The U.S. War on Public Health
Photo Credit: Spencer B Davis
In the last five months, the U.S. public health sector has been hit by a wave of budget cuts, policy changes, and pseudoscience rhetoric from the Trump administration. Public health, in itself, is “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals,” according to Charles-Edward Amory Winslow. Public health shapes nearly every part of daily life, from building safety and transportation to food regulations and vaccination policies. The clean air we breathe, the ADA-compliant elevators we use, even smoke-free environments, all can be attributed to public health policies or initiatives.
Since the second Trump administration began, more than 20,000 jobs have been eliminated, billions in federal funding for scientific research has been paused or threatened, and vaccines have become a topic of increasing controversy in no small part due to the nation’s current Secretary of Health and Human Services, Robert F. Kennedy Jr., whose anti-vaccine views have been blatant. The U.S. government has been actively dismantling its public health systems and, as trust collapses and funding dries up, the consequences for population health–especially marginalized groups–are already materializing and will only worsen.
A Brief History of Public Health in the U.S.
The first public health agency in the U.S. was formed in 1798, the Marine Hospital Service. Initially, it was rudimentary and served only a small population, but its responsibilities eventually grew beyond the seamen population as it took on the role of preventing the spread of disease throughout the U.S. Its name changed to Public Health and Marine Hospital Service in 1902 and again to the United States Public Health Service in 1912.
While the USPHS played a key role in responding to disease outbreaks and setting federal health standards, public health in the U.S. has always been an amalgamation of federal, state, and local efforts. In the 20th century, major advances transformed public health, including widespread sanitation infrastructure, public vaccination campaigns, and workplace safety regulations that all helped slash mortality rates and improve life expectancy. In fact, according to the CDC, since 1900, the average lifespan has increased by more than 30 years and 25 of those years can be attributed directly to advances in public health.
However, public health in the U.S. has never been immune to political pressure or public skepticism. In the 1980s and 90s misinformation via media sensationalism and small, faulty studies claiming vaccines caused autism dealt a major blow to vaccination rates, and vaccine hesitancy grew exponentially from then to present day. Additionally, when the Center for Disease Control and Prevention expanded its scope to chronic disease prevention and HIV/AIDS, federal responses were underfunded. In fact, in 1983, Margaret Heckler, the former Secretary of Health and Human Services, told Congress that funding for AIDS was unnecessary. Dr. Don Francis responded with this memo to his bosses, imploring them to push for more funding in the wake of the increasing epidemic. In the case of HIV/AIDS, stigma and governmental delay contributed to thousands of preventable deaths.
Today’s public health system is shaped by this complicated legacy: a system capable of incredible progress, but acutely vulnerable to political interference and public mistrust. This could be seen during the COVID-19 pandemic, when medical mistrust and misinformation led to increased health risk and a larger spread. What was once a proud institution that kept populations safe is now under siege–not by a lack of capacity, but by deliberate defunding, decades of misinformation, and an ever-growing disregard and even attacks from those in power.
The Current Crisis
Since the beginning of the second Trump administration, the public health sector has faced significant upheaval. The Department of Health and Human Services (HHS) announced a reduction of 20,000 positions, nearly a quarter of its workforce. This attack on HHS affects not just the department, but also key agencies like the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), which the HHS oversees. It also affects the initiatives connected to HHS, such as public infrastructure including emergency preparedness for biological threats, major health insurance programs (e.g. Medicare and Medicaid), the National Institutes of Health (NIH) which the HHS works with and helps fund, and social services initiatives addressing issues like child abuse and domestic violence, and many other initiatives associated with HHS.
According to the Association of American Universities, the NIH experienced a substantial setback with the cancellation of $1.9 billion in research grants, which has disrupted scientific projects across the country. These cuts have sparked alarm about the future of innovation and health, an outcome that is likely to be especially dire for both medical research and research on marginalized populations due to the Trump administration’s recent restrictions on inclusive–and, frankly important–language. The administration has banned the use of terms like “women,” “diversity,” and “equity” in grant applications, which has forced researchers to either alter and omit inclusive language, or abandon critical projects focused on reproductive health racial disparities, and more.
CDC funding reductions have already had tangible consequences on the state level. For example, in Georgia, the Department of Public health laid off 180 employees after key federal grants were terminated. These layoffs severely impacted services such as vaccine access, disease tracking, and rural health outreach. Disease surveillance, also referred to as epidemiological or disease tracking, is essential to detecting disease outbreaks before they can spread and become difficult to control, which can cost lives.
Compounding the crisis is the appointment of RFK Jr. as the Secretary of HHS. Kennedy, with a long history of promoting vaccine misinformation, has defended the federal cuts and used his platform to cast doubt on well-established public health systems and practices. His actions have fueled mistrust and emboldened anti-science rhetoric within government policy circles as well as the general U.S. population. RFK Jr. published abject misinformation through a book he co-authored called “Cause Unknown,” promoted medical racism, and he has been identified as one of the twelve responsible for the majority of misleading claims about COVID-19 vaccines. Amid multiple measles outbreaks across the country, this history of vaccine misinformation and RFK Jr.’s mixed messages about the MMR vaccine–the full two doses of which is 97% effective to prevent the disease–could not come at a worse time.
Even beyond national borders, the U.S. has signaled its retreat from global health leadership. The administration’s withdrawal from the World Health Organization (WHO) marked a turning point in international cooperation, severing ties with the world’s largest coordinating body for health emergencies, vaccine distribution, and disease tracking. The departure has strained relationships with global health partners and further diminished the U.S.’s credibility in global health diplomacy.
Together, these developments represent a coordinated dismantling of public health infrastructure. With dwindling resources, a shrinking workforce, and top-down hostility toward science, the U.S. is becoming increasingly unprepared to manage emerging health threats–and marginalized communities are, once again, poised to bear the brunt of the consequences.
The Stakes for the Future
This systematic war on public health is not just bureaucratic reshuffling. It poses immediate and long-term threats to the nation’s health and economy. The reduction in funding for agencies like the CDC and NIH has already led to the termination of critical programs, such as the Diabetes Prevention Program–which has created major insights into how to tackle a widespread chronic disease which threatens U.S. health–and has hindered research on other chronic diseases and pandemic preparedness. This leaves the U.S. more susceptible to health crises, with decreased ability to respond efficiency to emerging threats.
Proposed cuts to Medicaid also threaten to decimate long-term services, which would specifically affect low-income individuals and those with disabilities. South Dakota, Missouri, and Oklahoma are likely to be left in a difficult position with these cuts, especially, due to changes in their constitutional amendments requiring they participate in Medicaid expansion. The elimination of rural health programs further exacerbates disparities, which will leave vulnerable populations with limited access to essential healthcare services. Some specific, real-life examples of how this will affect not just the nation as a whole but the everyday American include food safety risks due to reduced staffing, putting children at risk through the elimination of lead poison monitoring at schools, making medical care more difficult to access through the elimination of programs that keep rural hospitals open and clinics staffed.
Now, while the threat to health in itself is substantial, there is also the economic factor to consider. The healthcare sector is a significant component of the U.S. economy. Cuts to public health funding would result in the loss of up to one million jobs and a $113 billion decline in state GDPs, no small amount. Beyond the immediate loss of employment and economic output, these cuts will have far-reaching consequences in long-term economic resilience by undermining a healthy workforce, increasing future healthcare costs, and weakening the nation’s ability to recover from health emergencies.
Why Does This Matter & What Next?
The politicization of public health decisions and the sidelining of scientific expertise has eroded public trust. This skepticism hinders effective health communication and compliance with public health measures, compromising the nation’s ability to manage health crises, something which, when it comes down to it, affects every single individual. Whether it’s containing a viral outbreak, ensuring clean drinking water, or responding to natural disasters, public health systems are our first line of defense–because they work to prevent a crisis in the first place.
When these systems are gutted or ignored, the most vulnerable suffer first and the most: low-income communities, people with chronic illnesses, the elderly, disabled individuals, and communities of color. Eventually, though, the ripple effect reaches everyone. Without coordinated public health efforts, preventable diseases will spread more easily, healthcare costs will rise, and our ability to respond to climate-related health threats will collapse.
What’s next? We can’t afford to be passive. Defending public health starts with recognizing it as a public good worth investing in. That means:
Voting for leaders who prioritize science-based health policy.
Challenging misinformation when we see it, both online and in everyday conversations.
Supporting funding for agencies like the CDC, NIH, and local health departments.
Holding those in power accountable when they attempt to undermine these systems for personal or political gain.
Public health only works when we treat it as a collective responsibility. The question shouldn’t be whether we need it, the question should be whether we’re willing to fight for it in this war before it’s too late.