The headline of a Washington Post editorial board piece caught me off guard last week. It read, “Trump’s record on science so far is a mixed bag.” I read on to try and understand the points made but found myself disappointed and confused by the message conveyed.
Somehow despite the Trump administration appointing several climate deniers to key public health positions, working more closely with the oil and gas industry on policy than with public health organizations, and failing to name a science advisor, the authors argue that that there are “hopeful signs” in the public health arena despite the failures to protect the environment and reasonably approach the risks of climate change.
But to the editorial board of the Washington Post I say: you cannot separate public health from the environment and climate change. Just because the Department of Health and Human Services (HHS) has health in its name doesn’t mean it’s the only federal agency responsible for protecting public health. The fact is that our health is affected by a host of public policy decisions outside of the Centers for Disease Control and Prevention (CDC) and U.S. Food and Drug Administration (FDA’s) purview. What about environmental health at the EPA? Occupational health at the Department of Labor? Nutrition and food safety at the Department of Agriculture? I have a hard time thinking of a single federal agency the decisions at which don’t have impacts on public health in some way. Every arm of the federal government has a responsibility to protect all Americans from a variety of potential harms, from malnutrition to the devastating health impacts of poverty.
You might not think of the U.S. Department of Housing and Urban Development, for example, as having public health impacts. But, researchers have found that individuals receiving housing assistance from HUD are more likely to have access to health care than those on waitlists to receive housing assistance.
What about the Department of Commerce? The U.S. Census Bureau provides accurate and up-to-date statistics on a range of issues related to health in the United States, ranging from fertility to disability to health insurance coverage. This information helps other government agencies, state health departments, organizations, and the rest of us identify what health interventions might be needed for certain communities.
To narrow the focus of positive scientific developments to just one federal department and to use what I would consider a low bar for a good record on science fails to consider the ramifications that the Trump Administration’s actions and general disdain for science are having and will continue to have on public health. Yes, it’s true that the National Institutes of Health director and the CDC director are scientifically qualified to hold those positions. It’s true that Alex Azar, new head of HHS, has publicly stated that the CDC should be able to conduct research on the impacts of gun violence on public health. But, it’s also almost a year and half into the Trump administration and we’ve seen FDA’s Scott Gottlieb delay science-based added sugar labels at industry’s request, the previous CDC director resigned due to conflicts of interest so serious that she was unable to contribute to discussions ranging from tobacco to Zika vaccines, HHS removed LGBT health resources from its Office on Women’s Health website last fall and defunded over $200 million in teen pregnancy prevention program grants. The list goes on.
While there is promise of science-based policy decisions that will come out of HHS, there are also great concerns about the public health ramifications of this administration’s already very long list of attacks on science. At the EPA alone, the 22 deregulatory actions that Administrator Pruitt has bragged about saving taxpayer dollars actually will mean unrealized benefits for communities facing risks from environmental contaminants throughout the country.
For example, Pruitt has issued a proposed rulemaking to begin rolling back the 2015 Coal Ash Rule which would have required utility companies to monitor ponds storing coal ash waste (a byproduct of coal production), report leaks and spills regularly, and make lining ponds mandatory. If this federal requirement is no longer in place, we will see continued leakage of heavy metals into groundwater and surface water with known health consequences, including cancer risk, for nearby community members. Administrator Pruitt is doubling down on his misunderstanding of how science should inform policy by hinting at issuing a directive that would enact language from the HONEST Act. This would be an asinine move that would hamstring EPA’s ability to use a variety of scientific studies to support its policies which would have a drastic impact on its ability to enforce its own standards to protect public health from things like air pollution and lead contamination.
There have been several attempts at other agencies, like the Department of Interior (DOI), to stop monitoring and collecting data on environmental health impacts altogether. In August, DOI halted a National Academies study it had begun to fund that would have looked at the impacts of coal mining operations on residents of Appalachian states. Then, in December, DOI ordered NAS to cease yet another planned study that would review the department’s ability to inspect offshore oil and gas operations, originally commissioned to help prevent public health risks the likes of which were seen after the 2010 Deepwater Horizon explosion. These research endeavors would have contributed to the body of evidence to help the government better protect public health from oil spills and downstream impacts of coal mining, but the administration’s actions display apathy toward both evidence and protecting public health.
And while there has been some progress made in defense of science priorities, like the fact that the 2018 fiscal year budget from Congress was signed by the President even as it protected strong funding to the science agencies, the mere fact that the President’s budget initially called for a 30% decrease in funding for EPA, and its Office of Research and Development and enforcement programs shows that using science to protect public health is not a priority for this administration. Acknowledging this fact, we understand how important our role is to continue to defend the scientific work of each agency so that we can preserve as much of our public health safety net as possible, despite political appointees’ and industry lobbyists’ best efforts to undermine it.
This week marks National Public Health Week as designated by the American Public Health Association, and while we should think about how to better protect the health of the next generation this week, we should remember that there are children at risk every second. All arms of government and all of us have a role to play in improving their lives not just through better access to healthcare, but through public safeguards that minimize or eliminate risk from all exposures. From air quality controls to pesticide tolerance levels to gun safety reforms, it’s our duty to build, not to demolish, the public health infrastructure that will allow the next generation to accomplish all of the feats they aim to take on.
Follow along with the American Public Health Association’s National Public Health Week’s conversations on twitter @NPHW and with the hashtag #NPHW.
