Into the unknown: Trump's stance on health

Abstract

The New Year is a time for resolutions, with many of us redoubling our commitments to improve our own health. This January, against the backdrop of these health resolutions, the USA will inaugurate real estate mogul and reality TV personality Donald J Trump as the 45th President of the United States. With his inauguration comes uncertainty about the future health of the US population and the globe—a fear of the unknown. When it comes to Trump's stance on health, unknowns abound; throughout the campaign and since the election, he has been notably vague. An optimist might argue that his health policy is thus a blank slate, open to constructive input from medical advisors and those knowledgeable in policy, implementation, and funding. On the other hand, based on what little we do know, there is ample reason for pessimism. Trump's most vocal stance with regard to health is his vow to scrap the Affordable Care Act (ACA). Although he has briefly softened that stance, his appointment of ardent Obamacare critic, Tom Price, as Secretary of the Department of Health and Human Services (HHS) suggests that he may indeed opt for a wholesale repeal, perhaps replacing the ACA with a version of Price's Empowering Patients First Act. We have even fewer clues about whether or how Trump might tackle the rising burden of non-communicable diseases (NCDs), which cause 70% of deaths in the USA. These diseases are costly, consuming 86% of health spending in 2010. With Trump, money seems to talk, so perhaps the high price tag of NCDs will get his attention. But it remains to be seen whether he and Price will, for example, continue to prioritise the Healthy People 2020 initiative of the HHS, which includes among its 1300 objectives an aim to reduce the incidence of diabetes and obesity by 10% over 10 years. One also wonders what will become of the Prevention and Public Health Fund (part of the ACA), of which over US$200 million is earmarked for chronic diseases. And how will Trump deal with the ongoing obesity epidemic? In the USA, a third of all adults and nearly one in five children and adolescents are overweight or obese, with the burden falling disproportionately on minorities and those from low-income families. A 2012 report from Trust for America's Health and the Robert Wood Johnson Foundation projected a 10–20% rise in obesity-related health-care costs in nearly all states by 2020, estimating that reducing the average adult BMI by 5% would save billions of dollars in health spending. Trump would be unwise not to take heed, but one wonders—with his self-professed love of fast food and distaste for exercise—whether he will do so. A pivotal part of reversing obesity is calling for increased regulations on sugar content in foods and beverages and on food advertising to children. Such efforts are promising—for example, a UK-based report estimated that, over 5 years, a 40% reduction in sugars added to sweetened beverages would prevent 1 million people from becoming obese and prevent roughly 300 000 new cases of type 2 diabetes. However, it is difficult to reconcile these efforts with Trump's pervasive pro-corporation and de-regulation rhetoric. Trump has also been silent on research funding, and although clues are sparse—he has yet to appoint a science adviser or key cabinet positions—many scientists worry that a cut in research funding is inevitable. Looking beyond the health of his own nation, Trump seems set to undo much of Obama's progress on improving the health of others on the planet. His populist stance and criticism of foreign aid has left many worried that official development assistance might be slashed. Here again we have little insight from Trump himself, and his transition team has reportedly yet to engage the US Agency for International Development, which oversees delivery of most foreign aid. Trump has also called climate change a “hoax”, has vowed to pull out of the Paris Agreement and to revoke Obama's Clean Power Plan, and has named vocal climate change denier Myron Ebell to run the Environmental Protection Agency. Many people argue that the Trump presidency represents a long overdue shake-up to the American political establishment. Perhaps this is true. Regardless, as we enter this era of as-yet unknowns, medical professionals, researchers, healthcare advocates, funders, and civil society organisations must remain unflinchingly focused on promoting a positive, progressive health agenda. In the end, nothing should trump the health of the planet and its inhabitants. For US obesity stats http://www.cdc.gov/obesity/data For US obesity stats http://www.cdc.gov/obesity/data