Catalysing needed change for health systems in the USA

Abstract

Powerful voices calling for change to address the health-care crisis in the USA are gaining momentum.1Woolhandler S Himmelstein DU Ahmed S et al.Public policy and health in the Trump era.Lancet. 2021; 397: 705-753Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 2Blumenthal D Hamburg M US health and health care are a mess: now what?.Lancet. 2021; 397: 647-648Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 3The LancetHealth in the USA: under examination and under repair.Lancet. 2021; 397: 641Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar These voices are in response to the Lancet Commission on public policy and health in the Trump era: a deep analysis of the causes of long-standing systemic failure of health-care delivery in the country. The proposed change is crucial but daunting, and can be catalysed by deepening the collaboration between clinical medicine and public health. Both efforts share the common goal of maintaining good health; yet they operate on parallel tracks in the USA. A well equipped public health system serves to enable and optimise health-care delivery as it increasingly transitions from health institutions to care within communities, families, and homes4Emanuel EJ The real cost of the US health care system.JAMA. 2018; 319: 983-985Crossref PubMed Scopus (29) Google Scholar and directs a concerted focus towards the health literacy of the US population. During the COVID-19 pandemic, a well equipped public health system would have ensured greater availability of testing facilities and universal implementation of preventive measures. By acting as the front-line barrier, it would have buffered the clinical health-care delivery system by substantially decreasing the burden placed on it. Failure to do so has cost the USA in terms of deaths and illness related to COVID-19 and the cost of the stimulus package and the vaccines. The country's leadership in the development of the COVID-19 vaccines is yet another testament to the USA as a powerhouse for medical research and innovative technology. It is not enough. The Biden administration provides an opportune time for improvement in planning and deployment. We declare no competing interests. Public policy and health in the Trump eraThis report by the Lancet Commission on Public Policy and Health in the Trump Era assesses the repercussions of President Donald Trump's health-related policies and examines the failures and social schisms that enabled his election. Trump exploited low and middle-income white people's anger over their deteriorating life prospects to mobilise racial animus and xenophobia and enlist their support for policies that benefit high-income people and corporations and threaten health. His signature legislative achievement, a trillion-dollar tax cut for corporations and high-income individuals, opened a budget hole that he used to justify cutting food subsidies and health care. Full-Text PDF