As I write this Note, it is 11 pm on Election Night. Some of what I write may reflect a reality which has changed by the time you read this in the morning. As of this writing, it remains unclear who has won the presidential race.
This uncertainty comes on the heels of a challenging four years in many ways, not least for health. I have often written about how the Trump administration has embraced, in its rhetoric and its policies, a counterproductive approach to many of the factors that shape health. From its efforts to undermine the Affordable Care Act, to its withdrawal from the Paris Climate Agreement, to its targeting of immigrants and LGBT Americans, to its attempts to further fray our country’s social safety net, to its economic policies which deepen the inequalities that inform health divides, the administration has consistently deprioritized health. This is to say nothing of its mismanagement of the Covid-19 pandemic, where the administration’s willingness to downplay the virus and dismiss public health best practices has placed lives at risk. In falling short, the administration has—however inadvertently—reminded the country of how important issues like climate change, inequality, social justice, and investment in public health infrastructure are shaping a context that generates health.
And yet, despite this, this moment finds us with an election that is currently undecided, even as we have broad national acknowledgement that this election truly matters for much—and particularly for health.