Buyer’s Remorse, Betrayal, and Blame: Who Will Be Held Responsible for the Adverse Health Impacts of the US Elections?

Predictions that US population health and health inequities are likely to grow worse in the wake of the 2024 US elections and that US government support for public health, science, and both global health and climate change initiatives will be curtailed^1,2 have a critical but unspoken counterpart. To wit: who will be blamed?³

POLITICAL, ECONOMIC, AND IDEOLOGICAL THREATS TO HEALTH

After all, poorer health and worse health inequities are hallmarks of societies dominated by political ideologies and politicians that prioritize market fundamentalism, individualism, authoritarianism, and so-called “traditional culture” (including religious fundamentalism), as compared with societies where political ideologies and state power uphold social equity and protect collective goods (e.g., keeping healthy the air, soil, water, and relationships on which all life depends).^1,4,5

Promising a five-alarm fire, Project 2025, the right-wing manifesto for the new administration, aims to eviscerate both the “regulatory state” and the “welfare state.”^1,2 The agenda includes (1) massive tax cuts for corporations and wealthy individuals, imposition of high tariffs, and mass deportation of both undocumented immigrants and those with temporary protected status; (2) policies curbing health care (e.g., upending the Affordable Care Act, further restricting abortion care), slashing funds for safety net programs, and shredding funding for and authority of public health and environmental agencies; and (3) pulling the United States out of the World Health Organization and the 2015 Paris Climate Agreement, coupled with gutting of US environmental, clean energy, and occupational safety and health regulations.

While not all policies proposed at the time of writing this piece may go into effect, consider the likely myriad impacts of, say, mass deportation of undocumented immigrants in the United States—who work in precarious circumstances with wages driven down precisely because employers wield the threat of deportation. Beyond harms to the health of these immigrants and their communities, costs will rise for food, housing construction, warehouse-dependent commerce, and health aides, and these costs will be exacerbated by intensifying climate change via worse storms, floods, and wildfires. These price hikes will disproportionately impact US adults without a college degree and their families—whose ranks include, among voters, White adults (66% of whom voted for Trump⁶), adults of color (64% of whom did not vote for Trump⁶), and also those who were unable or unwilling to vote.

PUBLIC HEALTH, ACCOUNTABILITY, AND THE POLITICS OF BLAME

Who, however, will be blamed, by whom, when population health profiles tank, health and health care inequities widen, and billionaires reap bonanzas?³ Will there be “buyer’s remorse”?³ A sense of betrayal?³ Or, in the time-disgraced playbook of authoritarian governments, will blame be affixed to those deemed to be—in the language of the new administration—internal “enemies of the people” who are demonized as “pests” who “poison the blood” of the nation (echoing the language of eugenicists, Jim Crow supporters, and fascist “racial hygienists” in Europe and the United States in the 1900s to 1940s)?^3,7

Our job in public health is to prevent scapegoating and to document and make vividly clear, in media and forums of all forms, the causal connections between economic and social inequity, illiberalism, and the people’s health. We must ensure that blame for immediate and subsequent health harms is affixed, as warranted, to the new administration’s actions, policies, and plutocrat allies. The timeworn excuse so often invoked to explain and explain away past injustice—“they didn’t know any better”—is a lie that cannot stand. In keeping with this issue’s theme “Threats to democracy are threats to public health,” and mindful of the Journal’s founding 115 years ago, may the record be clear, 115 years from now, in 2140, that many of us in public health fought back and fought for a better, more equitable future in which all can thrive.