Story at a glance

  • The coronavirus pandemic exacerbated existing inequities in the United States, especially for Black, Indigenous and Latino communities.
  • A commission of 33 experts from the United States, United Kingdom and Canada shows the effects of public policy decisions both before and after the pandemic on COVID-19 mortality.
  • The report found that the Trump administration’s decisions cost thousands of American lives both before and during the pandemic.

When 33 experts from the United States, United Kingdom and Canada gathered for the first meeting of the Commission on Public Policy and Health in the Trump Era, none of them had heard of COVID-19. They couldn’t have — it didn’t exist yet. 

In order to get a bigger picture of how public policy decisions were affecting public health, The Lancet, one of the oldest peer-reviewed general medical journals, established the commission in 2017. Now, data from original analyses, published studies, legal documents, news reports and government websites reveals the fatal consequences of the Trump administration’s decisions. 


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“While the USA ranks highly in its global health security index, the COVID-19 pandemic has shown how woefully inadequate the country’s health care and public health system has been in protecting the nation’s health. The COVID-19 pandemic has exploited existing health and social inequalities and nowhere is this more apparent than in the USA. At moments of instability, the world needs a strong USA, bolstered by a healthy population, to lead a global response,” said Richard Horton, editor-in-chief of The Lancet, in a statement.

When the coronavirus pandemic broke out in late 2019, however, the United States wasn’t healthy, according to the commission’s report, published Thursday. The stage had been set decades ago: Americans' life expectancy began falling behind other high-income nations in 1980 and hasn't recovered since, with higher midlife mortality rates among Black and Indigenous Americans compared to their non-Hispanic, white counterparts. Between 2008 and 2016, cuts in funding for public health agencies led to the loss of 50,000 front line workers. 

So when COVID-19 arrived in the United States, the report found nearly 11 percent of Americans suffered food insecurity, increasing the risk of preexisting conditions that made them vulnerable to the disease, and housing crowding was a hotbed for the spread of disease. 


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“Americans’ health was deteriorating even as our economy was booming,” said Steffie Woolhandler, a professor at the City University of New York and Harvard lecturer, in a statement. “This unprecedented decoupling of health from national wealth signals that our society is sick. While the wealthy have thrived, most Americans have lost ground, both economically and medically.”

Under the Trump administration, rollbacks of environmental protections, tax cuts and deregulation cost an estimated 461,000 American lives in 2018, according to the report. Forty percent of U.S. deaths last year could have been averted if the country had not gone into the pandemic with such a high mortality rate, the report found. Some of that is attributed to the 2.3 million additional U.S. residents who became uninsured as a result of the Trump administration's actions, including 726,000 children, as well as underfunding of the Indian Health Service. 

“The Commission highlights how racial disparities in health have grown in the last four years, especially as COVID-19 has taken its grim and unequal toll in Black, Latinx and Indigenous people,” said Mary T. Bassett, director of the FXB Center for Health and Human Rights at Harvard University, in a statement. “The disastrous, bungled response to the pandemic made clear how existing, longstanding racial inequities simply have not been addressed. It's time to stop saying these preventable gaps cannot be eliminated. The report calls for structural solutions, including reparations, to ensure everyone has the right to health.”


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Published on Feb 11, 2021