One of the foundational elements of Donald Trump’s appeal is that he can restore the United States to a partly remembered, partly mythical past where it dominated a whiter, safer, more protected world. It is a hazy era that combines the brief unipolar moment of the post-Cold War 1990s with the protectionism of the 1930s and 1940s, a place safe for white men, even mediocre white men, unthreatened by competition or equality.
Health is one area where Trump is likely to have success in taking America back, especially after the successful nomination of Robert F. Kennedy Jnr as health secretary. Kennedy, famously, is a vaccine denialist who has peddled the discredited claim that vaccines cause autism.
Kennedy has a strong base to work from: vaccination rates for US children have been falling in recent years, driven by anti-vaccination parents exploiting exemptions from childhood vaccination mandates. Cases of measles — which was briefly eliminated in the US in 2000 but which has since returned — surged last year, and there is currently a significant outbreak in Texas, one of the centres of vaccine denialism.
The performance of the first Trump administration on health was disastrous. As a result of Trump’s inept handling of the pandemic, US life expectancy fell far faster in 2020-21 than in comparable countries. And while it recovered more quickly than elsewhere under the Biden administration, it remains well below other Western countries — Americans still die four years younger than their counterparts in other developed countries, despite the US spending far more as a share of GDP on health than any other country.
One of the contributing factors is the opioid crisis plaguing the US. Despite Trump declaring it a public health emergency during his first term, deaths from opioid overdoses accelerated massively in 2020 as the pandemic set in and curtailed access to health services. Numbers have continued to increase since then.
According to UNICEF data, maternal mortality in the US in 2020, at 21 deaths per 100,000 live births, placed it 66th in the world (Australia’s level is three deaths per 100,000 — the average for the top 20 industrialised countries is four). It leapt from 17 to 21 during Trump’s first term, but that was only a continuation of previous trends; it was just 12 in 2000. Republicans have blamed Black women for the trend and suggested they be excluded from maternal mortality data.
On neonatal mortality, according to UNICEF data, rates in the US fell noticeably between 2020 and 2022, but the US still comes in 50th globally.
Echoing cuts to health spending during Trump’s first administration, Elon Musk has now (illegally) cut critical funding to National Institutes of Health research (the cuts have been temporarily stayed by a court), and Musk staffers are targeting Medicare and Medicaid systems, where Musk alleges there is massive fraud. The Centre for Disease Control is now facing massive job losses.
The Trump administration’s elimination of USAID will have significant impacts beyond America: USAID provides three-quarters of US health aid funding — around US$6 billion a year — while in some sectors, such as maternal and child health, all US health aid is provided via USAID, meaning that US international assistance will now be shut down entirely. US health assistance has been relatively flat in real terms since 2010. Ironically, the shutdown of USAID will mean declines in health outcomes in developing countries that often have better maternal and neonatal mortality outcomes than the US currently does.
The attack on health funding — both domestically and internationally — reflects the MAGA mentality at work. It is incapable of conceiving government as a positive tool that can be used for public benefit: government is instead a rort that either delivers for you and people like you or delivers for other groups rather than you — in which case it must be destroyed. The Trump administration, even more so than the first time around, is an exercise in distorting the US federal government to deliver outcomes for Trump and his cronies, and shutting down or wrecking those parts of government that do not deliver for him.
The toll will be revealed in health statistics in years to come — but by then they will just be numbers, rather than the lost and ruined lives of sons, daughters, mothers, fathers, brothers and sisters.
Have something to say about this article? Write to us at letters@crikey.com.au. Please include your full name to be considered for publication in Crikey’s Your Say. We reserve the right to edit for length and clarity.
