The United States could have averted 40% of the deaths from COVID-19, had the country’s death rates corresponded with the rates in other high-income G7 countries, according to a Lancet commission tasked with assessing Donald Trump’s health policy record.

Almost 500,000 Americans have died from the coronavirus, with the number widely expected to go above half a million in the next few weeks. At the same time some 27 million people in the United States have been infected. Both figures are by far the highest in the world.

In seeking to respond to the pandemic, Trump has been widely condemned for not taking the pandemic seriously enough soon enough, spreading conspiracy theories, not encouraging mask wearing and undermining scientists and others seeking to combat the virus’s spread.

Dr. Mary T Bassett, a commission member and director of Harvard University’s FXB Center for Health and Human Rights, said that “the U.S. has fared so badly with this pandemic, but the bungling can’t be attributed only to Trump, it also has to do with these societal failures … That’s not going to be solved by a vaccine.”

In a wide-ranging assessment published on February 11, the commission said Trump “brought misfortune to America and the planet” during his four years in office. The stinging critique not only blamed Trump, but also tied his actions to the historical conditions which made his presidency possible.

“He was sort of a crowning achievement of a certain period but he’s not the only architect,” said Bassett, “And so we decided it’s important to put him in context, not to minimize how destructive his policy agenda has been and his personal fanning the flames of white supremacy, but to put it in context.”

The commission condemned Trump’s response to COVID, but emphasized that the country entered the pandemic with a degraded public health infrastructure. Between 2002 and 2019, U.S. public health spending fell from 3.21% to 2.45% – approximately half the share of spending in Canada and the UK.

To determine how many deaths from COVID the U.S. could have avoided, the commission weighted the average death rate in the other G7 countries – Canada, France, Germany, Italy, Japan and the UK – and compared it with the U.S. death rate. In another comparison, the commission found if U.S. life expectancy was equivalent to the average in the other G7 countries, 461,000 fewer Americans would have died in 2018.

The Lancet commission on public policy and health in the Trump era, launched in April 2017 to catalogue Trump health policies, examines the driving forces of his 2016 election win and offers policy recommendations. The 33 commissioners are from the U.S., U.K. and Canada and work in public health, law schools, medicine, unions, indigenous communities and other groups.

The commission devotes as much time in the report to its namesake as it does to the conditions that made him possible. A line is drawn from neoliberal policies pushed in the past 40 years, such as those that intensified the drug war and resulted in mass incarceration, to health inequities Trump exacerbated while in office. Many of the connections date back even further, to the colonization of the Americas and the persistence of white supremacy in society.

“I really think one of the accomplishments of the report is its historical truth-telling,” said Bassett, New York City’s health commissioner from 2014 to 2018.

Trump’s response to documented health inequities and growing inequality was to attack programs and policies intended to make health insurance more affordable and accessible. In Trump’s first three years in office, there were 2.3 million more people without health insurance.

Between 2017 and 2018, the health insurance coverage rate decreased by 1.6 percentage points for Latinos – roughly 1.5 million people – and by 2.8 percentage points for Native American and Alaska Native people, while remaining stable for the white population, according to the commission.

The report not only assesses health policy, but also includes lengthy sections on immigration, Puerto Rico, reproductive rights, racism and the environment. Dr Adam Gaffney, a commission member and Harvard Medical School assistant professor, said: “To only focus on medical care would neglect the many other inequities and injustices that produce health and sickness.”

The commission said evidence is growing that Trump’s regulatory rollbacks have increased death and disease. Between 2016 and 2019, the annual number of deaths from environmental and occupational factors increased by more than 22,000 after years of steady decline.

The negative consequences of the rescinded regulations disproportionately affected the states which most supported Trump in 2016. These are also states most affected by rollbacks in health insurance coverage, according to the report. The commission did identify a positive in Trump’s domestic agenda: his support for the First Step Act, a prison and sentencing reform bill that reduced mandatory minimum sentences for a number of drug-related crimes among other things.

The commission also noted that historical advances usually follow a period of conflict and struggle and included recommendations for healthcare workers to advance progress in the wake of Trump’s presidency.

The report includes a list of policy recommendations to address the issues it raised, including providing compensation for descendants of enslaved Africans and indigenous people, raising taxes on the wealthy, reducing defense spending and adopting a single-payer, national healthcare system.

“I hope this report pushes those with power to pursue the necessary policies to make this a healthier and happier nation, ”Gaffney said.

Аmаndа Hоlpuch

Stеfаnі Rеynоlds

Help deliver the independent journalism that the world needs, make a contribution of support to The Guardian.

The Milwaukee Independent began reporting on what was then referred to as the mysterious “Wuhan Virus” in January 2020. Other local media did not picked-up on the story until many weeks later. Our early features focused on the economic impact, social issues, and health concerns long before other Milwaukee news organizations even mentioned the coronavirus. Over the following year, we have published hundreds of articles about the pandemic and how it has affected the lives of Milwaukee residents. This extensive body of work can be found on our COVID-19 Special Report page, a chronological index of links by month. Our editorial voice remains dedicated to informing the public about this health crisis for as long as it persists.
For medical resources, please visit the CDC’s COVID-19 page or the Wisconsin Department of Health Services. All editorial content published by Milwaukee Independent can be found at With a mission of transformative journalism, our staff is free from commercial bias and are not influenced by corporate interests, political affiliations, or a public preferences that rewards clicks with revenue. As an influential publication that provides Milwaukee with quality journalism, our award-winning photojournalism and features have helped to achieve a range of positive social impact that enriches our community. Please join our effort by entrusting us with your contribution. Your Support Matters - Donate Now