During the second Trump administration, major shifts in health care policy, funding and focus have adversely affected public health, including what care can be provided and to whom, panelists said during a Trust for America’s Health webinar.
But there are bright spots: Advocacy through the courts and at the state and local level can still protect public health systems, and community engagement can shine a light on initiatives that improve health for all, they said.
Why advocacy is important
Darlene Huang Briggs, deputy director of special projects at the Network for Public Health Law, pointed to lawsuits that have helped to protect public health staff, grants and public health infrastructure cuts sought by the Trump administration, in addition to rulings in favor of the American Academy of Pediatrics, which filed lawsuits against the administration’s vaccine policy changes.
“I feel like our field has seen the light that advocacy is so important and part of everybody’s jobs,” Briggs said. “I think there’s a real sense of we are all in this together.”
Dr. Olusimbo “Simbo” Ige, commissioner of the Chicago Department of Public Health, discussed how the federal government has tried to claw back millions of dollars in funding for HIV, wraparound services and related work in Chicago and 10 surrounding counties, which would affect around 20,000 people who depend on those services. She noted that HIV organizations, people with HIV, elected officials and others rallied together to advocate for the services, and ultimately, a restraining order and temporary injunction were issued, preserving funding.
Ige also highlighted why public health work is important, noting that life expectancy for people of color in Chicago trailed other cities. However, because of public health initiatives and investment, the city has begun to close racial life expectancy gaps. Additionally, she said, overdoses and violence in the city have been reduced as a result of such investments.
“This is why we need to protect this infrastructure, but we are spending all that time now writing letters, making noise, saying, ‘Let us protect the good work that we have started,’” she said.
Advocacy at the state and local level is the focus for Scott Thorpe, executive director and founder of the Southern Alliance for Public Health Leadership. Thorpe said that area often is overlooked, even though state and local policies have a major impact on communities.
“I don’t think they hear from advocates enough, and so we spent a lot of time facilitating that, in doing more to connect them to folks who work in public health who are seeing this stuff day to day,” Thorpe added.
Additionally, lawmakers don’t always have the data they need to make public health decisions, he said. “I cannot tell you how many legislators I have talked to on both sides of the aisle who will say, ‘All of the people who live in my community are vaccinated.’ And I can share the data to show that is definitely not true.”
Tekisha Dwan Everette, executive vice president at Trust for America’s Health, said that public health policy decisions affect us all, not just specific populations. “The key notion is if we are not speaking up about what is happening and providing the data and information to those who are able to make policy decisions – because policy is an intervention in public health – then we are risking the continuation of negative and poor outcomes,” Everette said.
Resources needed to address challenges
Public health efforts need accessible resources to address today’s challenges, including infrastructure and staffing, as well as ensuring that policymakers recognize the value of public health, Ige said.
“If we don’t have the disease investigation specialists and the epidemiologists and the public health inspectors who ensure that infrastructure is secure and safe, it has consequences for everybody,” Ige said. “It is not just that we are giving vaccines; it is that the very fabric of most economies … depends on having a protective infrastructure that enables people to live, work and play in a healthy environment, and that is what we do every day.”
She highlighted several areas where public health work is visible and can have a definitive impact on communities, as long as funding and infrastructure are in place. In Chicago, chronic disease is the No. 1 reason residents don’t live past age 65, and among the issues contributing to chronic diseases are access to healthful foods, opportunities for exercise in communities and tobacco marketing. Ige said that those are areas that public health targets. She also noted the impact public health has on preventing disease outbreaks stemming from the city’s 17,000 food establishments, and said the city would feel the negative effects not just in health care but also in tourism and other sectors.
Thorpe agreed that more funding is needed, particularly in rural areas across the South, where his organization works. Rural hospitals, as well as labor and delivery units, are closing; many states have not expanded Medicaid; and access to care can be limited as providers struggle with low reimbursements. “Access is priority No. 1 across so many areas in the South right now, as we see health care infrastructure just on the verge of collapse in a lot of places,” he said.
Briggs added that partnerships are vital as funding for public health initiatives has been reduced. “We will all have to be cognizant of meeting to work together and use limited resources more efficiently,” she said.
Briggs also noted that trust is at the center of public health work and positive community interactions can “[allow] us to have the advocacy wins that we are looking for.”
Community engagement
What’s important to community partners isn’t tied to the administration in charge or to a specific moment in time. It is the ability to access health care and the social drivers, such as transportation, that make it difficult for families to get the care they need, Thorpe said. By working closely with community partners, his organization can take their messages to lawmakers to illustrate the depth of the issues facing the community and paint a more comprehensive picture.
“We have to keep those community partners really centered in our work because they know better than we do, almost always, what is happening at a really hyperlocal level,” Thorpe said.
In Chicago, Ige said she is “using an all-of-community approach” that elevates the voices of people with lived experience and shows how public health work affects everyone. If an emergency department, for example, is overrun with people who have measles, then the waiting time for everyone will rise, which is a problem for the entire city, not just certain communities.
Her department also works with community organizations, faith-based groups and organizations in sectors outside of health care, and hears from people who have concerns about extending resources to other communities to demonstrate the visible and collective impact of public health work.
“Having services for those who need it the most also makes it easier for you to access the services that you need,” Ige said.