Fighting to Protect Public Health in the Trump Era

Donald Trump’s policies have caused and will continue to cause large-scale death. According to Dr. Brooke Nichols, a professor at Boston University School of Public Health who oversees a running impact tracker, the destruction of USAID and the various food and medical aid programs under its umbrella has already caused nearly half a million preventable deaths in the developing world. Trump’s destruction extends to domestic operations. In just seven months, he and Health and Human Services Secretary Robert F. Kennedy Jr. have significantly weakened the country’s public health system, moved to cut medical research at universities nationwide, and promised to cut Medicaid substantially. 

One of the leaders fighting to protect public health in the Trump era is the National Medical Association, the largest and oldest organization representing Black doctors and their patients in the U.S. On July 22, the NMA inducted Dr. Robert Mitchell as its new president. Mitchell is board-certified in anatomic and forensic pathology by the American Board of Pathology. He is also a tenured professor of pathology and serves as chief medical officer for the faculty practice at Howard University, his alma mater. He is the co-author of Death in Custody: How America Ignores the Truth and What We Can Do About It, a study of preventable deaths in jails and prisons. 

I recently spoke with Mitchell on the phone about the Trump regime’s attack on public health, higher education, and DEI. This interview has been lightly edited for clarity and brevity.

DM: In your position as a forensic pathologist, a medical doctor, and president of the National Medical Association, how do you assess Trump’s war on public health, especially how Robert F. Kennedy, Jr. is executing it through the Department of Health and Human Services?

RM: One of the things we prioritize at the National Medical Association is evidence-based care, whether that relates to the care of an individual patient or the larger community, which we define as “public health.” Medicine is a science. Therefore, it needs to be science-based. However, what we’re finding is that the decisions being made by the Trump administration—not properly collecting data, putting expertise on the back burner, the response to the measles outbreak, and the undermining of vaccinations, neglecting the need for Medicaid coverage and supplemental insurance for the disinherited—these are not evidence-based decisions. They are political decisions.

You say it is a “war.” I used similar language in my inauguration speech when I was installed as the 126th president. I noted that physicians have a red cross on our helmets. Our job is to serve and fight for those on the battlefield. The war waged on public health is intentional and will lead to many deaths in communities across the United States.

DM: If the administration isn’t making decisions based on evidence, what are their criteria, as far as you can tell? Who is most at risk due to what you call their “intentional war on public health”?

RM: The most endangered are the most in need. Those individuals who currently need Medicaid are not going to seek care when disease and injury are preventable, but will only seek care when disease and injury are inevitable. Inaccessibility to preventive care leads to higher morbidity and mortality. Then, those who take the opinion of political officials without a medical background, who do not give evidence-based advice, place themselves at higher risk and are also in danger. We see that with those who refuse vaccinations and even refuse to vaccinate their children.

Those without access are the most vulnerable, and when I say “access,” I mean it in the W.E.B. DuBois sense of access as education, economics, housing, and environmental justice. Those who suffer from disparities in access are most at risk. But this is not a risk that only affects poor folks. It is going to affect all Americans. That is how public health works.

I cannot read the minds of those making these decisions, but as an outsider, I can only suggest that the decisions are based upon how to enrich a small few. Let me give you the evidence for that conclusion. As a public health official and someone who has worked in medicine for two decades, I know that healthcare’s finances have ballooned. There is no way in the world that we can allow the cost of health care to continue on this trajectory. Value-based care, promoting prevention, and rewarding providers, medical care associations, federally qualified hospitals, and patients for engaging in necessary education and practice for prevention—that is the work that decreases the cost of health care. What decreases the cost of health care is more healthy people. Healthier people will need expensive care less frequently. So, when you remove people from having access to prevention and the care to treat disease and injury, individuals will choose to eat, take care of their families, and pay their mortgage. They will let disease and injury fester in a way that they need care later, and that care is more expensive. So, the care that is going to be delivered in this country if the Republican plans continue will increase costs and decrease life expectancy.

DM: Another battleground is higher education. You are also a professor at Howard University, your alma mater. What are the dangers of Trump’s assault on higher education?

RM: I come from a middle-class family. My family wasn’t poor—a college-educated mother, a father who was a businessman. When I went to medical school, my loans were about $180,000. That was more than tuition, but I had to take the loans out because I had to live. I could not work in medical school. I tried. I was an FBI forensic scientist. I was trained as an evidence technician, planning to work in the local field office while attending medical school. That lasted two weeks. There was no way that I could work and study as much as one needs to study to do well in medical school. I lived in a very small apartment above a barber shop. Rent was $400 a month. You can imagine what type of accommodations I had for $400. Today, graduate education loans are capped at $100,000. If that rule had been in place before, I couldn’t be a doctor today—not because I wasn’t qualified, nor even because I couldn’t pay for medical school. I’ve paid the loans back.

So, those who can’t pay the balance above $100,000 to go to medical school will not be able to go to medical school. Poor people, first-generation wealth, and blue-collar people cannot afford to send their children to medical school, even if those children have 4.0 [grade-point averages] and the potential to become excellent physicians. I’m worried about limiting poor and working-class people’s ability to go to medical school, not only because it will adversely affect those students, but also entire communities. There is already a physician shortage in this country, and there are already disparities for those in the medical field willing to take care of the disenfranchised. Now, we’re going to make it worse.

DM: To continue the metaphor, Diversity, Equity, and Inclusion (DEI) is the third battlefield of the war. Of course, “DEI” can mean anything with the current crew. Same question: How does the attack on DEI threaten America?

RM: If you were to ask any Fortune 500 CEO, they would tell you that diversity of experience, thought, and background is good for the bottom line. It makes economic sense to have a diverse workforce. Even if there is no moral impulse for diversity, the argument that it makes better financial sense should resonate.

We know that in health care, you have better outcomes in communities when those communities have a shared background, which leads to trust with physicians. That is why it is important for the National Medical Association to stand up and say that diversity, equity, and inclusion are paramount. The requirements of the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education for diversity in recruitment and retention were important not only for medical students and residents, but also for the outcomes of patients positively affected by a diverse workforce. With those requirements no longer being enforced, we risk patients being unable to get quality health care. We have providers and medical students who don’t have the same cultural experience with their diverse colleagues. Everyone becomes better after having proximity to those who are different. At its core, medicine is an empathetic art. Empathy is a huge component of health care—medical practice, nursing, and physical therapy. You name it.

If you don’t have that proximity but later have to provide care for those who are different, where will you get your emotional quotient? That EQ has to be built in.

Degrading DEI standards will increase disease and injury in communities that differ from the majority.

DM: What are some ways the NMA works to counter this, and what do you hope to achieve with your leadership?

RM: We’re ensuring that our residents are supported. Many times, we have found that Black residents have been targeted and removed from residency without justice. We’re working with the Young Doctors Project, which takes young men from urban settings during the eighth grade and mentors them through high school, college, and medical school. We’ve partnered with Elevate MeD, which helps medical students get into residencies. We have another partner, Nth Dimensions, which allows medical students to move into orthopedic programs, where there is a paucity of diversity. We work closely with the Student National Medical Association. We have a strong post-graduate section within the National Medical Association.

We support ourselves as we become entrepreneurs within medicine or move into academia.

We also focus on health justice, violence prevention, environmental justice—and climate change, because drinking clean water and breathing clean air are essential to good health outcomes.

We are also an advocacy organization. The NMA was at the table 60 years ago when Medicaid was written into law, and other medical associations did not favor it. We advocate for equity in health care delivery, no matter where you are from, the money you have, or whether you are rural or urban.

This year’s theme is “Mobilizing Health Justice for a New America.” The days of standing around and talking are gone. We need to start fighting and moving.

DM: Given the high stakes, are you advocating for health care professionals, especially your members, to raise their voices and contribute more to the ongoing debate?

RM: One hundred percent. I’m traveling the country and willing to visit any city, bringing the members of the National Medical Association to the debate, to discuss what needs to happen locally and nationally. I was just in Cincinnati. I was just in Tunica, Mississippi. The NMA just had our annual convention in Chicago.

My grandfather was one of the first Black physicians in Atlantic City. He graduated from med school in 1932, started his practice in 1935, and used to take pies and cakes for payment from those who couldn’t afford care. So, I ask our members to determine how much free health care they can give in their practice. Then, let’s create a national clinical collaborative that provides free health care to communities. Then, let’s use that to pressure the corporate world to pay for medical equipment, the nursing staff, and the technicians. We need to do that if the government doesn’t step up. Health care is a human right.

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