RFK Jr. is wrecking public health — but we can (and will) survive this
There really is a way to make America healthy again. It's just not Kennedy's way
The greatest invention of the Industrial Age isn’t the iPhone or lithium-ion batteries or even the internal combustion engine — it’s public health. Unfortunately for our “see it to believe it” culture, public health works best when it’s practically invisible, just humming along in the background. Thus, there are few things Westerners take for granted more than reduced child mortality, reduced death in child birth and the eradication of history’s most brutal diseases like polio and smallpox.
Thankfully, very few of us know what it’s like to grow up with half our siblings dying from relatively minor infections or experiencing life-long disability from surviving an epidemic. Those days are behind us — or so some of us thought.
For anyone paying the slightest attention, it’s clear our global society is quickly devolving, reverting back to a time before antibiotics and widespread sanitation. It sounds extreme, but little else would explain the fixation on raw milk, for example. A combination of engrained ignorance and political interests is eroding the foundation of something that made our capitalist society possible in the first place. It’s hard to build an international trade empire if your customers are too sick to work or die often.
Because we are so many generations removed from the people who coughed up bloody bits of the Black Death, it’s understandable human nature why so many of us refuse to acknowledge COVID-19 is a serious illness or think ditching vaccination is wise. Naïvety is intoxicating and no one likes confronting their own ableism or mortality. It’s these forces that are allowing us to grind basic tenets like germ theory and fluoridation into the woodchipper. It’s an astonishing level of reckless stupidity that we will be contending with for generations.
But let’s not get too sentimental about public health either. It’s far from a perfect system. We can think of it like a great oak, with many branches and deep roots. There’s no denying this tree has been poisoned by profit-seeking incentives that have produced giant, twisted branches like Big Pharma or health care insurance middlemen that profit from denying claims. In spite of this, it has helped people live longer, healthier lives compared to those over a century ago — and to fix the issues that plague it, we need to fertilize it, not chainsaw it down. But that’s exactly what we’re doing.
“Public health — and trust in public health — is being eroded in the U.S.,” Dr. Andrea Love, an immunologist and microbiologist, told Salon by email. “We are seeing rejection (and in some instances, legal action) against long-supported and evidence-based public health measures: vaccinations, pasteurization and food safety, water fluoridation. We are also seeing an erasure of investment and funding in research and health care infrastructure that focus on understanding and improving public health. It has been difficult as a scientist, science communicator, and member of this country to see this occurring when we have the most scientific knowledge we have ever had in human history.”
This is the kind of leadership at HHS these days: wasting resources attacking established science while dismantling the systems that protect against epidemics and research treatments.
It’s bad enough that the public is being gaslit about an ongoing measles outbreak that has so far spread across 25 states, infecting more than 700 people, with more than 540 in Texas alone. This epidemic, caused by a virus that was once eliminated in the U.S. in 2000, has claimed at least two lives: two children, one eight-years old and the other only six. The death of a New Mexico man who had measles is still under investigation.
Despite a recent New York Times headline that suggests this is the "new normal," the resurgence of preventable disease is not a law of nature — it's literally a choice we, as a society, are making.
And so much more illness is on the rise, from Victorian-era diseases like tuberculosis to novel tropical diseases like “sloth fever.” The threat of another pandemic, be it bird flu or another COVID-19 surge are always present. But now Republican leadership wants us to pretend like none of this is happening while firing the people who track these sorts of things and gutting social safety nets like Social Security and Medicaid.
Last month, Health Secretary Robert F. Kennedy Jr. announced “a major restructuring” of the Health and Human Services Department, which has so far resulted in the mass layoff of about 10,000 federal health workers. At least eight top-level managers at the Centers for Disease Control and Prevention have resigned in recent weeks, all while the agency has clawed back $11.4 billion in COVID-19 research dollars and suppressed a report on measles suggesting that individuals get vaccinated. Most recently, the Trump administration forced out Peter Marks, the nation’s top vaccine regulator at the Food and Drug Administration, who wrote in his resignation letter “It is unconscionable with measles outbreaks to not have a full-throated endorsement of measles vaccinations.”
Though Kennedy has recently said that the measles-mumps-rubella vaccine is the best way to prevent infection and spread, this is in sharp contrast to his previous statements denying vaccine efficacy, including last week when he incorrectly stated that some vaccines “never worked.”
Maybe Kennedy wants to give lip service to the MMR shot after attending the funeral of an unvaccinated victim of the Texas measles outbreak, but actions speak louder than words: earlier this month, dozens of free measles vaccine clinics were shuttered in Texas due to federal funding cuts. And Kennedy still won’t let go of this ridiculous notion — debunked again and again — that vaccines are a cause of autism. That hasn’t stopped Health and Human Services from recently appointing a discredited vaccine skeptic to investigate this link. On April 10, Kennedy said we’d “know by September” what has “caused the autism epidemic.”
In a statement, Christopher Banks, CEO and president of the Autism Society of America, responded that Kennedy’s remarks are “both unrealistic and misleading,” adding that such efforts “risk undermining decades of progress and causing real harm to the autism community.”
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But this is the kind of leadership at HHS these days: wasting resources attacking established science while dismantling the systems that protect against epidemics and research treatments, not to mention denying people access to health care. The institutions monitoring, treating, researching and informing us about disease are now either broken, underfunded or pushing misinformation. It begs the question: is public health even a thing in this country anymore?
“As it currently stands, public health no longer exists at the federal level,” Dr. Ryan Marino, an emergency medicine physician at Case Western Reserve University School of Medicine, told Salon by email. “It’s still to be seen if this very intentional gutting of our public health institutions, infrastructure and funding will decimate state and regional public health but these ‘cuts’ in spending are likely to mean less services everywhere and for everyone.”
To illustrate how far back this trend goes, professor Sean Valles, director of the Center for Bioethics at Michigan State University, pointed to a 2013 report by the U.S. National Research Council and the U.S. Institute of Medicine, which summarizes the situation in its title: “Shorter Lives, Poorer Health.” Since then, average life expectancy in the U.S. has only dropped further.
“There is some good news, including that drug overdose deaths are finally falling,” Valles told Salon by email. “But the overall picture is dire. As a Commonwealth Fund report puts it, compared to other high-income countries, ‘The U.S. has the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality, and among the highest suicide rates.’”
None of this started with the Trump administration, not even the first one, though the decline has clearly accelerated in just a few months. As Daniella Barreto, host and producer of the podcast “Public Health is Dead,” explained, “The Biden administration paved the way for the further destruction of public health when they decided, in a feat of circular logic, that the COVID pandemic was over because they said so. People latched on to that because they wanted it to be true.”
Barreto gave numerous examples, from how testing was severely limited under Biden, which meant less data to track the SARS-CoV-2 virus, to how in 2021 the CDC was lobbied by airline business interests to shorten COVID isolation guidelines or how the agency’s then director, Rochelle Walensky, said that masks were a “scarlet letter.”
“The push for ‘back to normal’ and short-term profits for corporations have come at the expense of everyone’s long-term health, including children’s,” Barreto told Salon by email.
Congress also bears a lot of responsibility for how public health has been starved, Love said.
“Simply because Biden was President did not give him ultimate authority to repair a lot of infrastructure that had been eroded,” Love explained. “For example, the USDA/FDA budget and personnel cuts from Trump's first term have led to reduction in workforce to conduct food safety inspections that aren’t able to be corrected quickly — especially when the Congress did not allocate more funding to these agencies. RFK Jr’s claims that his gutting of health agencies will improve public health are objectively false — we know that things that will improve public health, and halting funding for critical interventions, research, community outreach/education, and global health will do the opposite.”
Love said that by rejecting public health and defunding the scientific research that is its foundation, “we are all going to become less safe, less healthy, and less secure.”
Indeed, many people are at greater risk of disability or death from these policies — not just at home, but across the globe. Trump’s decision to withdraw from the WHO and the dismantling of USAID and other essential programs will have ripple effects. As the CDC puts in their guide to global health security, “In today's interconnected world, a disease threat anywhere is a threat everywhere – and outbreaks can disrupt American lives and livelihoods even if they never reach America's shores.” Which makes a recent finding by the World Health Organization — that almost 75% of U.N. countries have experienced severe disruptions to health services — somewhat rattling.
“The rhetoric from this administration takes the mentality that health is an 'individual' issue, and not shaped by social determinants of health and societal initiatives,” Love said. “Health issues do not adhere to country boundaries, especially when we are talking about infectious diseases. I do worry that this damage will cause generational, perhaps irreparable harm, as the U.S. erasing its own scientific institutions but also the collaborative ecosystem globally will have far reaching effects.”
In Barreto’s opinion, that’s precisely the point. “The extreme cuts at HHS also impact environmental health, sexual health, and sexual violence prevention programs as well as health and safety regulatory bodies,” Barreto said. “I believe this administration is not unaware that the people who will bear the brunt of this are racialized, disabled, trans and otherwise marginalized.”
If top-level public health basically doesn’t function anymore, where does that leave the public? At least 23 states and the District of Columbia are currently suing Kennedy and the HHS, The Guardian reported, “alleging the abrupt terminations of $11bn in public health funding were ‘harmful’ and 'unlawful.’” A judge later blocked these cuts. But more than staunching the bleeding is necessary, as Valles explained that public health improvements take hard work and investment.
“Today, we need to be a period for rebuilding the public health workforce, so that we have the next generation of public health workers of all sorts, from community health workers who help people to sign up for benefits like food assistance for their children, to CDC researchers vigilantly watching for the next pandemic,” Valles said. “Instead, the federal government is now trying to lay off hundreds of probationary employees at the CDC, rescinding some of the layoffs, and now many of them are caught in legal limbo as courts decide whether their layoffs were illegal. Meanwhile, federal grants that support the work of public health around the US are being haphazardly canceled. This is not how to rebuild or reform an effective public health workforce, it is how to destroy one.”
Love said we need to reclaim the importance of science, which “requires a systemic mindset shift that won’t happen until the misinformation spread by wellness profiteers is clamped down on.” She also emphasized the role of Congress, universities and the media to “push back” on these attacks.
“It needs to be common knowledge what the consequences of these actions will be, even for people who think they aren’t going to be impacted,” Love said. “Without our government supporting these initiatives, we may need to turn to other sources of support. Other countries, philanthropic organizations. But that isn’t a substitute. It’s a band-aid on a broken bone.”
As long as there is a public, there will be public health, Valles said. What shape it takes depends on a lot of things we can’t always control — social determinants of health like income and zip code — so without clear direction on the federal level, we have to begin more locally.
“As a first step, I encourage U.S. readers to learn more about the health of their own communities,” Valles said. “Look up your county in the database of county-level health measures to how your county compares to state and national averages in things like percent of children experiencing poverty, access to opportunities for exercise, and breast cancer mammogram screening rates. If you enter your address on this website, you can see the life expectancy of people living in your neighborhood … Or go to this website to see a map of that data for neighborhoods across the U.S.”
Ultimately, to slow the erosion of public health, it needs to be something that people generally value. It may seem insurmountable to get the Trump administration to reverse course, but it will only be possible if people demand it.
“It’s easy to see what’s happening and feel defeated; it’s objectively awful,” Marino said. “But public health has always been fighting uphill battles without enough resources. And perhaps the hardest part has always been convincing the public to care about public health. I hope that people do not have to suffer and die for people to realize the value that public health provides, even when programs seem so distant. I guess we will see whether people care or not.”
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