Burning Down the House: The Most Recognized Public Health Achievements Have Become a Hit List for the Trump Administration

The Centers for Disease Control and Prevention (CDC) and other public health organizations periodically create lists of significant public health achievements in the United States and globally. The main purpose of such lists is to shed light on the driving forces behind the progress and gains that have been made in life expectancy and other key metrics. In addition, since public health achievements are often invisible and/or conflated with medical care, identifying and celebrating some of the major public health contributions to injury, morbidity, and mortality reduction is an important endeavor.

In reviewing lists of great public health successes, it becomes painfully obvious that the second Trump administration is unleashing targeted assaults upon virtually all of these notable achievements. Although the current sabotage of vaccines, water fluoridation, and public health budgets is rightfully receiving substantial attention, nearly all of the most recognized achievements are also experiencing attacks through reductions in federal resources for research, programs, staff, data collection, and surveillance, as well as rollbacks on federal policy and regulation. It’s as though the Trump administration is using well-accepted, evidence-based lists of the greatest advances in population health as its agenda for burning down the entire house of public health.

In April 1999, the CDC published a list of the “Ten Great Public Health Achievements” in the United States between 1900 and 1999. This well-accepted list reflects the tremendous progress achieved in public sanitation, injury prevention, and medical interventions for the primary prevention of many infectious and chronic diseases. All of these achievements are the synergistic result of scientific research advances, public education campaigns, investments in governmental public health infrastructure, public-private partnerships including with medical care systems, and changes in public policy at the local, state and federal levels. This list of 20^th century great achievements includes:

• Vaccinations
• Motor vehicle safety
• Safer workplaces
• Control of infectious diseases including typhoid, tuberculosis, polio, and sexually transmitted infections
• Decline in deaths from coronary heart disease and stroke
• Safer and healthier foods
• Healthier mothers and babies
• Family planning
• Fluoridation of drinking water
• Recognition of tobacco use as a health hazard

CDC updated this list in 2011 to showcase significant public health advancements globally in the first decade of the 21^st century, highlighting ongoing progress in key areas, such as vaccine-preventable diseases, motor vehicle safety, occupational safety, maternal and infant health, cardiovascular disease prevention, and tobacco use prevention and reduction. The 2011 list added the achievements of public health preparedness and response, cancer prevention and early detection, and childhood lead poisoning prevention.

The World Health Organization recently created a list of global public health milestones and achievements since its inception in 1948. This list includes many examples of international collaboration regarding public health standards, policy, and practice (e.g., the International Classification of Diseases, the Global Fund to fight HIV, malaria and tuberculosis, and a Comprehensive Mental Health Action Plan), and significant advances in addressing maternal and infant health, family planning, tobacco use prevention, and the global control of infectious diseases including malaria, HIV, and antimicrobial resistance. 

These lists of achievements do not bely the fact that serious public health challenges and problems remain. Of course, much more needs to be done to address some of the key issues in the Make America Healthy Again agenda, such as improving nutrition and food quality, reducing the burden of chronic illness on population health, and improving child health. Even so, countless public health experts have been writing in protest about many aspects of the Trump administration agenda with different foci, arguments, and tones. For example, see Oberlander and Gollust on “public health under siege,” Sharfstein on federal health infrastructure and leadership, and Gostin on US global health leadership. In addition, the Democratic members of the US House Committee on Oversight and Government Reform just released a report on how the Trump administration’s “reckless crusade” is harming Americans’ health, with a focus on medical care/treatment, health care access, and vaccines.

A key framing point that needs to be further elevated is that the attacks on public health are not only being directed at a handful of issues for which Secretary Kennedy holds fringe beliefs or vendettas, but also that our nation’s (and the world’s) most celebrated public health achievements have become a hit list for the Trump administration. Rather than building upon objective science, decades of public health experience, and evidence-based gains, the current administration is overtly undermining the foundational and synergistic public health functions, services and agencies (including the CDC and FDA) that have made the most celebrated public health advances possible. The attacks are wide and far-reaching, with very few public health issues being spared. These include:

Occupational safety: The Trump administration is regressing workplace safety protections through several actions, including: 1) huge budget and staff cuts at the National Institute for Occupational Safety and Health and at the Department of Labor, affecting research, policy, and enforcement staff; 2) a plan to eliminate many field offices of the Occupational Safety and Health Administration and the Mine Safety and Health administration; and 3) a large number of regulatory rollbacks that encompass easing safety standards for construction and mining work and halting the tracking of workplace injuries and illnesses. In addition, the administration is promoting corporate self-policing and internal safety audits in lieu of government oversight and citations.

Environmental standards: A cacophony of rollbacks on environmental regulations and vehicle emissions standards was implemented in 2026, primarily through the rescinding of the Endangerment Finding. Although these regulatory changes will improve the affordability of vehicles for consumers, they also weaken myriad quality and safety standards for water, air, power plants, and vehicles. An evidence-based analysis of the potential impacts of this sweeping deregulation agenda concludes that it will “cause long-lasting health harms, disproportionately affecting low-income and other vulnerable groups.”

Tobacco control: In early 2025, the CDC Office on Smoking and Health and its programs were gutted. Furthermore, there are numerous examples of how the current FDA is being kind to big tobacco by easing regulatory processes for e-cigarettes, flavored tobacco products, and nicotine pouches. The role of public policy and regulation in the sharp decline in tobacco use globally is well documented. However, in an effort to downplay the role of public policy, Secretary Kennedy has erroneously claimed that susceptibility to the risks of smoking is primarily genetic, arguing that “only 1 in 5 (smokers) died from lung cancer” and ignoring the fact that tobacco use is the cause of many life-threatening chronic illnesses, including heart disease, serious respiratory disease, and several other types of cancer.  

Maternal/infant health and family planning: Numerous Trump administration actions threaten proven public health approaches to maternal, infant, and reproductive health, including the key role of family planning. The administration gutted many programs and the majority of positions in the CDC Division of Reproductive Health, including the team that provides updates on best contraceptive practices to clinicians and the Pregnancy Risk Assessment Monitoring System. Sweeping activities that slash family planning infrastructure and contraception access, both domestically and abroad, are underway.

The Trump Administration has been forced to recapitulate some of its budget and administrative infrastructure assaults through court orders and Congressional mandates. However, it is undeniable that great disruption and damage is ongoing. This includes heartbreaking setbacks in hard-won improvements in public opinion and trust regarding governmental public health. Furthermore, many state legislatures are taking policy signals from Washington, DC that have led them to loosen school-entry vaccine requirements and further reduce their own public health budgets even though combined federal and state cuts are quite likely to threaten public health and damage state and local economies.  

Better addressing the many lingering and emerging population health challenges, creating new federal priorities and goals, and improving government efficiency can certainly happen without turning the great public health achievements of the past century into a hit list fueled by polarized politics and a large dose of unscientific claims and beliefs. Balancing individual freedoms and private interests with public protections has always been a fundamental aspect of governmental public health. Such debates and discussion must continue without simplistic cries for “medical freedom” and unsubstantiated assertions that the entire public health enterprise is inefficient, ineffective, and corrupt.

While further analyzing and calling attention to the attacks in specific public health areas (e.g., vaccines, infectious disease control, and family planning) is essential, the bigger picture needs to be emphasized as well. The message that needs to be made loud and clear is that public health approaches have greatly contributed to reductions in injury, illness, and death, yet the Trump administration is attacking, dismantling, and deprioritizing almost all of the most recognized and proven approaches for national and global health gains. This includes objective research free from political interference, high-quality data for tracking, surveillance, and reporting, community-engaged education, public-private partnerships with funding and staff, policy and regulation supports, and public trust. The Trump administration is burning down the entire public health house with no stated rationale beyond myopic claims that governmental public health is “costly and ineffective” and is a burden to the private sector. These unjustifiable actions are harming the public’s health, and recovery will take decades if not checked and halted soon.

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