Biden vs. Trump: Should Their Position on Public Health Drive Your Vote?

by Justin B. Moore, PhD, MS, FACSM

Single-issue voting is the phenomena where a voter will choose a candidate (or often a party) based upon their stance on an issue that is of central importance to the voter. The classic example is that of abortion rights. Since the landmark Roe v. Wade decision nearly fifty years ago, one struggles to come up with an issue that is more clearly polarizing than the belief (or lack thereof) in a woman’s right to legal abortion. In a time when politicians regularly avoid direct answers, evade questions, or cloak their positions in rhetoric, abortion rights are one area that often elicits a clear answer. One would think that other topics would elicit a similar response, but even the denunciation of racism has become politically charged. However, in the current presidential election, public health has become a polarizing issue that both candidates appear willing to share their position on with little spin. This leaves the public health community with a conundrum: with all the issues that can guide our vote, does a candidate’s position on public health rise to the level of a single issue that decides the vote?

To answer that question, it’s important to examine the position of the candidates on the issues of disease prevention and health care. Mr. Trump’s position on disease control and prevention is clear based upon the actions of the Trump administration. The president has repeatedly attempted to cut the budgets of the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the National Institutes of Health (blocked by bipartisan congressional action), and he fired the US pandemic response team in 2018. In these proposed cuts, chronic disease prevention appears to be the most often selected target. This lack of support for primary prevention while simultaneously cutting funding for health care that would provide access to secondary or tertiary care leads to only one conclusion: Mr. Trump sees no role for the government in chronic disease control or prevention. One might argue that this is consistent with a conservative dedication to reduce government size and interference in the lives of Americans, but Trump and the republican party also support increasing the size of the military (the largest government employer) and restricting marriage rights. Meanwhile, democratic presidential nominee Joe Biden has proposed a comprehensive approach to expanding public health activities in response to COVID-19 and other threats.

Similarly, the republican position on health care has evolved from one of government mandated personal responsibility [the individual mandate of the Affordable Care Act (ACA) comes from a republican proposal in the 1990s], to…well…not much. After four years of attempting to repeal the ACA, the Trump administration and republican senate haven’t produced a coherent health care proposal. It would appear that they support the quasi-free market approach that predated the ACA which has historically produced sub-optimal outcomes, especially for the working poor, communities of color, and other marginalized groups. The Biden position is more nuanced, but the prevailing position is that universal coverage must be achieved, although the mechanism is up for debate within progressive circles.

Ultimately, it’s up to the individual voter to decide which position is most consistent with his/her values, but the positions held by the candidates are relatively clear. Does public health and health care rise to the level of a single-issue vote in a time when other related issues (eg, abortion rights, climate change, immigration, etc.) are also extremely polarizing? For those working in public health, an argument can be made for “yes,” as our livelihoods are potentially hanging in the balance. Expanded public health and health care funding will result in public health job creation and security, which should benefit all of us working in the field. However, this issue is bigger than economic gain, as it directly impacts the public health workforce’s ability to perform the 10 essential public health services. One candidate clearly supports the public health community’s ability to perform these services, while the other does not. Whether this is enough to ensure your vote in the upcoming election is a personal decision, but as a public health worker (or as a citizen of America), please understand that your vote will be for or against public health. Choose wisely.

Justin B. Moore, PhD, MS, FACSM, is the Associate Editor of the Journal of Public Health Management and Practice and an Associate Professor in the Department of Implementation Science of the Wake Forest School of Medicine at the Wake Forest Baptist Medical Center in Winston-Salem, NC, USA. Follow him at Twitter and Instagram. [Full Bio]

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