If there is one lesson that recent years have taught us, it is that elections matter. The outcome of the 2016 election had consequences for our country, our world, and our health. Some of these consequences have been excruciatingly immediate. They include the physical and psychological harm done to children who have been separated from their families at the US border, the danger faced by women all over the world who lack basic reproductive care due to the Trump administration’s reinstatement of the Mexico City Policy, and the devastation in Puerto Rico that was worsened by the administration’s indifferent response to Hurricane Maria. Other, less-immediate consequences will be felt most strongly in years to come, especially if the US does not change course from the administration’s policies. They include the environmental damage caused by industrial deregulation, the danger of disinvesting in public goods, and the widening economic inequality that the administration has done little to halt and much to advance. In recent weeks, we have seen these imminent and long-term dangers converge in the potential appointment of Brett Kavanaugh to the US Supreme Court. Should Kavanaugh be confirmed, he will likely be the deciding vote on a range of issues core to health, including reproductive rights, the legal equality of the LGBT population, and voting rights.
All of these developments point to how health is ineluctably linked to politics. Last week, I wrote a piece echoing Rudolf Virchow’s observation that “medicine is a social science and politics is nothing else but medicine on a large scale.” In that piece, I argued for a slight amendment to Virchow’s phrase—it is not so much medicine, but health that is deeply tied to what happens in the political world. Our health depends on the social, economic, and environmental conditions in which we live. These conditions are shaped at the level of politics. Even before 2016, history taught us that the outcome of a single election can have profound, generation-defining consequences, and that these consequences can depend on the slimmest of margins. Take, for example, the election of 1876, between Republican Rutherford B. Hayes and Democrat Samuel J. Tilden. The Reconstruction-era race was to succeed President Ulysses S. Grant, the former Civil War commander who, as president, worked to protect the rights of newly freed slaves by using military force against the nascent Ku Klux Klan and supporting the Fifteenth Amendment. Like Grant, Hayes was a Republican—the party of Lincoln, and, at the time, the party enforcing the policies of Reconstruction in the South. The 1876 election results were too close to call—Tilden had 4,284,020 votes to Hayes’s 4,036,572, with 20 remaining electoral votes in dispute amidst allegations of fraud. After months of controversy, a backroom deal was struck: Democrats would agree to a Hayes presidency, if Hayes would agree to remove federal troops from the South, effectively ceding power to segregationist southern legislatures and abandoning the black population to nearly a century of institutional racism in the form of Jim Crow. We live with the effects of this election to this day. Given all we know about how racism can undermine health, its corrosive effect on communities, and the damage it can do when it is codified into law at the political level, it is difficult not to wonder how less sick we would be had some of the more progressive, racially egalitarian policies of Reconstruction been allowed to continue. When we grapple with the legacy of segregation and bigotry in the US, and the health consequences of these conditions, we are, in part, grappling with the legacy of the election of 1876. And it all came down to 20 electoral votes.
Just as elections can deepen and codify injustice, they can also be instrumental in advancing progress. In the presidential election of 1964, for example, the incumbent Lyndon Baines Johnson won a landslide victory over Senator Barry Goldwater. Johnson carried 44 states to Goldwater’s 6. Following the assassination of President John F. Kennedy, Johnson had spent the remainder of his predecessor’s term fighting to pass the most comprehensive civil rights bill in the country’s history. His overwhelming victory over Goldwater gave him a mandate to continue advocating for bold domestic legislation, enabled by a two-thirds majority for his Democratic party in both houses of Congress. In the end, Congress would pass close to 200 pieces of major legislation put forward by Johnson, including Medicare, Medicaid, and the Voting Rights Act of 1965. LBJ called his program of reform the Great Society. While his domestic achievements would soon be overshadowed by civil unrest and the escalating war in Vietnam, Johnson’s legislative momentum in the years after the 1964 election continues to have a far-reaching effect on American life and health. While Medicare and Medicaid are perhaps the two Great Society measures most explicitly linked to health, the initiative’s focus on poverty, education, urban renewal, and the environment represents an ambitious attempt to engage with the fundamental determinants of well-being in populations, and to lift up the poor and the marginalized, with an eye towards advancing social justice. In 1964, Americans were given a chance to pass judgment on LBJ’s earlier push for a fairer society through the Civil Rights Act of 1964. Their resounding approval let Johnson proceed with his domestic ambitions, creating, in the process, the template for a more socially involved, activist federal government.
The upcoming midterm elections stand to be among the most significant in our country’s history, rivaling these examples from our past. Not only will they shape the Trump administration’s capacity to carry out its agenda, they will also test the progressive momentum we have seen over the last two years. From the push for gun safety reform led by the Parkland activists, to increased support for single-payer health care, to growing calls for social, economic, and environmental justice, the Trump era has been a fertile time for social movements. Our school has been active on many of these fronts, from our work against the repeal of the civil rights of the transgender community, to our longstanding research and activism around the issue of gun violence, to our continued engagement with the challenge of climate change. Taken together, this work has helped fuel the movements that have inspired millions to organize, march, and even run for office in pursuit of a better world. In November, we will see if these movements can also inspire people to take the most important step in the life of a politically engaged citizenry—to vote. If they do, they will have done much to help replace the harms of the Trump era with a politics that promotes health, rather than a politics that undermines it.
I hope everyone has a terrific week. Until next week.
Warm regards,
Sandro
Acknowledgement: I am grateful to Eric DelGizzo for his contributions to this Dean’s Note.