How the Trump Administration's Policies May Harm the Public's Health.

S ince this past November, when Donald J. Trump was elected to become the nation’s 45th president, there has been substantial and justifiable concern about the impact that his administration may have on health. Much of that public conversation has focused on the impact of the administration’s rollback of the Affordable Care Act (ACA). Perhaps the most significant consequence of repealing the ACA would be the potential loss of insurance coverage for 18 million Americans,1,2 which would effectively roll back hard-fought gains that finally brought the United States into the same ballpark with other high-income countries in providing basic health insurance coverage for most (even if still not all) of its citizens. Beyond the consequences of losing health care coverage is the possibility that Trump’s health policies would have a far greater impact on the public’s health. In order to understand these consequences, we need to acknowledge that much of health is based on non-health-care-related factors. Although the public discourse around health focuses on medicine and health care, social, economic, cultural, and structural conditions have a far greater impact on overall health.3 For example, the United States has enjoyed an unprecedented improvement in health over the last hundred years. In 1900, US life expectancy was 47. Remarkably, by 1950, life expectancy had climbed to 68, a gain of 21 years. This improvement in health was driven in large part by a reduction in mortality from infectious disease. It is important to realize, however, that this improvement in life expectancy preceded the widespread use of antibiotics, beginning with penicillin in the late 1940s. Rather, this gain in life expectancy can be traced to the introduction of such measures as the use of chlorine in municipal water, effective sewage systems, and the systematization of health departments and regulations to ensure safer food, water, and sanitation. Underscoring this point, the United States gained only 9 years in life expectancy in the second half of the twentieth century, rising from 68 to 77 in 1999.