Incarceration increased four-fold, initiated by President Nixon’s racially motivated war
• on drugs and compounded by harsh laws enacted under Presidents Reagan and Clinton
• Welfare eligibility restrictions implemented by President Clinton removed benefits from millions
• Deindustrialisation spurred by trade agreements that favoured corporate interests
• over labour protections reduced economic opportunity in many regions of the USA,
• damaging health and increasing receptivity to racist and xenophobic appeals
• Market-based reforms commercialised and bureaucratised medical care, raised costs, and shifted care toward high-income US residents
• Despite the Affordable Care Act, nearly 30 million people in the USA remained
• uninsured and many more were covered but still unable to afford care
• Funding cuts reduced the front-line public health workforce by 20%
• The Biden administration must cancel Trump’s actions and also address the healthdamaging structural problems that were present before Trump’s presidency:
• Raise taxes on high-income people and use the proceeds to bolster social, educational, and health programmes, and address urgent environmental problems
• Mobilise against the structural racism and police violence that shorten the lives of
• people of colour
• Replace means-tested programmes such as Medicaid that segregate low-income
• people, with unified programmes such as national health insurance that serve all
• US residents, aligning the interests of the middle class and the poor in maintaining excellence
• Reclaim the US Government’s role in delivering health and social services, and stop channelling public funds through private firms whose profit-seeking skews priorities
• Redirect public investments from militarism, corporate subsidies, and distorted
• medical priorities to domestic and global fairness, environmental protection,
• and neglected public health and social interventions
• Reinvigorate US democracy by reforming campaign financing, reinforcing voting,
• immigration, and labour rights, and restoring oversight of presidential prerogatives

Full Text and Executive Summary