Like the COVVI-19 pandemic Has decreased, the mortality of other causes in the United States has continued to climb, reflecting the worrying trends that are not seen in any other high-income country. Despite American health expenses of around US $ 13,500 per person in 2022 – twice that of homologous countries – its inhabitants are more likely to die younger, avoidable and treatable causes, by a suicide and drug overdose or complications of childbirth (see (see Go.nature.com/4i41oqc). It is not due to any law of nature, but to a failure on the scale of the system.
Instead of investing in public care, American policy has prioritized market -based ideologies. This means subsidizing pharmaceutical companies and private insurance while under -funding for public health and social services, allowing businesses and charitable organizations to operate in their place – a process known as the privatization of public health. This generates significant profits by exacerbating medical needs and costs, but leaves millions without care.
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The dismantling by the Trump administration of public health systems through proposed or promulgated cuts in Medicaid, in the United States Indian Health Service, National Institutes of Health and Centers for Disease Control and Prevention, as well as food and housing assistance programs, is likely to intensify these fatal dynamics. Trump also put an anti-vaccine and anti-psychiatry activist, Robert F. Kennedy Jr, under the control of the country’s health systems.
In response, many health leaders have Described the politicization of public healthDescribing it as a neutral area in sits by political forces. But that did not diagnose the problem badly and obscure the solution.
The real crisis is not only public health – which fundamentally concerns policies dictating the distribution of resources necessary to protect human life – has been politicized. It is that he was not politicized enough.
Decades of bipartite failure have prepared the field for this moment. As journalist Ed Yong described it in The Atlantic in 2021 (see Go.nature.com/4bun7HV), public health has “gladly reduced its own political voice”. American political leaders and health officials have abandoned the former truth that political reforms to counter poverty, inequalities and inadequate social services are crucial to prevent diseases. A medical field focused on the treatment of disease as a substitute to prevent it through public policies now deplores the supposed intrusion of health in health.
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But there can never be an apolitical approach to public health. Political choices concerning care infrastructure, economic taxes and inequalities, environmental and consumption regulations, social housing and labor rights, for example, are intrinsically political. They determine who lives and dies, whose life counts and how much.
What has left us health so vulnerable to partisan capture is not an excess of policy but rather a depoliticizing distortion of public health which fix individualistic medical care and personal responsibility, rather than public responsibility to combat the social and environmental causes of diseases and care for those who are sick or disabled. This weakens the communities, feeds resentment and social division, limits the political imagination and undermines the political organization between the groups which could achieve change.
The American medical profession, which has long been conservative, has considerable responsibility. We, doctors, have historically avoided engagement with politics, with the exception of policies that could affect our remuneration and our power, often justifying our inaction by calling on scientific neutrality and professionalism. But, as Trump clearly indicated, our refusal to engage politically has not protected public health or medical sciences – she left both defenseless.