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May 27, 2018

Scorecard shows public health goals could suffer under Trump

January 19, 2017

Scorecard shows public health goals could suffer under Trump

Speculation abounds on what a Donald Trump presidency will mean to the future of public health, particularly health care coverage.

To measure the potential impact of commitments and statements made by the president-elect and his appointees, researchers at U-M, Oxford University and the London School of Hygiene & Tropical Medicine have drafted a scorecard showing the likely consequences if the new administration follows through with what they have said in areas ranging from Obamacare and climate control to reproductive health and gun violence.

Their findings are reported in the Lancet.

"The Trump presidency is likely to take the U.S. backwards on almost every form of public health policy, from health care access to global health to climate change," said Scott Greer, associate professor of health management and policy at the School of Public Health. "Not only will such a shift undo decades of bipartisan consensus on many issues, it is also unlikely to happen without serious domestic political consequences.

"There's no way to sugarcoat it. We know a lot about what we need to do to improve public health, including by expanding health care access, for example. And there are explicit Trump and Republican commitments to do the opposite."


Scott Greer, associate professor of health management and policy, discusses how public health goals may be affected by the Trump presidency.


Using the United Nations' "Sustainable Development Goals," objectives agreed upon by most countries in the world, Greer and colleagues zeroed in on the key health goals and matched them with relevant statements by Trump and other Republican Party leaders.

They then created a traffic light system of scoring, with red designating the actions of the administration that most assuredly would reverse progress on health policy, amber suggesting the outcome is unclear and might not lead to a negative outcome, and green indicating a position that supports further progress.

The scorecard for the incoming administration was mostly red with some amber and no green. Those in the red include universal health coverage, evidenced-based health policy (the science behind health care), reproductive health, vulnerable populations (prisoners and detainees), social determinants of health and health inequalities, and gun violence.

Greer emphasizes that the researchers don't know what the new administration will actually do, but that their analysis is based on what Trump and his team have said about these issues, and the current state of politics.

"The politics risk putting public health on one side of a partisan divide, which is not where a field committed to evidence and health ought to be," he said. "That makes it imperative to not just voice objections to harmful policies, but also to work across parties and every level of government to identify areas where there can be progress and agreement found. Being patronizing and partisan is not the right strategy."

Greer says what remains uncertain is where Trump will land compared with his party.

On some issues, like environmental and occupational health regulations, he is aligned with party leaders. But one of the biggest questions is what he'll do to follow up on his statements to repeal and replace the Affordable Care Act. Party leaders want to repeal the ACA and convert Medicare into a voucher system and Medicaid into a block grant.

"Substantial numbers of Trump voters as well as large parts of the health care system, rural and urban, depend on these programs, and Trump explicitly defended Medicare during the campaign," Greer said. "Pursuing the full Republican health care agenda could present insoluble policy and optics problems for the party, and potentially even drive a wedge between movement conservatives, whose objective is to shrink the state, and Trump voters who want to defend the programs they need.

"The real question is how much Trump picks out his own agenda and pushes it, and how much he just chooses to sign the budgets and legislation that the Republicans in Congress serve up."


Helen McFarland
on 1/19/17 at 7:35 am

"Greer emphasizes that the researchers don't know what the new administration will actually do,.."

I think this sentence says it all.

Joe Bob
on 1/19/17 at 8:01 am

More hype that's not warranted.

Bonnie Krey
on 1/19/17 at 9:18 am

It is noted within the title of this article "COULD" not will.

Sue W.
on 1/19/17 at 10:39 am

Yes and it also could not. Maybe it should have been titled that it "may not".
Still think it was a slow news day.

Kevin Atkins
on 1/19/17 at 9:23 am

"[D]ecades of bipartisan consensus"? Like the vote on the ACA?
'Using the United Nations' "Sustainable Development Goals," objectives agreed upon by most countries in the world'; possibly agreed upon, but not actually enacted.
"We know a lot about what we need to do to improve public health"; the wonder of having all the answers when you're all of the apparent age of Greer.
Want to bet if Trump said he wanted single payer or to increase the enforcement capabilities of the EPA these self-same folks would warn about the problem of access inherent to the former (see CHC or NHS) or the effect on civil liberties of the latter.

Gilbert Stiefel
on 1/19/17 at 9:33 am

Of course, this is speculation but it is based on stated intent. If I say my intent is to punch you in the nose, do you put your hands in your pockets?

Atkins Atkins
on 1/19/17 at 10:36 am

Speculation on stated intent? Speculation in a moment. Stated intent, or someone's judgement as to what will be the result of a particular statement? In this article, short on specifics, we get the judgement of Greer and associates of what will be the result of statements when put in force. Maybe, maybe not!! Speculations indeed.

We are left with someone telling me that your intent is to punch me in the nose. Perhaps I should ask what are the biases of the person making that claim before making judgements about any threat you might pose to me.

I would add that your example, using a violent act as your analogy, is interesting. Perhaps I might speculate that your set point for disagreement is low and your early response is to think in terms of violence!!

Bill Westin
on 1/19/17 at 10:48 am


Kevin Atkins
on 1/19/17 at 11:13 am

Bill, from your response, my speculation is that you are person of discriminating intellect!!

Mark Simpson
on 1/19/17 at 12:46 pm

#fake news! When Eisenhower became president omg a general as president he'll start another war! When JFK became president we will have to all live under the Bible, people without a real job continue to say the sky is falling. This has political bias all over it. A special kind of click bait.

John Signorino
on 1/25/17 at 1:09 pm

The researchers looked at some commonly used public health metrics and "matched them with relevant statements by Trump and other Republican Party leaders."

This appears to be a sensible approach. If a politician makes statements regarding public health and they and their party are in a position to turn those statements into actual policy or law, these statements represent credible evidence of intent. At that point, it is rational to analyze the potential impacts.

In fact, other alternatives do not appear rational. For example, we could ignore all statements made by politicians until they actual enact policy; however at that point you may not have the time to carefully consider and weigh the implications and you are not holding your political leaders accountable for the words.

I appreciate the authors' efforts to consider the implications of policies based upon statements of the ruling party. This type of analysis allows me (and hopefully others) to decide whether to support or object to those stated policies, and to have time to make our voice heard (such as by writing your Congressman). As such, I do not think that this is fake news or click bait and I enjoyed the article. Thank you.

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