December 19, 2016

On December 1, students and faculty from Drexel and other area universities gathered to reflect on implications and impact of the presidential election for the practice of public health. Ana Diez Roux, MD, PhD, MPH, Dean of the Dornsife School of Public Health, moderated the discussion – charging a panel of faculty and students from the school to analyze what the election outcome may mean for the field and what the public health community should be thinking about and doing together. “It is an opportunity to consider our values as a public health community and how we should continue to move those values forward,” Diez Roux said.

The speakers offered thoughtful analysis, and each began with the caveat that the direction President-elect Trump will take remains unclear: his impact on population health will depend on the people and policies he puts in place once he takes office.

“They’ve said ‘repeal and replace’ with regard to the Affordable Care Act (ACA) – and talked about ending the individual mandate, and eliminating Medicaid expansion,” said Rob Field, PhD, JD, MPH, professor of Health Management and Policy and in the Kline School of Law. He noted that at the same time, after meeting with President Obama, Mr. Trump said he “favors” ACA provisions that allow children to remain on parents’ policies until age 26, as well as the ability the law provides for people with pre-existing conditions to get insured.

Said Field: “It’ a game of chicken that changes on an almost daily basis.”

Alex Ortega, PhD, chair of the Department of Health Management and Policy pointed out that Trump’s nominee to be Secretary of Health and Human Services (HHS), Rep. Tom Price (R-GA), has proposed moving health care reform away from mandated coverage to a more free market approach. “[It’s] called the Empowering Patients First Act – which sounds great – but moves toward individual responsibility and away from the population health approach the ACA,” Ortega said. “That approach pushes for health saving accounts with large deductibles – which works for the wealthy, not the working class… Healthcare.gov will be gone.”

On the issue of the environment, Jerry Fagliano, MPH, PhD, chair of the Department of Environmental and Occupational Health, conceded that “a lot of damage can be done” if the Trump administration disengages from the Paris agreement and others on climate change, or backs away from the EPA clean power plan to improve fuel efficiency in cars to reduce pollution. At the same time, he sees some cause for optimism: “There are positive trends in private investment and government policies,” he said. “Cities are most responsible for greenhouse gas emissions and are showing a lot of leadership on reducing pollution across the world.”

Ana Martinez-Donate, PhD, associate professor of Community Health and Prevention, pointed out that while the president-elect has made various promises about how he’ll deal with immigration – he has yet to elaborate on how he will achieve his promises – and left the nation’s 41 million immigrants in limbo. The outlook could be especially bleak for the immigrant youth, brought here as young children, who gained protection from deportation under Deferred Action for Childhood Arrivals (DACA) an immigration policy started by the Obama administration in June 2012. “What’s scary is that deporting them is very doable – they have registered under DACA, so they can be found,” Martinez-Donate said.

John Rich, MD, professor of Health Management and Policy and director of the Center for Nonviolence and Social Justice, said the fear factor was exacerbated by the “toxic and hateful” rhetoric that dominated the presidential campaign. “A consequence of this vitriolic discourse is that people feel a climate that is more hostile than before,” said Rich. “Youth and LGBT folks who already felt marginalized – now feel worse and afraid.”

Marla Gold, MD, Dean Emerita and professor of Health Management and Policy, scanned the grim faces in the audience and quipped: “You people look like you need a balloon drop!” She expressed concern about “racism, xenophobia and misogyny” expressed during the campaign and suggested an antidote: the creation of jobs. “If there is a bipartisan effort to create infrastructure jobs, and people seem to calm down – the ‘isms” will fall away,” she said.

Shannon Marquez, PhD, MEng, Associate Vice Provost for International Programs who also directs Dornsife’s Office of Global Health, called for the new president to honor “our role in the global community.” With a nod to Cuban visitors from the University of Cienfuegos who were in the audience, she noted that the Dornsife School of Public Health’s first student travel program to Cuba took place last summer, and warned, ‘[Drexel’s] new course will die – if  President-elect Trump takes a pro-embargo hardline with Cuba.”

A student speaker, Epidemiology doctoral student Ana Ortigoza, MD, MS ’16, expressed concern about the ability of international students to study here in the US, if visas are restricted by anti-immigrant policies. She called on students to leverage their education to be “social agents” to support their communities. Matthew Kearney, MPH, a doctoral student in Community Health and Prevention, brought a positive spin to the discussion: “While it may seem dark, we are learning, and there will certainly be opportunities,” he said. “Though the age of Obama is ending, we will see lots of good work in the future.”

Speaking of his millennial generation, Kevin Clifford, MPH ’18, observed that “If we’d come out in strength to vote in November, it would have been a “landslide for Hillary.”

“This election hurts,” Clifford conceded. “But rather than beating our heads and focusing on what went wrong, we need to focus on what we can do.”

Jennifer Kolker, MPH, Associate Dean for Public Health Practice and associate teaching professor of Health Management and Policy, took both a practical and inspirational view.

“We need to be vigilant and pay attention,” she said. “A lot of changes in public health won’t be banner headlines – they will be budgetary tweaks, defunding, and not easily seen… The first federal budget will tell us a lot.

“People didn’t vote down public health,” Kolker added. “Keep your eyes on the prize – and keep moving forward. That’s how I’m getting through the next four years.”

Dean Ana Diez-Roux wrapped, calling on attendees to “rediscover the transformative power of facts and truth.

“Thank you and to be continued,” she said, promising resume the conversation when the new administration is in place next year.