Navigating the Complex Public Health Moment in the Aftermath of the 2024 US Election

The recent US federal election has occasioned a substantial amount of reflection on the part of a broad range of sectors. Public health is no different, and, perhaps, has even more cause for such reflection. President-elect Donald Trump has long been on the record as being antagonistic toward a number of ideas that have been central to the work of public health, and has played a role in enacting efforts that have been antithetical to this work. It makes sense, then, that those who care about a progressive vision of health would be concerned about his return to power.

In the aftermath of President-elect Trump’s first election, I wrote an essay in these pages that argued that President Trump would be harmful for health on two fronts—through disinvestment from the structures that influence health, and through seeding divisiveness that, in and of itself, affects health. That all, more or less, turned out to be correct.

On the first front, the first Trump administration’s actions included, but were not limited to, overseeing a change in the Supreme Court that led to the Dobbs decision, overturning 50 years of Roe v. Wade and widespread access to abortion rights, limiting Medicaid expansion, threatening the Affordable Care Act that has provided health insurance coverage for nearly 50 million people since 2014, and, during the COVID-19 pandemic, muddling public health efforts to contain the pandemic. On the latter, President Trump, and then again candidate Trump, is amply on the record as disparaging a range of groups that are of core concern to public health, including immigrants, persons of color, veterans, and persons with disability. The resulting social division led, not unexpectedly, to social upheaval that we know in turn leads to poor health.

The re-election of Donald Trump as President, then, has been met in public health by breath-holding anticipation. Further compounding what may be characterized as a sense of quiet dread in the field have been President-elect’s Trump’s nominations for key health positions. The nomination, as of this writing, of Robert F. Kennedy Jr, for Secretary of Health and Human Services (HHS), given his track record of opposition to vaccines that save millions of lives and his disregard for decades of science about the causes of HIV, is cause indeed for concern. Similarly, the nomination of Dr. Dave Weldon, who has previously promoted largely debunked ideas about thimerosal as a cause of autism, is a cause for some concern. Other nominees for key health posts have had a range of positions that are outside the mainstream of public health, each raising their own questions and reinforcing the idea that public health may be in for a challenging few years as the Trump administration settles in come 2025.

So, what does this then portend for the near future of public health? It does not seem unreasonable to consider this a difficult moment, one that holds substantial threat, and one for which those whose daily work is concerned with promoting the health of the public should brace. I generally agree with this view. However, that being said, there is perhaps hope in the moment, and an approach that can, without being unduly Pollyannaish, leverage the moment for good, towards better health for populations, if not in the short-term, then at least in the long-term. What might such an approach look like? I offer three suggestions.

First, it is important to recognize that the election of Donald Trump, and in downstream consequence the appointment of individuals who will shepherd public health in the coming years, emerges from a genuine public appetite for change in federal administration. It would be foolish to regard this as a mere aberrance considering the mandate given to the president-elect by his winning of the popular vote, the first time a Republican has done so in 20 years. This should give pause to anyone in public health, recognizing that, in part, this election comes in the aftermath of the COVID pandemic. Our handling of the pandemic was central to many of the cultural discussions and disagreements that have followed and made their way into the election-era conversation. The actions of public health saved lives during COVID, and yet the era has been marked by a precipitous drop in trust in science. This should encourage us in public health to work to understand the forces that led to this perhaps unexpected turn of events. There is no question that some of this challenge comes from explicit efforts at disinformation and the deliberate undermining of trust in the field. But it is also likely that there is a difference of perspectives about the role of public health throughout the country and that, as such, this calls on the field to think carefully about our communication, the trade-offs inherent in public health actions, and how to lean on the work of public health to engage the whole public, rebuilding trust in the process.

Second, it seems an appropriate moment to interrogate how we have seen our role in public health, to genuinely ask whether there are good ideas that may emerge from quarters that have not been aligned with public health in recent years. President-elect Trump, for example, created challenges for public health during the pandemic, but his administration was also responsible for Operation Warp Speed, a public-private initiative that fast-tracked the development of COVID vaccines, an achievement Trump has touted even in the face of pushback from his base. The nomination of Robert F. Kennedy Jr for secretary of HHS reasonably elicits concern, but his focus on the obesity epidemic, and on potential contaminants in food, should be welcome. Others in public health have already noted the opportunities that may be present for a secretary of HHS who is committed to improving food and nutrition in the country, pointing out a path to synergies that can perhaps be catalyzed by a moment of change. While a “Make America Healthy Again” agenda emerged from populist sloganeering over the past decade that has been largely antagonistic to the values and aspirations of public health, the phrase, taken at face value, surely can align with the intent to do just that. American health has underperformed for several decades and was substantially worse than all peer countries long before COVID. If this is an opportunity for a redoubled effort to improve national health, that should be welcomed, and if there are avenues of agreement that public health can align with, that holds promise for next steps to engage with a new administration going forward.

Third, it is of course not at all unlikely that a new administration will take steps that are inimical to the goal of advancing the health of the public. The United States has long faced an underinvestment in public health that has affected national health, never more so than during the COVID pandemic. Further disinvestment in public health would put the country at even greater risk. Similarly, changing vaccination schedules that have saved millions of lives can lead to resurgences in diseases that have long ceased to be a concern in this country, endangering many. Threatened rethinking of the research infrastructure in the country could endanger what has long been the preeminent source of health discovery in the world and has fueled innovation in the United States. Such efforts need to be resisted through the tools that are available to us, as we provide the data that illustrate a better way forward and encourage public endorsement of the values that can advance the science that informs health. This will call for consistent and persistent engagement on the part of practitioners of public health. It is indeed these potential threats to the health of the public that make this a more important time than ever for the engagement of public health in the national conversation.

It is next to impossible to predict how the Trump administration will intersect with the health of the public given the contradictory ideological makeup of the incoming administration and the many inconsistencies of the President-elect himself. It is, however, possible to map out how we can intersect with the moment towards the end of advancing public health. And it is quite certain that the coming years shall require vigilance and adaptability on our part. We might argue that this is always the case, and if the moment reaffirms our role and responsibilities, that is perhaps to the good of our long-term goal of improving the health of populations.

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