From MMXX to MMXXI: The Way Forward to Renew American Health Policy

Calendar year 2020 was a year of tremendous turbulence for the public’s health. Prolonged heat waves across the nation fueled numerous wildfires that destroyed thousands of acres of forest, hundreds of properties, and many lives. We experienced 28 named severe storms, including 12 hurricanes. Climate change contributed greatly to the severity of all of these significant weather events. Politically, the fight to mitigate climate change was undermined by regulatory rollbacks that will accelerate climate change by continuing the widespread use of fossil fuels while not reducing the toxic gases that fuel climate change and the particulate matter known to harm our health.

The COVID-19 pandemic that has infected more than 11 million Americans and caused more than 240 000 deaths¹ is a catastrophe. It is the most destructive infectious disease we have seen in more than 100 years and has been the cause of the greatest economic and social upheaval since the Great Depression. More than 2.4 million people have become unemployed across a wide range of the economic stratum, but like most detrimental economic impacts, the poorer you were, the more likely you were to lose your job. In addition, women have been more severely impacted by these job losses than men. From a health perspective, the pandemic exposed for all to see the health inequities that still plague our society. Communities of color and those working in “essential” occupations have borne the brunt of the most severe health impacts, including higher COVID-19 morbidity and mortality rates.

Trust was assaulted in the most brutal ways with the undermining of our scientific processes and the politicization of many our most trusted health agencies.

We live in a globalized world where health is dependent on planetary events beyond our borders. Both the COVID-19 pandemic and climate change are prominent examples of this fact. Yet, the United States formally left the Paris Climate Accords on November 4, 2020, becoming the only major world power to not participate. The administration also notified the United Nations Secretary General of our intention to withdraw membership in the World Health Organization (WHO). Prominent legal experts question the legality of this act without the express consent of Congress since the initial entry into WHO was by a joint resolution of Congress and withdrawal would be in violation of Congressional intent. Fortunately, actual withdrawal would not officially occur until July 2021, and President-elect Biden has stated that he will reverse this decision on the first day of his administration.

Meanwhile the nation’s other epidemics of obesity, opioid addiction, and firearm violence continue unabated, and new ones have emerged like the epidemic of sexually transmitted infections.

By contrast, progress has been made in several areas of health as measured by the Healthy People 2020 indicators. Fourteen of the 26 indicators are showing improvement, with four of them meeting or exceeded their targets. These four were (1) air quality index exceeding 100 (number of billion person days), (2) children exposed to secondhand smoke, (3) adults meeting aerobic physical activity and muscle strengthening, and (4) reduced homicides.² The combined impact of all of these health issues has allowed a modest increase in life expectancy over the last year.

Health insurance coverage has diminished for about 1 million people³ because of the administration’s efforts to undermine the Affordable Care Act. In addition, it is estimated that 1.3% of people may have lost their health insurance coverage because of the pandemic.

THE WAY FORWARD

The 2021 health policy agenda starts by restoring trust in our health agencies by first appointing our most qualified professionals. Policymakers must lead using science and the best evidence available. We must restore our place in the world in scientific prominence by investing in research.

Aggressive efforts to control the COVID-19 pandemic means

• National leadership to ensure a well-reasoned response plan to scale up testing, contact tracing, and supply line management.

• Finalizing the scientific review and distribution plans for a new SARS-CoV-2 vaccine and competently distributing and administrating it.

• Depoliticalizing the pandemic response to rebuild trust in our health agencies and enhance mask wearing and social distancing.

• Leading by example.

These are first steps to rebuilding our public health systems to respond to health threats for the 21st century.

We must roll back the many antienvironmental executive regulatory actions of the past administration and renew the regulatory processes where needed. A clean energy revolution will achieve carbon neutrality by 2050 through a just transition that creates jobs and addresses environmental justice concerns.

The Affordable Care Act is the vehicle to enhancing health insurance coverage to achieve a system where nobody is left out by strengthening its basis and adding a public option as an option for all. Reducing health costs and controlling the growth of health insurance over time is another urgent goal. Allowing Medicare to negotiate for prescription drug prices is essential.

It is urgent to address the epidemic of gun violence, the disproportionate number of women of color who die during pregnancy, and the persistent disparities in chronic disease incidence and deaths. Structural racism, criminal justice reforms that impact health, and other social determinates of health are upstream solutions requiring persistent and definitive actions. Ensuring reproductive rights and expanding access to mental health services are high on the agenda.

In 2021, we have the opportunity for a restart, but we need to act fast. Let’s jump out of the starting blocks because time is of the essence. The time is now to end the pandemic, restore our trust in science, and start building a green economy that generates jobs and realizes and builds the robust and accessible health foundations that will once and for all allow our nation to achieve the goal of the American Public Health Association to be the healthiest nation.