Here’s common ground for Trump, Congress, and public health
Maps show high-priority preventive health needs among the president-elect’s base and others, writes Dr. Eric B. Larson
by Eric B. Larson, MD, MPH, Group Health Research Institute (GHRI) executive director, and Group Health vice president for research
After last week’s stunning presidential election, many are wondering how the new administration will prioritize action to meet the nation’s health care needs. Questions about the future of the Affordable Care Act, funding for health research, and support for regulatory agencies like the FDA abound. If President-elect Trump wants to deliver on his promise to “make America great,” where might he begin?
One big opportunity is to solve health and health care problems in the very communities where he has the most support. I’m reminded of a conversation I recently had with my friend and colleague Dr. Steven Schroeder, professor of health and health care at the University of California, San Francisco Department of Medicine. As former president and CEO of the Robert Wood Johnson Foundation, Steve has spent a lot of time thinking about strategies to improve the health of large populations. He knows how the countries of the world stack up when it comes to life expectancy, infant mortality, and other measures of well being. He has studied how governments can get the best “bang for their health care buck,” if you will. That’s one reason he recently established the Smoking Cessation Leadership Center at UCSF; tobacco addiction causes more premature deaths than all the other preventable causes combined.
Over dinner just before the election, Steve told me about a commentary he had just published in Preventive Medicine that takes a careful look at one of the greatest determinants of health in America: social class. With a widening gap between rich and poor in our country, the United States continues to slip behind other developed nations when it comes to important measures of health and well being.
A prevention “Moon Shot” for the Southeast
Problems like smoking, obesity, drug and alcohol addiction, and teen pregnancy are disproportionately affecting poor and less-educated people in our country. And although we typically have associated health disparities with racial minorities, Steve points to a recent study showing that less-educated white males in our country are disproportionately facing health problems linked to social causes as well. This doesn’t lessen the significance of inequities among poor minorities. But it’s interesting to note that for the first time in U.S. history, young white men are losing ground in life expectancy because of increases in suicide and misuse of alcohol and drugs such as opioids.
While class-based health problems exist nationwide, Steve writes that they are especially concentrated in the Southeastern part of the country — states like West Virginia, Kentucky, Arkansas, and Mississippi. So if we want to make a big difference in the nation’s health status, he says, we could promote a “Moon Shot” focus on the kind of social determinants of health that lag in the Southeast.
I took another look at Steve’s paper after the election. This time, I was struck by how CDC data showing geographic differences in smoking rates and deaths from lung cancer resemble the geographic distribution of the election results. Many states with the highest concentration of preventable health problems — states such as West Virginia, Kentucky, Arkansas, and Mississippi — also have the highest concentration of people who voted for Donald Trump. With the exception of a few outliers — Wyoming, Indiana, and North Dakota — the association is apparent: The higher the smoking rate, the higher the percentage of people who voted for Trump.
Initiatives could benefit everyone
Considering this — along with the exit polls that said Trump supporters cast their votes in hope of “change” — it occurs to me that the new administration has a big opportunity if they will take it. Changing disadvantaged Americans’ lives for the better can be done by focusing on efforts that move the dial on social determinants of health.
Of course, activating such solutions is challenging and will require continuing government action to ensure better access to affordable health care for the poor — an issue that is sure to be contentious as Trump determines his stance on the Affordable Care Act going forward. But focused government policy and funding decisions may be an opportunity for the new president and Congress to work together with political allies and opponents to make a unified commitment to measurable, positive change that will benefit not only their supporters, but the U.S. population at large. Initiatives to reduce smoking, suicide, obesity, drug abuse, and other socially determined health problems could vastly improve quality of life for a vulnerable population. And long term, these actions could improve economics for everyone by slowing growth in health care costs.
Given how divisive the election was, perhaps the new administration will be looking for ways to quickly show it can lead efforts that improve quality of life for all Americans. It’s a highly optimistic wish, I know. But given all that we at Group Health and elsewhere know about health care’s potential to improve people’s lives, I believe it’s one worth expressing.
