Opinion Guest Essay How to Wreck the Nation’s

Health, by the Numbers How to Wreck the Nation’s

Health, by the Numbers Illustration by Javier Jaén

After decades as a physician studying the factors that determine our risks of getting sick and how long we live, I am convinced that the actions of the Trump administration will cost lives. Researchers like me know the data. For years we have warned that Americans have shorter life expectancies and higher disease rates than people in other high-income countries.

Now, the poor health of Americans is about to get worse.

While Robert F. Kennedy Jr., America’s health secretary, makes a spectacle of his plans to make America healthier (a laudable goal), in actuality, the administration is kneecapping the very infrastructure that would make that feasible and is instead enacting policies that will compromise health.

The Department of Health and Human Services has terminated thousands of grants, including funding for pandemic prevention, and research grants related to cancer, vaccines and chronic diseases. The loss of research funding will delay medical discoveries. Though the agency publishes a weekly list of terminated grants, the full scope of funding cancellations has been obscured, especially at the National Institutes of Health, the major funder of medical research. A database created by Harvard researchers, Grant Watch, has helped to fill in the gaps.

Grants terminated by the Department of Health and Human Services Reduced from 15/10 to 5 Centers for Disease Control and Prevention $5.8 billion Reduced from 15/10 to 5 National Institutes of Health $3.2 billion Reduced from 15/10 to 5 Substance Abuse and Mental Health Services Adminstration $543 mil. Reduced from 15/10 to 5 Food and Drug Adminstration $3 mil. Reduced from 15/10 to 5 Administration for Children and Families $401k Since President Trump has taken office, H.H.S. has cut over $9.5 billion in grant funding that had been approved but not yet distributed to programs and researchers. The largest grant cuts were at the Centers for Disease Control and Prevention, the nation’s nerve center for tracking diseases and preventing premature deaths. The administration also gave out pink slips to some of the country’s top epidemiologists and effectively ended C.D.C. programs on core issues ranging from chronic diseases and lead poisoning to reducing deaths from drug overdoses, maternal deaths, childhood injuries, smoking and more. The administration cut over $4.6 billion in grants related to pandemic response, both for Covid and future pandemics. It laid off experts on imminent health threats, such as widespread transmission of bird flu to humans, leaving the country dangerously unprepared for the next emergency. Mr. Kennedy fired all 17 members of the panel that produces the nation’s vaccination guidelines, replaced them with multiple vaccine critics and cut $1.1 billion in funding for vaccinations, including support for a program that helps provide free shots for low-income children. High levels of vaccine coverage are important to maintain herd immunity, and making it harder to get vaccines could lead to a resurgence in vaccine-preventable diseases. Over 2,600 grants were terminated at the N.I.H., eliminating $3.3 billion in promised funds and threatening the nation’s position as the world leader in biomedical research. The administration claimed it was cutting N.I.H. funding to target research tied to “diversity, equity and inclusion” and “radical gender ideology.” This included studies on reducing health disparities among people of color and L.G.B.T.Q.+ communities and efforts to lower pregnancy complications among minority women. (Mr. Trump’s policy was recently ruled illegal by the courts.) But research in these targeted areas only accounts for around 7 percent of the total cuts. Around $170 million in cuts were for studies of cancer, which remains the second leading cause of death in the United States, claiming more than 600,000 lives each year. Cuts in cancer research will cost lives by delaying the discovery of cures and better methods to slow cancer progression. Over 170 grants were cut for research into H.I.V. prevention and treatments, threatening the 1.2 million Americans and almost 40 million people worldwide who are living with H.I.V. Mr. Kennedy has promised to tackle the burden of chronic disease, but around 390 cut grants were for studies of the most prevalent chronic diseases, such as heart disease, diabetes, Alzheimer’s and obesity. The administration is cutting funding for training programs for the next generation of doctors and scientists by over $578 million, forcing many young people either to abandon their careers or pursue them overseas. Other grants were caught in the terminations as well, including cuts to basic science research to understand the causes of diseases. Many researchers whose work has been terminated say they still don’t know why their studies were targeted. (The N.I.H. has been directed not to cancel more research projects for now.) Although approximately 100,000 Americans die each year from drug overdoses, the administration canceled 129 grants from the Substance Abuse and Mental Health Services Administration. Seven grants, including those to research how to better protect food and drug safety, were cut from the F.D.A. The Trump administration made massive staffing cuts to the Administration for Children and Families and has closed down several offices that oversee Head Start, which since 1965 has been the government’s flagship program to help low-income children. Head Start-funded preschools have reported delays in getting grant funding. The damage done by slashing the nation’s research infrastructure — the loss of knowledge to save lives and the loss of scientific talent to other countries — will have lasting consequences. But torpedoing research is only one way the administration is putting our health at risk. Sources: HHS TAGGS; Grant Watch Note: Data as of June 29.

The administration has upended the operation of almost every agency that deals with our health and medical care, leaving behind fewer staff members and programs to address critical needs, and changing policies in ways that could endanger us all. Regulations to protect health and safety are being lifted. Experts who monitor health threats have been fired. Medical schools are threatened. Congress is poised to make huge cuts to Medicaid, which would leave millions of Americans without health care coverage and force closures of health clinics, many in rural areas.

Don’t get me wrong, I am not defending the status quo. There is plenty of waste and inefficiency to fix in health care and research, and fresh approaches can help. But dismembering health agencies won’t improve efficiency. Real change comes from streamlining programs to better serve the public, not from closing programs and walking away.

The ripple effects of the havoc at health agencies will eventually reach you. The air you breathe could become more polluted because the administration is permitting factories to resume emitting toxins. Your drinking water could contain lead because the administration is closing lead abatement programs. Bacterial contamination of your food may increase since food safety workers have been fired. There may be fewer primary care doctors in your community because the administration is cutting funding for training programs. Cutting-edge treatments may be unavailable because the N.I.H. has terminated clinical trials.

Out of the 356 drugs that were approved from 2010-2019 … N.I.H. funding contributed to 354 of them, totaling $187 billion. Only 2 were privately funded. Out of the 356 drugs that were approved from 2010 to 2019 … N.I.H. funding contributed to 354 of them, totaling $187 billion. Only 2 were privately funded. Source: Cleary et al., JAMA (2023)

The logic is baffling. Even though the United States faces a mental health crisis, especially among youth, the Trump administration is slashing funding for programs on mental illness, addiction, domestic violence and suicide prevention. It’s no longer offering specialized support to L.G.B.T.Q. callers to the national suicide prevention hotline, and it’s cutting nearly 600 contracts for the Department of Veterans Affairs. It canceled funding for a desperately needed program that expanded the number of mental health professionals in our children’s schools, which had won bipartisan support in Congress after the mass shooting in Uvalde, Texas. Unintentional injuries are the leading cause of death in children, but the administration has all but eliminated the injury prevention center working on efforts to prevent deaths from poisoning, car accidents and drownings.

Diseases that are preventable and rare in modern countries may now pose a threat in the United States. The measles outbreak is our first warning. Other vaccine-preventable diseases will increase if politicians like Mr. Kennedy continue to cast experts aside, roll back immunization guidelines and sow doubt about their safety.

All this under the banner of “Make America Healthy Again.” In a dangerous sleight of hand, Mr. Kennedy goes before cameras to make a big deal about food dyes and bizarre claims about autism while his department erases programs to address the nation’s leading chronic diseases. For example, smoking is the leading cause of preventable deaths in the United States. If this administration’s goal is truly to make America healthier, why has it effectively shuttered the nation’s top office on smoking? Mr. Kennedy rightly promotes the importance of healthy eating, but the administration is cutting funding for food assistance. He warns about the dangers of pesticides, but the administration is reportedly reconsidering a ban on asbestos and is moving quickly to relax other regulations meant to protect Americans from toxins.

Planned cuts by the Trump administration would defund research on the leading causes of death cause of death annual deaths primarily researched by proposed funding cut Heart disease 681,000 National Institute on Body Systems* -39% Chronic lower respiratory diseases 145,000 Diabetes 95,000 Cancer 613,000 National Cancer Institute -37% Stroke 163,000 National Institute on Neuroscience and Brain Research* -40% Alzheimer’s 114,000 National Institute on Aging -40% Drug overdoses 97,000 National Institute of Behavioral Health* -38% Suicide 49,000 Covid, flu and pneumonia 95,000 National Institute of Allergy and Infectious Diseases -36% Sources: HHS.gov; CDC WONDER Note: Annual deaths as of 2023. Proposed funding cut figures are based on the difference between 2025 and 2026 budget proposals. Institutes with asterisks are proposed consolidations of existing N.I.H. institutes.

Organizations like the American Medical Association are beginning to speak out, but their comments are largely restricted to specific issues such as Medicaid or immunization guidelines. The threat to the health of Americans is larger than one issue. It’s about more than Medicaid. It’s about more than vaccines. It’s about the totality of the administration’s agenda. It’s the cumulative effects of the entire basket of policies that put Americans at greatest risk.

Physicians like me know from the data that lives will be lost as a consequence. More than 6,000 health professionals (myself included) have warned the public about their concerns in an open letter. Yet institutions of all kinds seem to be cowering to Mr. Trump, afraid of being punished or prosecuted for questioning his wishes. The administration has defied the courts and gone after law firms and universities, and is unlikely to spare medicine. Just as it has pressured the media to alter the news, the government is now challenging medical journals to alter what they publish.

Times like these call on us to speak the truth. On matters of life and death, physicians like me have an added duty to warn patients and the public. People may feel that a shakeup in Washington is long overdue. But too many Americans, including our leaders, take their health for granted, assuming that the infrastructure to prevent disease and save their lives will always be there, that America will always lead the world in science and that systems to keep their children safe will always exist. None of this can be counted on, especially now.