Death by a Thousand Federal Cuts: Trump Administration Actions Will Not Make America Healthy Again

Since the day Donald Trump was inaugurated as the 47^th President of the United States, his administration has “flooded the zone” with a deluge of executive orders and administrative actions that have significantly downsized and restricted federal funding for research and data systems and also deeply cut the financial and human resources of myriad domestic and foreign initiatives. In addition to the slashing that has already occurred, many more government programs and even entire agencies are clearly now on the chopping block. This includes a potentially huge cut to Medicaid in the next budget cycle.

At the same time the administration is cutting programs, budgets, and people, Trump also issued an executive order on February 13, 2025 that created the President’s “Make America Healthy Again” (MAHA) Commission. This order begins with a purpose motivated by well-known facts about population health in the United States that have been the focus of teaching, research, public policy, and Healthy People strategic planning for decades. This includes the fact that life expectancy in the United States is significantly lower than in comparable countries and that we also have relatively high rates of chronic disease and mental illness. The executive order proceeds to state that it will be the policy of the federal government to fund objective “gold-standard research on the root causes of why Americans are getting sick.”  

The MAHA Commission is to be chaired by the Secretary of Health and Human Services (HHS) and comprised of several federal agency secretaries, commissioners, and directors. The focus of this commission will be on “understanding and drastically lowering chronic disease rates and ending childhood chronic disease. This includes fresh thinking on nutrition, physical activity, healthy lifestyles, over-reliance on medication and treatments, the effects of new technological habits, environmental impacts and food and drug quality and safety.”

This is seemingly good news, as there has already been a huge investment in and commitment to child health and chronic disease prevention and control in the United States. We have high-quality initiatives, population-based data systems, researchers with excellent training and objective work, and multiple journals that publish peer-reviewed research regarding all named priority issues. There is already a deep research base regarding the strengths and weaknesses of a wide range of clinical, community-based, and policy interventions.

However, the overt disconnect between this order and the dozens of other orders and actions during the first weeks of the second Trump administration is astounding. For those of us who have dedicated our careers to population health research, teaching, and policy efforts aimed at making Americans healthier, the MAHA order feels like hypocrisy and gaslighting amidst the full-frontal attack on public health programs and infrastructure, health-related research and data collection, public health communications, Medicaid, environmental protections, public education, and all efforts to address social inequality by race, ethnicity, gender, and disability.

If President Trump and the MAHA Commission sincerely want to make America healthier, decades of population health research and undeniable facts must be acknowledged and used in the efforts, such as:

• Trends and patterns in life expectancy in the United States are very well researched, including that a major driver of our relatively lower life expectancy is that we have higher deaths rates from all of the leading causes with the excess mortality primarily among people with lower education and income levels and among several racial/ethnic minority groups. Life expectancy will never improve to the levels enjoyed by most other high-income countries without addressing the fact that death rates are higher for specific sociodemographic groups across the life course starting with infant mortality.
• The root causes of the chronic disease epidemic are also very well researched and have more to do with social factors than biology or genetics. If the MAHA Commission truly wants to address root causes, members will have to embrace the socioecological model of health which places the health of individuals within contexts that matter for health: within interpersonal relationships and family settings, within the organizations/institutions that affect everyday life like schools, workplaces, and churches, within community and environmental settings, and within macro environments that include culture, the economy, and public policy influences. For example, the food and nutrition that people put into their individual bodies matter for health. However, food options, behaviors, and consumption patterns occur within families, schools, neighborhoods, cultures, and in socioeconomic and policy/regulatory contexts. Addressing the root causes of all population health phenomena requires the basic understanding that individual health is nested within and must be addressed at multiple levels of influence.
• Improving child physical and mental health must fundamentally address our shamefully high rates of child poverty, food/income/housing insecurity, and adverse child experiences, especially among children of color. Slashing Medicaid, Head Start, services for children with special needs, the Supplemental Nutrition Assistance Program, and other social welfare programs will only hurt the health and welfare of children in all states.
• The abrupt ending of federal funding to state/local health departments for public health, mental health, and addiction services, along with the bizarre reorganization and huge downsizing of HHS (including the Centers for Disease Control and Prevention) is causing significant crumbling in the scaffolding of our public health infrastructure. This, along with the gutting of staff and data systems essential for tracking and communicating about public health issues, will only serve to ignore and cover up rather than address problems.
• Health care coverage, access, and quality matter greatly for health including for chronic disease prevention/control at all ages. Current and predicted additional funding delays and cuts to Medicaid, the Veterans Administration, Federally Qualified Health Centers, and Title X funding along with the gutting of the Agency for Healthcare Research and Quality are not at all aligned with making America healthier. 
• Cutting NIH funding for vaccine hesitancy research while wastefully launching more research on the disproven and dangerous theory that vaccines cause autism propels science backwards and will increase the risk of additional outbreaks of vaccine-preventable diseases, such as measles and pertussis, among children. 

The Trump Administration’s scorched-earth strategies for decreasing federal spending, gutting our nation’s public health infrastructure, and halting all efforts aimed at addressing undeniable social inequality are not going to make America healthier. Rather, these efforts are going to increase suffering and death by a thousand cuts to federal investments in public health, health care, research and data surveillance, food security, poverty alleviation, education, environmental protections, and many more areas that matter for population health.

It is impossible to predict how one specific cut will by itself lead to measurable increases in morbidity or mortality. However, the cumulative insults to many people, especially those already living in poverty and resource-constrained environments, will be significant and disastrous. These administrative decisions are going to decrease life expectancy and worsen other outcomes by denying essential attention, resources, and action towards the real health risks faced by people and communities, including those who are marginalized by poverty, race, and other factors that those with their heads deep in political sands pretend not to see. And, by the way, these political actions are also going to further decrease our plummeting birth rates because the social drivers of lower life expectancy are also the social drivers of decreased total fertility rates.

The willful ignorance embedded within the MAHA movement should not go unchallenged. The Commission charged to address key population health problems facing the country should call for strengthening rather than gutting public health infrastructure, essential research and data systems, health insurance and social welfare programs, public education, and other investments in the myriad social factors that matter for health from the prenatal period to old age. Furthermore, the people and institutions dedicated to the objective science of population health—including universities, think tanks, professional associations, foundations, and the National Academies of Science, Engineering, and Medicine—should play a strong and vocal role in ensuring that the MAHA Commission members listen to and follow the science where it is substantive and clear. Furthermore, they should be able to do so without fear of retaliation and retribution from the Trump administration. 

Our bench strength regarding children’s health and chronic disease prevention and control is deep and unrivaled worldwide. Making Americans healthier requires building upon what is already known about the biological and social root causes of illness, the effective versus ineffective clinical and community-based prevention interventions and policies, and the importance of science unfettered by politics and ignorance. Clearly many population health problems exist, and numerous approaches have failed. However, as is always the case in public administration and budgeting, government effectiveness and efficiency in addressing complex problems can be improved with careful planning and hard but informed choices without simply burning everything down.

The population health community is ready to rise to the call for a healthier America because this has always been the core motivation of our field. Allow us to assist by identifying and building upon the existing deep wisdom in the science and practice of child health and the prevention and control of chronic and infectious disease and injury. Let’s invest in rather than deeply cut the research, data surveillance, and government action that is necessary to identify root causes, key strategies for effective multi-level action, and progress towards important goals. Otherwise, there is no doubt that we will regress in core measures of population health and individual well-being. And if this happens, blood will literally be on the hands of President Trump, the HHS Secretary, and all those who go along with the willful ignorance of the basic and sound principles of public health protections and population health science.

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