Trump and health.

Unless America votes for both its first female and second president of colour, we will have another four years of President Trump. What does this mean for health, here and in the US?

Guns and health

Given the assassination attempt, gun violence might be seen as the most immediate issue. In 2021 guns cost the lives of 48,830 Americans, half of whom died at their own hands. This includes 2,500 under 18’s, an increase in child deaths of 50% in two years. 

Trump has been a supporter of the freedoms that allows ownership of sophisticated and inappropriate weapons, such as the one used to shoot him, by just about anyone who wants them. Will his own experience result in more effective gun control laws?

Quite the opposite. As an example of out of control gun culture, his choice of prospective Vice President, JD Vance spoke proudly and to most of us, bizarrely, of his grandmother keeping 19 loaded handguns scattered around her house, 

“…this frail old woman made sure that no matter where she was, she was within arms’ length of whatever she needed to protect her family. That’s who we fight for. That’s American spirit.”

Cue enthusiast applause! It’s fair to say that no Republican is talking about gun restrictions needed to prevent gun crime, mass shootings. Or political assassinations. 

Violence

There are more guns than people in the US and given huge numbers of Americans believe political violence has its place, who know where this will lead. Civil War in the USA is no longer seen as  fantasy.

After the shooting, Trump called for calm and a more respectful political discourse. Meanwhile, some Republicans, after all their vitriol directed at Hilary Clinton and Joe Biden, blamed Democrats for inflaming politics, Trumps inflammatory rhetoric rapidly returned to its usual insulting, derogatory tone. Of course, Jan 6^th was a good example of how Trump and his followers can encourage and embrace violence. What happens if Trump is narrowly beaten this November is anyone’s guess, but significant violence can reasonably be predicted.

Speaking of violence, Trump has stated he will give Israel all it needs to ‘finish the job’ in Gaza. Whatever he says about US exceptionalism and isolationism, the USA will continue to export weaponry around the globe, though notably perhaps not to Ukraine after Trumps promise to end the war by a phone call, presumably by giving Putin everything he wants.

How about Trumps Health policy last time?

During Trump’s first presidency he tried and failed to repeal and replace the Affordable Healthcare Act, albeit without any clear description of its replacement. Operation Warp Speed delivered COVID vaccines but is now something he keeps quiet about as so many of his supporters are not only opposed to vaccination buy into the delusion that vaccines killed more people than they saved. Again, the fully vaccinated Trump keeps quiet despite advocating boosters, at least until 2022.  

The Trump presidency was slow to react to the pandemic and he will be remembered for calling it “a little flu’ and the “China virus” as well as wayward predictions of its end. In short, his performance was awful. The US suffered a high death toll in line with its poor public health, high levels of obesity, fragmented health system, massive social inequalities, but poor decision making and bad leadership played their part. I will never forget the vast over-confidence of his pronouncements on disinfectant as therapy for COVID.

His ‘Right to Try’ act was designed to allow the use of novel and unapproved drugs for terminal care even though the FDA could previously allow this. He boasts the gimmick has saved “hundreds of thousands” of lives, even though nowhere near that number could even have been eligible. 

His Supreme court Justices appointees paved the way to removing abortion rights and, in some cases, has led to the criminalising of abortion in many US States. So far, so bad.

Next time?

In addition to his ongoing obsession with repealing ‘Obamacare’ – clearly a personal vendetta with echoes of his vitriolic Birther campaigns against the former president – what might he do next?

The Heritage Foundation are an influential and well-funded bunch of former Trump colleagues whose policy recommendations were tellingly embraced during this last presidency and have updated suggestions in a document called “Project 25”.  Despite his denials, it is likely to detail what a Trump Presidency might look like and how the far-right in America might see the future. 

They suggest cutting eligibility for Medicare funding, reduce its budget, cut its ability to negotiate exorbitant US drug prices and to promote private insurance plans through Medicare Advantage programme. 

They want to end federal funding for transgender care, end provision of abortion under any circumstances including prohibition of abortion pills and even end funding for the morning after pill. They want encouragement of ‘natural family planning’ which any doctor will know is no family planning at all and to defund Planned Parenthood, an organisation which helps women with family planning. 

They also want to end federal influence of sex education, doctor the teaching of American history, in particular in regard to slavery and racism, and end same sex marriage. There is no doubt this will lead to harm and hardship for the 600,000 women who obtain abortion annually and lead to dangerous backstreet abortions. All along with reducing support for single mothers and ending same sex marriages.

They want to reclassify many state jobs as political appointees so that Trump can replace swathes of what we call civil servants with his own followers. As in the UK, these public service institutions are complicated and costly to establish, but easy to destroy.

Prof. Edzard Ernst, a long term blogger on all things medical,  sees this as fascism coming to America. He was born just after WW2 in a Germany decimated by Fascism, so has first-hand experience of what this means. 

Climate change

Our changing climate is a direct and increasingly irreversible, accelerating threat to humanity. The far-right solve the problem not only by pretending it doesn’t exist, but to compound this idiocy by drilling for yet more oil. The harm to health this will bring to this, and all future generations dwarfs any other health consideration. 

Regulatory and environmental agencies will be under a more effective attack next time, even when it is self-evident that climate change is driving extreme weather events, harming our ability to produce food and is, to use that hackneyed term, and existential treat to humanity.

Trump and Antivaccination

Amazingly, just a few days after the shooting, Trump called RFK Jr, the third Presidential candidate, and the phone conversation was, rather hilariously, accidentally taped and intentionally released by RFK III, much to his father’s annoyance. 

The recording reveals the depth of Trumps scientifically illiteracy. He claims that vaccines cause autism, more or less because someone told him so, that American children are over vaccinated and given ‘horse sized’ doses of vaccines. All genuine BS. Interesting that, at least in the 1:40 clip, RFK could not get a word sideways past the ever-rambling Trump.

What motivated the call seems clear. Trump must think that RFK’s rabid antivaccination is likely to steal more votes from him than the Democrats – so he muttered about giving RFK some sort of role in government, presumably around public health. 

Acting on this promise would result in illness and deaths due to resurgence of infectious diseases. Afterwards, JFK stated he will not withdraw, but that is a space worth watching!

Over here

There are huge consequences to the otherwise talentless Trumps remarkable flair for the sort of PR, presentation, and opportunism that wins votes in the USA. 

If he can ignore experts and science to believe that vaccines cause Autism, then we can guarantee that he will ignore the challenges of climate change driving the increasing number of disasters, destruction of the natural world, or indeed, the huge changes hurtling towards us with AI. 

That so many Americans seem to treat him like a deity if utterly depressing. I simply fail to see how anyone could not see through his veneer of plausibility.

Meanwhile, Nigel Farage, our own little version of Trump, has already departed his new Clacton constituency to be with his American hero and will bring back lots of these nutty ideas to the heart of our democracy. He too uses inflammatory language to manipulate social inequality driven anger while advocating polities which increase it, prefers insurance-based healthcare, is anti-abortion, anti-vaccine, admires Andrew Tate and is, I’m am sad to say, a significant political player who shares Trumps lack of intelligence and flair for attention grabbing.

My hope is that parliamentary scrutiny will expose his illiteracy of science and lack of responsibility; but I wonder if reason and science will be, to use that old term with a dangerous new meaning, “Trumped” by his own well-honed PR skills in anger and outrage.

We live in the most dangerous times ever.