Trump budget a roadmap to worsening health

Sepatuads.com   April 12, 2017   American Public Health Association, behavior, environment, socioeconomic status., Trump Budget, Washington Post   Comment  

Source (Washington Post)

The May issue of the American Public Health Association reviews the budget cuts which it sways would be "devastating to public health."  (This issue is not yet on line - this will be the URL when it is uploaded).   I've correlated this with the reporting from a month ago in the Washington Post.

It's important that we recognize that the failure of the AHCA and "repeal and replace" doesn't mean that public health is by any means safe.

• Health and Human Services: $15.1 billion cut (18%)
• Centers for Disease Control and Prevention: additional 12% cut if the ACA's Prevention and Public Health Fund is eliminated.  The Administration promises $300 million for Zika research - but that will taken from somewhere else in the CDC budget.
• National Institutes of Health $5.8 billion (18%).  That's less cancer research - and fewer new basic science discoveries
• Environmental Protection Agency  $2.5 billion cut (31%).  This threatens Superfund site cleanups and drinking water inspections and will decimate enforcement efforts
• Department of Labor $2.6 billion cut (21%) eliminating grants that support training in occupational health
• Department of Agriculture, $4.7 billion cut (21%). The administration pledges not to cut back on food safety inspections -but who believes that?  The Administration pledges to fully fund SNAP (aka food stamps), although the actual budget there is lower due to the improved economy.
• Department of Energy $1.7billion cut (6%)  Programs to decrease carbon emissions are wiped out, and there are new dollars for nuclear disposal.

This is to say nothing of the efforts to further trim a social safety net that is already more threadbare than that of most of the developed world.  

Sometimes we in the health care world spend so much time thinking about how to improve the medical care delivery system that we can have a blind spot about how little of health care outcomes is driven by the medical care system -and how much is driven by socioeconomic factors, environment and behavior.  Economic policies that lead to increased poverty and income disparities will also worsen health in the US. The Trump Administration is disassembling the levers that government has used to help improve the overall health of our communities.   We must argue as strenuously against these ill-advised budget cuts as we did against the reckless attempt to repeal the Affordable Care Act.