The Fund supports several networks of state health policymakers to help identify, inspire, and inform policy leaders.
The Fund identifies and shares policy ideas and analysis on topics important to state health policymakers, particularly on issues related to state leadership, primary care, aging, and health care costs.
Keep up with news and updates from the Milbank Memorial Fund. And read the latest blogs from our thought leaders, including Fund President Christopher F. Koller.
The Fund publishes The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to health policy leaders.
The Milbank Memorial Fund is an endowed operating foundation that aims to improve population health by connecting leaders and decision makers with the best available evidence and experience. It does this work by:
The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
David Rosner Read Bio
Back to The Milbank Quarterly
The recent decision by the Trump administration to withdraw from the Paris Agreement was a stunning moment in the post–World War II era. Along with Trump’s decision to withdraw from the Trans-Pacific Partnership, threats to modify the North American Free Trade Agreement, insults to NATO leadership, and efforts to build a wall along the US-Mexico border and deport millions of people, it has been widely condemned as part of a dangerous abdication of at least 70 years of American global leadership. When taken in context with the host of retreats on a variety of environmental issues and his attack on the Affordable Care Act, it signals Trump’s determination to fulfill his wayward campaign promise to return power to the people and to put “America First.”
In response to these “presidential actions,” a steady stream of criticism has poured forth from the nation’s leading newspapers and television and media commentators. Some have taken solace in the fact that the disorder in his administration and the Republican Congress has stymied some of the most radical tax and budgetary proposals. Some have even proclaimed that “the populist revolution . . . is already over—at least for now.”1
But we only have to scratch the surface of the Trump administration to see that a lot of damage is being done while we are focused on the president’s problems with multiple congressional hearings and investigations and the partly stymied legislative agenda. Most concerning, a stream of bad news is coming out of the Environmental Protection Agency (EPA) and the Department of Labor.
EPA Administrator Scott Pruitt has reversed an earlier EPA proposal to ban chlorpyrifosf, a pesticide ingredient widely seen as a possible carcinogen; encouraged the use of coal and removed restrictions on fracking; removed restrictions on drilling in the Arctic; and limited the agency’s ability to regulate toxic emissions like mercury, lead, and carbon dioxide from the nation’s power plants. The list goes on but, in general, he has rolled back protections of our air and water and given concerned environmentalists, scientists, and scholars the chills.2 Pruitt is following through on Trump’s campaign pledge that 2 regulations be cut for every 1 enacted and to get rid of the EPA “in almost every form,” leaving only “little tidbits” intact.3
The Occupational Safety and Health Administration (OSHA), already hobbled by decades of underfunding and industry attacks, is subject to crippling budget cuts and reversals of some of its most cherished policies, many of which have been decades in the making. In a previous column I detailed OSHA’s efforts to adopt a silica standard, an action that has literally taken decades to craft and put in place.4 So, it is particularly troubling to learn of the decision of the administration to rescind it. As detailed in Deadly Dust, my book coauthored with Gerald Markowitz, silica was identified as a cause of silicosis, a serious lung disease, in the 1920s and led to it being called the “king of occupational diseases” in the 1930s.5 Yet, because of silica’s importance to a number of industries that used it as a very cheap abrasive, neither state nor federal authorities could impose strict regulations on it. In 1970, when OSHA and the National Institute of Occupational Safety and Health (NIOSH) were created, silica was among the first materials that they sought to control: NIOSH recommended and OSHA sought to adopt dramatically lower exposure limits and to ban it as an abrasive in sandblasting.
Predictably, affected industries fought the proposals and the silica standard was not revised (see the original documents at toxicdocs.org). In the 1990s, under President Clinton’s OSHA, the issue was once again brought to the fore. Clinton’s Secretary of Labor, Robert Reich, called for the end of the silicosis epidemic by announcing OSHA’s national campaign, “If It’s Silica, It’s Not Just Dust.”David Michaels, the administrator of OSHA under President Obama, made silica a signature issue and worked tirelessly to finally adopt the standard for exposure first suggested in the early 1970s by NIOSH. That this 45-year effort could so easily be reversed by the Trump administration is abominable.
Similarly, the beryllium standard is long overdue. As early as the 1930s, the dangers of beryllium exposure were well documented. The development of the fluorescent lightbulb led to the discovery of beryllium as a cause of a strange new fibrotic lung disease among Sylvania lightbulb workers. OSHA had previously sought to regulate it but was also opposed by powerful industry groups. After strenuous efforts the plant finally installed equipment to protect their workforce. OSHA’s efforts to set a lowered rule is now being stymied by changes that promise to exempt many employers—and this is in spite of the fact that the largest producer of lightbulbs in the United States had already agreed to back the new restriction.
Many of these early battles to control dust diseases can be seen as part of an unending battle between administrations intent on either protecting workers or protecting industries. For much of its history OSHA has been the object of extreme derision and attack as the symbol of government “overreach” and unnecessary government regulation. But in our current era there may be an even more sinister reason: pure ideological commitment to oppose regulation no matter what the cost to workers’ and people’s health.
Under David Michaels and Lisa Jackson there was a concerted effort to inject new energy and authority into OSHA and the EPA. But now OSHA and the EPA are both in danger of seeing their most important public health protections destroyed through neglect. The Trump administration’s effort to “scrap two regulations for each new one adopted” will force administrators in the federal agencies to make what William Styron identified as a “Sophie’s Choice”—the choice between the lesser of two terrible evils.
David Rosner is the Ronald H. Lauterstein Professor of Sociomedical Sciences and professor of history at Columbia University and codirector of the Center for the History of Public Health at Columbia’s Mailman School of Public Health. He is also an elected member of the National Academy of Medicine. In addition to numerous grants, he has been a Guggenheim Fellow, a recipient of a Robert Wood Johnson Investigator Award, a National Endowment for the Humanities Fellow, and a Josiah Macy Fellow. He and Gerald Markowitz are coauthors on ten books, including Deceit and Denial: The Deadly Politics of Industrial Pollution (University of California Press/Milbank, 2002; 2013) and Lead Wars: The Politics of Science and the Fate of America’s Children (University of California Press/Milbank, 2013). He also testifies for plaintiffs in lawsuits on industrial pollution and occupational disease.
Get the Latest from the Milbank Memorial Fund
The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, political, historical, legal, and ethical dimensions of health and health care policy.