Mass layoffs at the Department of Health and Human Services (HHS) portend a future with more infectious disease outbreaks, chronic conditions, and a widening gulf in health between the most affluent and vulnerable, experts told the Guardian.
Further, they said, the Trump administration’s multipronged attacks on American science represent a generation-defining experience, a new chapter in the “boom and bust” cycle of health funding, and a masterclass in branding, as Donald Trump and the secretary of health and human services, Robert F Kennedy Jr, dismantle institutions in the name of improving them.
“I fear for the country,” said Dr Steven Woolf, a population health researcher at Virginia Commonwealth University and a family physician. “Many people not too fond of bureaucracy may feel this big shakeup in Washington DC is well overdue. But I don’t know that people appreciate what’s coming their way – much like a far-off tsunami warning.”
Experts said they see the chaos, confusion and upheaval – from the ideological purge of basic research grants early in Trump’s tenure to more expected layoffs at the National Institutes of Health – as leading to shorter, sicker American lives.
“These are cuts that are not driven by a rational strategy to improve population health,” said Woolf. “This is all being done in the name of ‘making America healthy again’ – that’s the incredibly bizarre gaslighting that’s going on.”
Scenes of confusion played out across the US last week as Kennedy enacted a 10,000-person cut to the 82,000-person health department – an overhaul compounded by roughly 10,000 cuts made by billionaire Elon Musk’s unofficial “department of government efficiency” and a $11.2bn clawback of federal funds from state and local health departments.
Experts said slashing the $1.7tn budget of the Department of Health and Human Services (HHS) is likely to starve the system of well-established interventions known to save lives. The impacts could ripple across decades, with cuts that touch everything from tobacco policy to HIV prevention.
In an indication of the chaos and confusion that has characterized the second Trump administration, Kennedy also told reporters that some HHS workers appeared to be mistakenly let go and would be reinstated. That appeared to never be the plan, according to Politico.
“Public health is this hidden field you haven’t seen as protecting you,” said Susan Polan, associate executive director of the American Public Health Association.
She added that “the best example of that is the office of smoking and health”, noting a cut made to the National Center for Chronic Disease Prevention and Health Promotion last week.
“Fifteen, 20, 30 years from now, there will be people who were smokers all their life,” said Polan. “We will see the results of that in heart disease, cancer, stroke.”
More than 16 million Americans live with a chronic disease caused by smoking.
All the experts that the Guardian spoke with expected an increase in infectious disease outbreaks, from bird flu and emerging diseases abroad – which the Centers for Disease Control and Prevention (CDC) would no longer have capacity to investigate – to HIV, syphilis, measles and tuberculosis.
“What we’ve seen here is a slash-and-burn approach that doesn’t let you answer that question of ‘what is the rationale behind this for someone who is focused on chronic diseases in America?’,” said Dr Richard Besser, president of the Robert Wood Johnson Foundation, a non-profit devoted to eliminating enormous inequalities in how long and well Americans live.
More than a week after cuts were made, the health department has not provided the public with a full accounting of the programs and positions eliminated or “restructured”, despite the health secretary’s pledges of “radical transparency”. In interviews, Kennedy told reporters that the majority of layoffs touched administrative functions, such as purchasing and communications.
However, in just a few examples of the cuts, among those laid off were experts in lead poisoning who were helping the Milwaukee school district eliminate lead pipes from schools; a team of six infertility specialists who tracked the success of in vitro fertilization clinics, leaving no one at the agency with expertise; and the staff of a sexually transmitted disease laboratory who were sent packing – leaving freezers of specimens and work on multi-drug-resistant gonorrhea to an unknown fate.
“One of the most common conversations I heard was: ‘What’s going to happen to my research? Who’s going to carry this work on if I’m not able to do it?,’” said Micah Niemeier-Walsh, a third-generation worker at the National Institute of Occupational Health and Safety (NIOSH) who studies cancer in firefighters, and described the office as “pandemonium”.
She said workers at the Cincinnati, Ohio, NIOSH branch gathered in hallways to wonder aloud who would take over the national cancer registry for firefighters once they were “RIF’d”, or laid off, in June. Firefighters are exposed to a dizzying array of known and potential carcinogens – and have cancer rates much higher than the general public.
“They’re facing losing their livelihoods, losing their own job, and still their concern is: ‘What about the NIOSH mission?’,” she said. “‘What about protecting workers in this country?’”
The ultimate shape HHS will take remains to be seen. Rather than address questions about the layoffs, Kennedy used the weekend to attend the funeral of a second unvaccinated child who died of measles in west Texas and promote unproven treatments for the disease. He also urged the government to stop recommending fluoridated public water.
As of now, the CDC recommends fluoride in water. Though it’s unclear how the CDC will carry out messaging about fluoridation, the office of oral health was “gutted” last week.
