The administration of former U.S. President Donald Trump deliberately harnessed racism and class animosity to push policies that caused hundreds of thousands of American deaths, according to a scathing new report in the British medical journal The Lancet.
After undertaking a comprehensive assessment of the health and environmental impacts of Trump’s presidency, the 33 scientists who co-authored the article estimated that rollbacks of environmental and workplace protections led to 22,000 excess deaths in 2019 alone. They also found that 40% of U.S. deaths during 2020 from COVID-19 would have been avoided if the country’s death rate had been closer to that of its G7 peers, and blamed Trump for eschewing the advice of public health agencies and politicizing common sense responses to the pandemic such as mask-wearing.
The findings rely on comparisons with previous U.S. norms and those in other countries to make statistical assumptions about what mortality rates might have been if Trump hadn’t swerved away from the global scientific consensus. Philip Landrigan, a pediatrician and epidemiologist at Boston College who was one of the report’s co-authors, argued that it was fair to make the linkage.
"Basically, the Trump administration stopped enforcing Clean Air Act,” Landrigan said, referring to the landmark legislation signed by President Richard Nixon in 1970 and used by President Barack Obama to regulate carbon emissions. Under the aegis of ending the "war on coal,” Trump’s Environmental Protection Agency reversed the Obama administration’s emissions rule and stopped trying to control fine particulate matter air pollution. As a result, the Lancet report said, concentrations of such pollution have increased after having declined steadily for decades before he took office.
Fine particulate pollution is closely linked to all sorts of lethal diseases, including childhood asthma, heart disease, lung cancer, and diabetes among adults.
"We see trend lines for deaths from environmental and occupational exposure start going up in 2017, reversing 50 years of decline,” Landrigan concluded. "It is hard to walk away from cause and effect.”
Trump’s last EPA Administrator, Scott Wheeler, repeatedly cited cost benefit analysis as a rationale for regulatory changes that undermined Obama-era attempts to curb pollution. On the campaign trail last year, Trump pledged to ensure that the U.S. had the "cleanest air and water in the planet,” even as his administration reversed policies created to achieve those goals. Representatives for Trump didn’t immediately respond to a request for comment.
The Lancet’s willingness to wade into the politics behind health policy is highly unusual among scientific journals. Richard Horton, the journal’s editor, is no stranger to controversy, however. Under his leadership, the magazine has come under fire for one-sided critiques of Israel, for assigning greatly inflated death figures to the U.S. invasion of Iraq in 2003, and for publishing a now widely discredited study linking vaccinations to autism. In April, the Lancet criticized Trump for pulling out of the World Health Organization, calling his decision a "crime against humanity.”
But the fact that so many scientists were willing to break from their traditional political neutrality to put their names on this assessment is "a signal of a changing time,” according to Gretchen Goldman, a research director at the Union of Concerned Scientists. While the Lancet has been more outspoken than others, she said, it’s not alone among science magazines in publicly criticizing Trump. Scientific American shocked many when it broke 175 years of tradition and gave its first ever presidential endorsement to Joe Biden, largely because it argued that Trump was such an awful alternative.
"If you told me four years ago that scientific journals would be speaking out against Trump, I wouldn’t have believed you,” Goldman said. "But since then, there has been quite a shift, reflecting both the severity of what Trump did as well as the changing willingness of the scientific community to engage in policy conversations.”
This report has its roots in the spring of 2017, when the Lancet formed a commission of experts with backgrounds in a wide range of topics such as clinical medicine, public health, and epidemiology to track the public health effects of the Trump administration.
On environmental policy, the report noted that Trump rolled back 84 vital regulations covering everything from toxins in water to the way scientific research gets used by the federal government, with 20 more rule changes still in progress by the end of his term. The resulting increase in airborne particulate matter was the primary cause of the excess deaths, the authors concluded. But they also proposed that Trump’s climate change denialism would be the most enduring stain on his environmental legacy.
While the commission excoriated Trump, it also acknowledged that deep-seated problem in America’s health system predated him by decades. The authors note, for example, that American life expectancy rates have been declining compared to other high-income nations since the 1980s.
But instead of moving to solve this decline, the report argues that the former president specifically exploited low- and middle-income white people’s anger over their deteriorating prospects to mobilize the racial animus and xenophobia that propelled his political success. The people who supported Trump were in fact among the worst affected by his policies, the commission found. The 22,000 additional 2019 deaths occurred largely in states that voted for Trump, while Democratic states such as California and New York had their own laws that acted as a safety net.
The report also emphasizes the racial disparities in health that grew under Trump, including the fact that most of the 2.3 million Americans who lost health insurance while he was in office were minorities. It also underscored the fact that COVID-19 has much more heavily impacted Black, Hispanic and Indigenous people.
As Mary T. Bassett, a former health commissioner for New York City and a member of the Lancet’s expert panel, wrote in a statement released with the report: "The disastrous, bungled response to the pandemic made clear how existing, longstanding racial inequities simply have not been addressed.”
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