For many of us in the public health community, the 2016 Presidential election was widely seen as a setback. The Affordable Care Act--imperfect as it is--will likely have many of its vital provisions repealed, potentially leaving millions of Americans uninsured. What's more, the next administration will likely be far less supportive of policies in alignment with the public health consensus on a myriad of issues including women's and reproductive health, LGBT health, and addiction.
Despite this pessimistic outlook, simply pointing out hurdles or setbacks will do little good in making any positive gains in the field of public health during a Trump Presidency. Specifically, there are battles in the realm of public health that are being fought and will need to continue being fought, regardless of who resides at 1600 Pennsylvania Avenue.
Ensuring Children Are Being Vaccinated
Vaccines have far and away been the most effective public health tool in stopping preventable disease and mortality. Scourges like polio and smallpox are now a thing of the past thanks to vaccines. Unfortunately, the anti-vax movement in the United States stands to undermine decades of progress made in eliminating preventable infectious disease. The outbreak of measles among children in the past year or two is a stark reminder that herd immunity does not work when too many parent choose to not have their children vaccinated. Ensuring that children in the United States are being immunized has been and will continue to be a top priority for public health officials.
Politically-messy as it may be, those of us in public health need to fight for far more limited criteria in which parents are allowed to exempt their children from being vaccinated in order to attend school (if not eliminate exemptions altogether). This includes removing (or at least greatly restricting the use of) so-called philosophical and religious exemptions. In the same way that public health policy has banned smoking in certain public places and businesses throughout the country (based on the idea that your rights end where my rights begin), the health and well-being of all students in a school should not be jeopardized because a few handful of students' parents refused to accept science and have them immunized.
Continuing the Decline in Teen Pregnancy
You do not need to be an epidemiologist nor work in public health to understand the benefits of reducing teen pregnancy. Greater educational attainment and increased participation in the workforce and just two of the most prominent benefits of avoiding an unplanned pregnancy during a woman's teen years. While the factors that influence teen pregnancy rates are multifaceted, there is a large part that public health policy plays.
For starters, medically accurate sex education in school is a must if we wish to keep teen pregnancy rates on the decline in the United States. While this should not be much a debate, the many states with Republican-controlled legislatures may influence what is taught. This may range from incomplete or inaccurate sex education to strictly abstinence-only education. Education about birth control methods is also vital. For example, research from the Guttmacher Institute shows that between 2006 and 2013, teens living in rural areas who received formal education on birth control methods declined from "71% to 48% among females, and 59% to 45% among males." The fact that such policy is set at the local level is a further piece of evidence that this is a battle that was going to be fought regardless of who won the election.
An additional area in which public health needs to be vocal is in ensuring access to contraceptives to sexually active teens. A recent analysis also conducted by the Guttmacher Institute found that while teen sexual activity remained stable between 2007 and 2012, the teen pregnancy rates continued to drop. They attribute this to improved use of contraceptives, and make the point that access to birth control is key to continuing this trend.
Lifting the Federal Ban on Gun Violence Research
While policy regarding school exemptions for vaccines and sex education and access to contraceptives may be set, in large-part, at the state or local level, the federal ban on funding gun violence research is most certainly a fight that will be directly affected by which party holds the oval office. A 1996 federal law, known as the Dickey Amendment, has the de facto effect of banning federal grant dollars from being used by the CDC to fund gun violence research. Specifically, the law does not allow the CDC to 'advocate for or promote gun control.' A major component of epidemiological research is to make recommendations, where applicable, based on the evidence when studying a public health problem. No doubt that such research into gun violence might lead to policy recommendations that might be viewed by some as gun control, but it hardly makes sense that we should not be able to at least get an empirical picture of gun violence in this country.
The Second Amendment and gun reforms are arguably the most hotly contested political issue of our time. Yes, the chances of overturning the ban on gun violence research during a Trump administration are slim to none. But uphill battles are commonplace in the field of public health. Regardless of who won the 2016 election, public health would not be in a position to rest on their laurels. Ensuring children are vaccinated was going to be a continuing fight in 2017. Continuing momentum in enacting policies that help reduce teen pregnancy was going to be an ongoing fight in 2017. And yes, attempting to overturn the two-decades-old federal ban on gun violence research was going to be an ongoing fight in 2017. The election may have been a setback for public health, but we are here and ready to keep fighting.