When It Comes to Public Health, We Need to Tap Into People, Not Pundits

The next Trump administration has already proven to be something we haven’t really seen before in American history: a mixture of profound incompetence, profound bigotry, and, well, a desire to destroy, a desire to harm — where deep nihilism is the point. Like one commentator put it down: “The overall theme is that he’s creating some kind of anti-government—not in the sense that he’s for smaller government, but in the sense that he’s the evil twin of government. Each appointee is chosen for the purpose of deliberately denying, even mocking, the government function he or she will be performing.’

Appointments occurring in public health and related roles only illustrate the point: Robert F. Kennedy Jr., who to believe that vaccines cause autism, HIV does not cause AIDS, and that Covid was “ethnically targeted” to avoid Ashkenazi Jews and Chinese. Then there is Dr. Mehmet Oz, the TV presenter, a dealer in quack remediesand a former faculty member who came out of Columbia University’s medical school, who was selected to direct the Centers for Medical Care and Health Services. Waiting for your time it’s a bunch of covid advocates who advocated letting people get infected before vaccines were available, predicted we’d reach herd immunity by April 2020, and compared vaccine and mask mandates to Nazi totalitarianism. In October I wrote about this crew and thought they were auditioning for positions in the Trump administration. Now the audition is over and the play is about to start. Most of these people, in addition to their conspiracy views, have little experience and knowledge in the positions they are about to fill. They have too suggested that they were being persecuted for his views and, as the man who will take over as president in January, is determined to retaliate.

What Ben Mazer called “brainwashing“RFK Jr. and others like him definitely do not help. In his article, Mazer rightly criticizes Leana Wen and Emily Oster, who suggest that Kennedy might be right about fluoride, raw milk, and vaccines if he simply “Grade A,” and if they are looking for scholarly engagement on these topics, they should look elsewhere. I would go a little further. Wen and Oster aren’t new to the game: During the pandemic, they used their positions to boost their own brands as truthers and antagonists of public health wisdom, and their writing this month is more of the same — their argument: “public health doesn’t understand, i get it” – even if it means drifting into the orbit of that lesser kennedy. At the end of the day, it’s a form of appeasement and accommodation, and it’s about staying in the game, being a “reliable” mediator on the right, and staying relevant in a discussion that’s headed for madness.

We will see a lot of this in the coming weeks and months. And we’ll see people looking for cover, too—those who depend on federal government funding—will feel that speaking out isn’t worth the price. Otherwise, we have two jobs.

Each of the new and proposed Trump administration nominees has their own obsessions, and all have nothing good to say about the FDA, CDC, or NIH. While there are arguments for reforming these institutions, Project 2025 suggests a template for what they will try to accomplish: dismantling the core responsibilities of these agencies, undermining their basic structure, which, even if partially successful, will leave American biomedical science, drug regulation, and public health in ruins. If it was tempting to say before the election that we shouldn’t take Trump’s rhetoric seriously, what happened in the last two weeks after the election should put an end to that fantasy of escape from his predation. That leaves us in damage control mode – it goes back to me mentioned last week— to do what Tim Synder suggested: “protect the institutions.” It also doesn’t help that Colorado Gov. Jared Polis, New Jersey Sen. Cory Booker, and RFK Jr. send each other another sweet love the tweets in social networks. But RFK Jrformer Democrat, has supporters among some on the leftas I explained last year.

But if many of us are going to spend 4 years in the political wilderness, we really have a major challenge: there will be times when we find ways to get things done at the federal level. However, focusing on a set of narrow issues with overlapping interests is not a top priority. We need to go back to basics.

Ed He wrote a insightful piece Art Atlantic in 2021 entitled “How Public Health Contributed to Its Own Downfall.” His thesis, supported by many historians of public health, was that our work in the early years of public health—the 19th century—was deeply connected to communities and improving people’s lives. In that era, we were community organizers and campaigners fighting for sanitation, clean water, and better working conditions in the factories of the new industrial age, just to name a few. In the 20th century, the field was subordinated to the medical profession, and public health work became an academic enterprise that

took on a narrower set of responsibilities that included data collection, diagnostic services for clinicians, disease tracking, and medical education… the field shifted away from allies such as labor unions, housing reformers, and welfare organizations who supported urban-scale projects in sanitation, workplace reforms and other ambitious health projects. This put health care in a precarious position—still in the shadow of medicine, but without the political base that was the source of its power.

We need to rebuild health care from the ground up, in local communities, according to its founding principles, with broad ambitions, rebuilding the deep connections that “spread to most of society” as He put it, which gave us the opportunity to offer monumental changes for the better in people’s lives more than a century ago. This is work that can be done away from Washington, D.C., so when the worst of the next few years are over, we can rise from this, from the ashes, into something better than when we started. It’s about taking health care into our own hands—as citizens of counties, cities, and towns—recognizing that nearly every one of us has a role to play in this renaissance. It depends on us, not a few.