“We cannot sit on the sidelines”: Lancet Commission publishes report on public health under Trump

“To me, you cannot be committed to health without being engaged in social struggle for health,” Dr. Bernard Lown said, twenty years ago. While some doctors see a divide between politics and medicine, Dr. Lown asserted, “There is no such divide.”

In 2018, a group of physicians and public health researchers took Dr. Lown’s words to heart, and waded into the political conversation to call attention to impact of the Trump administration’s policies on public health. They formed a Lancet Commission to “catalyse research on the health impacts of Trump-era public policy… and analyse current policies and alternatives.”

The Commission members had no idea the impact of Trump’s policies would have two years later, as a pandemic (and misinformation) spread across the world. Their timely final report, released in February 2021, pulls no punches. The Commission, co-chaired by Harvard Medical School professors Dr. Steffie Woolhandler and Dr. David Himmelstein, calls out the negative health impacts of Trump’s virulent racism, abuse of immigrant detainees, evisceration of environmental protections, repudiation of science, and more.

Of course, the structural problems in our health and social systems did not start with Trump. The Commission report describes how decades of neoliberal policies have contributed to lowered life expectancy, income inequality, and racial health disparities (which themselves are a result of 400 years of oppression starting in 1619). The Commission sets out an ambitious and needed policy agenda for health, which includes bolstering social programs and education, reinstating environmental protections, and creating an all-payer universal system of health coverage.

“Many of those who call the US their home know little of its history. This needs to change, and the report contributes importantly to historical truth-telling.”

Dr. Mary Bassett, member of the Lancet Commission

Importantly, the Commission’s recommendations emphasize policies to narrow the racial health and wealth gaps, such as reparations for Native Americans, Native Hawaiians, Puerto Ricans and African Americans for the wealth denied and taken from those groups in the past; enforcement of civil rights laws, voting rights, and fair-housing laws; and closing for-profit prisons and immigration detention facilities; just to name a few.

Our country’s long-standing racial disparities were manifested in disproportionate rates of infection, death, and economic consequences during Covid-19. “In 2020, 65 year old women white women were dying of Covid at the same rate as 53-year old Latinas, 52-year old Black women, and 48 year old Indigenous women,” said Dr. Mary Bassett, Lancet Commission member and Lown Institute Board Member, at the launch event of the Lancet Commission’s report. Yet our vaccine priorities do not reflect these disparities.

“The most important conclusion of this report is that we not sit on the sidelines.”

Dr. Mary Bassett

Knowing our history is essential for moving forward, said Bassett. “Many of those who call the US their home know little of its history. This needs to change, and the report contributes importantly to historical truth-telling,” she said. Bringing public health funding up to adequate levels is also essential if we want to avoid the next pandemic. “The whole public health infrastructure is too rickety, and it’s too rickety bc we don’t have enough funding,” said Bassett.

“The most important conclusion of this report is that we not sit on the sidelines. Bad policies have cost many thousands of lives and those of us committed to people’s health cannot accept this. Let’s join with others to change what we cannot accept,” said Bassett.