Lancet Commission 2021: Public Policy and Health in the Trump Era

This Lancet Commission assesses the impact of executive action and legislation during the Trump administration on health and wellbeing in the U.S. The Commission highlights how Trump’s efforts to repeal the Affordable Care Act, weaken environmental regulation, curtail reproductive rights, and defund public health agencies have exacerbated longstanding health inequities across racial and socioeconomic lines as well as caused tens of thousands of preventable, unnecessary deaths. U.S. life expectancy, which was similar to other high-income countries in 1980, trailed the G7 average by 3.4 years in 2018—representing 461,000 excess deaths in that year alone. The Commission also shines a light on racist and nativist rhetoric espoused by the administration, which disproportionately affected communities of color, low-income populations, and migrant populations.

The report connects the Trump administration’s detrimental legislation to the longer history of neoliberal policies in the U.S. that has widened disparities in the country, such as the racially motivated War on Drugs and welfare eligibility restrictions in the 1990s. The report contextualizes these federal actions with a broader policy landscape of deindustrialization and increasingly commercialized, costly medical care. To remedy this, write the authors, the incoming Biden administration must cancel Trump’s actions and address the structural problems preceding Trump’s presidency. Some suggested actions include mobilizing against structural racism, supporting health insurance for all, redirecting resources from military and corporate interests to public health and social interventions, and strengthening immigration and labor rights. The report is accompanied by infographics describing the current state of health in the U.S. as well as an audio podcast and video introducing key themes from the Commission.