高清福利片

In 2016, life expectancy at birth in the United States fell for the second year in a row, driven by obesity, suicides, the opioid crisis, and inaccessible health care. Now, more than ever, public health needs political commitment and respect for science.

Sadly, politics trumps health, emboldened by a President who prioritises rich over poor and corporations over healthy communities. Here are six ways the Trump Administration undermines public health:听听

1.听The war on science

President Trump constantly casts doubt on science. He suggested childhood vaccines cause autism (untrue) and cast aside the scientific consensus that humans accelerate climate change, withdrawing from the Paris Agreement.

Alarmingly, his Administration instructed the nation鈥檚 public health agency 鈥� the Centers for Disease Control and Prevention (CDC) 鈥� not to use seven words: diversity, transgender, vulnerable, foetus, entitlement, evidence-based and science-based.

Yielding to the National Rifle Association, Congress virtually forbids CDC from conducting firearms research.

2.听鈥淯nhealthy鈥� regulation

If the Trump Administration is committed to one big idea, it is gutting health regulations developed under former President Obama. Agriculture Secretary Sonny Perdue reversed Obama-era rules for healthy school lunches, , 鈥淚t doesn鈥檛 do any good if nutritious meals wind up in the trash can.鈥�

He also delayed plans to reduce the amount of salt in school lunches, even though 92 percent of children exceed the maximum recommended salt intake. The Food and Drug Administration (FDA) delayed new rules requiring 鈥榓dded sugars鈥� be included in nutrition labels until 2020, caving to food companies.

The Environmental Protection Agency (EPA) rolled back 76 Obama-era environmental protection rules. Vitally, the EPA reversed greenhouse gas and fuel economy rules, handing car companies a victory. To limit reproductive rights, the Department of Health and Human Services (HHS) rescinded Obama-era guidance that prevented states from de-funding health facilities offering family planning services, including abortions.

3.听Dismantling Obamacare

Congress tried unsuccessfully to repeal the Affordable Care Act (ACA) 70 times, but 鈥極bamacare鈥� has still been badly damaged. Congress is set to repeal the requirement that health insurers offer 鈥渆ssential health benefits鈥� including emergency, maternity/paediatric, mental health, drug-addiction, and preventive/wellness services.

Trump鈥檚 2017 budget gave corporations a massive tax reduction and repealed the ACA鈥檚 individual mandate to buy health insurance. Trump now wants to rescind the employer mandate, which requires large organisations to offer health听plans to employees.

Perhaps most cruelly, states can now opt-out of the ACA鈥檚 proposed expansion of Medicaid 鈥� the federal-state听health听program for low-income and disabled persons. The President has also given states permission to require Medicaid recipients work or lose their health cover.

4.听Pre-empting local regulation

Pre-emption is the ultimate deregulatory tool masquerading as legal doctrine. Pre-emption allows higher levels of government to block the actions of lower levels of government 鈥� its effect is to prevent cities (or even states) from protecting their residents鈥� health.

Federal pre-emption shields food companies from consumer protection lawsuits, while state-level legislation prohibits municipal taxes on sugary drinks. The 鈥楶rotection of Lawful Commerce in Arms Act鈥� protects firearms companies and dealers from liability for crimes committed with their inherently dangerous weapons. By law, the Consumer Product Safety Commission cannot regulate two products: firearms and tobacco.

5.听Funding games

Earlier this year, the Trump Administration released its 2019听budget, which included savage cuts to the National Institute of Health, CDC, and foreign health assistance. Congress baulked at cutting funding for health research and foreign aid, but CDC expects to be hit hard and is already pulling expert staff from low-income countries in preparation.

Also facing huge cuts is the ACA鈥檚 Public Health Prevention Fund, which supports CDC and state health departments for vital health protection, and the Global Health Security Agenda, which funds emergency preparedness (think Ebola,听Zika, Influenza).

6.听Shunning global values and norms

What may be worse than all this 鈥渦nhealthy鈥� policy is Trump鈥檚 flouting of American values 鈥� of justice and equity, human rights, and rules-based international norms and institutions.

Last month, the US withdrew from the UN Human Rights Council and froze all funding for Palestinian refugees. The Trump administration threatened trade sanctions against Ecuador for sponsoring a World Health Assembly resolution promoting the health benefits of breast feeding 鈥� until, ironically, Russia stepped in. The President also reversed Obama鈥檚 immigration policy of letting 鈥榙reamers鈥� stay in America 鈥� people who arrived as infants and have no other home. He separated mothers from babies at the southern border.

The saddest part of Trump鈥檚 policies is that they hit the vulnerable hardest, perhaps further reducing life expectancy and imperilling America鈥檚 already fragile safety net. Every day, the President of the country that gave birth to human rights and multilateralism shows disdain for global norms and institutions. America was once 鈥済reat鈥�. To make America great again, its leaders need to demonstrate moral authority.听听

This article was authored by听,听director of the WHO Collaborating Center on National and Global Health Law, Linda and Timothy O'Neill Professor of Global Health Law at听, Faculty Director of the O鈥橬eill Institute for National and Global Health Law and Visiting Professor at the听, and听,听Professor of Health Law and Governance at听听and听Adjunct Professor of Law at Georgetown University.

Professor Gostin and Professor Magnusson were featured speakers at a free seminar 'Public Health Law and Health Leadership in the United States: What can Australia learn?'听at the University of Sydney Law School on Thursday 19 July from 6pm, co-presented by the听and the听.

Want to find out more?

高清福利片 health law

Sydney Law School offers a 听and that includes units of study in medical law, public health law, mental health law and global health law and governance. It is open to both legally qualified candidates as well as those without a law degree.

Find out more about , including '' delivered by Professor Magnussen and '' delivered by Professor Gostin.听

Top image: Demonstrators march through downtown听Philadelphia听in 2017 in protest against a proposed repeal of the Affordable Care Act. Image: MB298/Wikimedia Commons.听