Inside the Biggest U.S. Public Health Shakeup in Modern History
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What major changes are happening in U.S. public health?
And this week, at home and abroad, America's approach to public health is changing rapidly. Tens of thousands of federal health workers are poised to lose their jobs. State health departments are seeing billions in funding from Washington being zeroed out. And foreign aid cuts are interrupting programs for malaria prevention and treatment of HIV. But along with cuts, new programs and new priorities are rising up in their place. So what's in store as the U.S. embarks on its biggest public health shakeup in modern history? Let's dive in. Well, we can't list all of the changes that are being made to the U.S. public health system, but let me run through a few of them very quickly. The Department of Health and Human Services is shedding around 20,000 employees within the Centers for Disease Control and Prevention. Entire departments are being eliminated, including for HIV prevention, violence prevention, and injury prevention. Also gone at the CDC.
is a team that maintained a database of injuries and violent deaths, which was widely relied upon by policymakers and researchers. And in a move that will be felt beyond the Beltway, the administration has cut off billions of dollars in federal grants that were awarded to state and local health departments for a range of programs, like tracking infectious diseases or treating addiction.
Why are federal health job cuts occurring?
That is being challenged in the courts, but in the meantime, some state health departments have already begun layoffs. With me today are Wall Street Journal health business editor Jonathan Rockoff and senior writer Betsy McKay. Jonathan, lots of changes clearly afoot here. What reasons is the administration giving for this shakeup?
A lot of this comes from this criticism of the pandemic response and how overarching the public health response to the pandemic was. And this feeling that because the public health authorities sort of overstepped their authority, we need to rein it back again. We see this most saliently in vaccines. There's a lot of criticism on the right about mandating vaccines and things like that. And so a lot of the cuts have been targeted at vaccines in particular.
Yeah, John is absolutely right. We are at the tail end of a very bruising pandemic, very bruising to public health in the sense that there was a lot of anger and backlash, and that remains, and the view that government was not efficient. More broadly speaking, the administration says chronic diseases are worsening and changes need to be made. So there's two things here. There are the philosophical changes. They view a smaller, more effective government and more focused on chronic diseases. then there is the immediate impact of the changes being made suddenly and the disruption that that causes.
Though obviously the long-term ones are not too difficult to conjure up, possibly a reemergence of certain diseases or at least slowed efforts to try and cure others, right?
Yeah, absolutely. Because when you disrupt a public health program or any health program, you are going to have consequences, if not immediately, certainly down the line. You know, an important part of fighting HIV is not treating people already infected with HIV, but preventing people from getting it, giving them access to pre-exposure prophylaxis, education, many other programs.
What are the implications of cuts to HIV prevention programs?
And most of them seem to be targeted for cuts.
We already see right now that no matter who's in charge, that there are going to be public health threats and that whoever is in charge is going to have to deal with them. Right now, we're seeing this measles outbreak in the Southwest and then some other states. And we're also dealing with bird flu. So these threats remain. I think part of what the Trump administration and Robert F. Kennedy Jr.
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Chapters
7 chapters
1
What major changes are happening in U.S. public health?
0:34–1:57
2
Why are federal health job cuts occurring?
1:57–4:02
3
What are the implications of cuts to HIV prevention programs?
4:02–4:55
4
How is the government restructuring public health priorities?
4:55–6:02
5
What is the future of chronic disease prevention in the U.S.?
6:02–8:01
6
What are the potential impacts of reduced funding for medical research?
8:01–12:21
7
How does public health spending affect global health initiatives?
12:21–14:39