Public health takes center stage in US midterm campaigns: ‘It’s already been politicized’

As public health has become increasingly politicized in the US, with a particularly chaotic year under the Trump administration, some political candidates are pushing back by making public health a central part of their campaigns – and the grassroots organization Defend Public Health has ideas about how to do it.

On Monday, the group launched guiding principles for campaigns to prioritize public health, called the People’s Health Platform, highlighting the importance of ensuring healthcare for all, protecting and expanding sexual, reproductive, and gender-affirming healthcare, preparing for the climate crisis and the next pandemic, and taxing billionaires, among other tenets.

“Public health needs to be a higher priority,” said Richard Pan, a pediatrician who is running to represent California’s sixth congressional district.

“I know people get really nervous that this will politicize public health. But it’s not been a priority. And it’s already been politicized.”

Under Robert F Kennedy Jr, the US Department of Health and Human Services (HHS) has slashed routine childhood immunizations, cut public health funding to states, spread misinformation during the worst measles outbreak in decades and proposed ending Medicaid and Medicare payments to hospital systems that offer gender-affirming care to pediatric patients.

“The Trump administration has taken an axe to our health and our rights,” said Nina Schwalbe, a public health leader who is running to represent New York’s 12th congressional district. “This is nothing short of malice, neglect and ignorance.”

Schwalbe called the new health platform “non-negotiable for all candidates” because it lays an equitable foundation and serves as a launching pad for “bolder action” to make communities healthier and safer.

“We want to make public health front and center in these midterms,” said Elizabeth Jacobs, professor emerita at University of Arizona and a founding member of Defend Public Health. “We’ve spent a year fighting these changes, but this era is going to end, and when it does, we have an opportunity to reimagine public health. It’s not enough to just fix it to how it was before. We have to do better and make sure that we’re serving everyone.”

It’s a message Jacobs hopes will appeal to politicians and voters of all stripes.

“It doesn’t matter where you are or what party you belong to. What matters is the health of everybody around us,” she said.

Defend Public Health volunteers now plan to approach candidates from all parties to ask if they endorse the platform, and those names will be made public.

“Voters have the right to know which candidates are going to protect their health and which won’t,” Jacobs said. After the election, the group will release “backing documents” that include strategies for putting the ideas into action, she said.

Schwalbe said the agenda could go even further: “We have an affordability crisis now in America, with skyrocketing healthcare costs hurting families all across the country.”

She would like to lower drug prices, provide basic health services and restore and expand Medicare, Medicaid, and the Affordable Care Act, with the goal of one day providing single-payer healthcare in the US. “Where you live, what you earn, or where you were born should not determine the care or services you receive,” Schwalbe said.

Guaranteeing universal access to healthcare is the first item on the Defend Public Health platform. Jacobs noted to the Guardian that “by the end” of her career, she “realized that the most important thing to public health is to ensure that everybody has access to healthcare above everything else”.

Other suggestions include restoring funding for scientific research, ending attacks on contraception, abortion, and gender-affirming care, fighting against health inequality, and rejoining international health bodies like the World Health Organization.

Public health also needs more stable funding, rather than the boom-and-bust cycle of panic and neglect, Pan said – most recently seen with the influx of Covid funding that is now ending.

“We don’t do that to the fire department,” he said. “Public health is part of public safety, and we need to have a baseline of support for that,” he said, calling it “a core function of government”.

When public health is rebuilt, it needs to be insulated as much as possible from political interference, Pan said. “Should there be more protections for civil servants? How do you ensure that there are qualified people?” The vote to confirm Casey Means, Trump’s nominee for US surgeon general, is in limbo, with key senators keeping mum on when or whether a vote will take place. One reason for the hold-up: officers of the US Public Health Service Commissioned Corps are required by law to be licensed in their fields; Means is not.

“Do we have those kinds of requirements for other appointees?” Pan asked.

These are the hard but important questions that candidates should raise as they think about building public-health safeguards, Pan said – and he wished the Defend Public Health platform had more detailed suggestions on policies. “As an organization of public health experts, it would be more helpful to articulate more fully the types of principles to achieve these aims,” he said. “Give some suggestions for how to build back better – what have we learned?”

With rural hospital closures, skyrocketing insurance premiums, spiraling disease outbreaks, and deadly bans on reproductive healthcare, “people are starting to become more aware of how these policies are actually going to affect them,” Jacobs said. At the same time, Kennedy has pushed an individualistic approach to health, which is in direct opposition to the concept of public health, she said.

“If you’re ignoring the fact that people may not have the tools to make individual choices, then we’re nowhere. We’re lost. This administration is really putting the burden of public health and your health on the individual,” Jacobs continued.

Public health is inextricable from politics, Schwalbe said, adding: “A healthy democracy requires healthy people.” That’s why it’s a central part of her platform, she said.

“We need public health experts in Congress who can deliver and fight back against quacks like RFK Jr dismantling the systems that protect our health and our democracy,” said Schwalbe.

And that message doesn’t need to be partisan, Jacobs said.

“We want to reach out to people on both sides of the aisle, because I do believe that fundamentally, parents, no matter where they are, want what’s best for their kids. They want their kids to be healthy,” she continued. “And we have a lot more in common than we have in opposition to one another.”