Stephen H. Woolf recently published a tour de force perspective entitled “When Disregard for Population Health Becomes US Policy”[1] in JAMA. The essay documents a suite of policy actions that together weaken access to care, erode surveillance and research, and increase exposure to environmental hazards and infectious diseases. Dr. Woolf adroitly notes that “Policies have consequences. Rural hospitals close when Medicaid funding declines. Injuries increase when safety regulations are lifted. Respiratory illnesses worsen when smokestacks emit more pollutants.”
Flawed public health policies are not new invention of the current administration – decades of policy decisions has led to the U.S. having higher disease and mortality rates compared to other high-income countries. Citing a study by Stokes and colleagues (Missing Americans: Early Death in the United States – 1933-2021)[2], the essay observed that the inability of the U.S. to achieve mortality rates of our peer countries has a real cost in American lives. Stokes et al. estimated that in 2019 alone, the U.S. experienced 622,534 excess deaths and 11.0 million total excess deaths between 1980 and 2019 compared to our peer countries.
Unfortunately, the current administration has adopted policies that may exacerbate the high disease and mortality rates in the U.S. population. These policy choices are reshaping the conditions that determine who lives, who gets sick, and who dies, including:
- Cuts to Medicaid and rising insurance premiums translate directly into delayed care, unmet chronic‑disease management, and hospital closures with impacts that will be disproportionately borne by rural and low‑income communities.
- Pausing surveillance systems and idling or dismantling critical public health databases removes the early‑warning systems that detect outbreaks, rising chronic conditions, or environmental exposures that policymakers and clinicians rely on to develop effective interventions or evaluate harms.
- Shifts in immunization guidance, reduced vaccine promotion, and canceled vaccine research lower herd immunity and slow the ability to respond to new pathogens. These changes raise the risk of outbreaks of measles and other preventable diseases.
- Large‑scale deregulatory actions increase emissions, weaken workplace protections, and reduce oversight which will lead to higher rates of respiratory disease, toxic exposures, and accidental injuries.
- Policies that reduce educational support, safety‑net programs, and economic security will increase stress and worsen mental health for all but the wealthiest Americans.
The impacts of these policies will likely be measured as hospital closures, outbreaks, and shortened lives. Public health officials, scientists and engaged citizens should treat these developments as urgent because they undermine the evidence base, reduce the capacity to prevent and respond to disease, and shift burdens onto the most vulnerable. As Dr. Woolf observes, “a nation that removes health protections, heightens exposure to infectious diseases and toxins, slows scientific advances, and restricts access to health care should expect bad outcomes.”
I hope to amplify Dr. Woolf’s call for public health professionals and organizations to build coalitions and speak out. Important steps can be taken now to help inform the public of how health policies may impact their lives and longevity. Public and environmental health organizations can prioritize activities to brief legislators, conduct media outreach, and support disease surveillance programs. Scientists can prioritize activities to preserve datasets, publish independent analyses of public health policies, and reach out to local groups and media. Concerned citizens can demand transparency from legislators and officials, support local health clinics, and advocate for more effective policies. As Dr. Woolf observed, “Informed consent matters. U.S. citizens may be content to live shorter lives than people in other countries and to accept policies that further compromise their health, but they should do so knowingly.”
[1] Steven H. Woolf, When Disregard for Population Health Becomes US Policy, JAMA, March 16, 2026.
[2] Bor J, Stokes AC, Raifman J, Venkataramani A, Bassett MT, Himmelstein D, Woolhandler S. Missing Americans: Early death in the United States-1933-2021. PNAS Nexus. 2023 May 29;2(6):pgad173. doi: 10.1093/pnasnexus/pgad173. PMID: 37303714; PMCID: PMC10257439.
