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On the United States election and global health, some insights into the challenges ahead

The Consortium of Universities for Global Health (CUGH), based in Washington and representing more than 170 organisations globally, has issued a powerful call for United States citizens to do their electoral duty.

Meanwhile, this week’s inaugural #CroakeyLIVE – a new social journalism service from Croakey Health Media – canvassed wide-ranging health issues around the US election, as Jennifer Doggett reports below.

On Twitter, follow the hashtag #USvotesHealth for ongoing news from the Croakey team.


Jennifer Doggett writes:

The world will be watching on November 3 when the United States goes to the polls to determine whether President Donald Trump wins another four years in the White House.

With the COVID-19 pandemic raging, an economy in free-fall, public concern about racial injustices, the increasing visibility of white supremacists, and fears about Trump’s response to an election loss, it seems extraordinary that experts believe this election is still “highly competitive”.

It could “go either way”, according to Bruce Wolpe, one of the panellists in last Sunday’s #CroakeyLive on the United States election and health.

At this event, a panel of health and political experts engaged with online participants for a lively and informative discussion about the implications of the upcoming election for the US, Australia and the world.

The panellists were:

  • Bruce Wolpe, a Senior Fellow at the United States Studies Centre who has worked with the Democrats in Congress during President Barack Obama’s first term and was Chief of Staff to former Prime Minister Julia Gillard.
  • Dr Summer May Finlay, a Yorta Yorta woman, public health academic at Wollongong University, Vice President (Aboriginal and Torres Strait Islander) of the Public Health Association of Australia, and Co-Vice Chair of the Indigenous Working Group of the World Federation of Public Health Associations.
  • Associate Professor Lesley Russell, a dual Australian/US citizen who jokes that she now has to worry about bad politics in two countries. She is a fellow at the United States Studies Centre and Adjunct Associate Professor at the Menzies Centre for Health Policy at the University of Sydney, who has worked as a senior policy advisor on health for the Democrats in the US House of Representatives, for the Obama Administration and for the Australian Labor Party in the Australian Parliament.

The discussion was moderated by Professor Bronwyn Carlson, Head of the Department of Indigenous Studies at Macquarie University.

Flashback to 2016

The panellists shared their memories of the 2016 election and their first reactions to the Trump victory.

Wolpe remembered being on Sky News commentating on the US election and said he found it hard to process the election outcome.

Four years on, he says that most of his fears about Trump have been realised. While he feels that US democracy is strong enough to recover from the past four years, he thinks another term would be disastrous and would leave the institutions of US politics “profoundly different to what the founders envisioned”.

Finlay was with Croakey’s Melissa Sweet and Marie McInerney, and others at the Lowitja Institute International Indigenous Health and Wellbeing Conference 2016 in Melbourne when the news broke. She remembered thinking that the idea of a Trump presidency was “surreal” and that many of the delegates were shocked by Trump’s election.

Croakey’s report from the conference, 2016

Russell was at home alone watching her husband Bruce Wolpe on TV. She described her “desperate hope” that the US can get back to some sense of normalcy and connectedness after the election.

Carlson was at a friend’s birthday party in New York state. She said no-one there anticipated the result and when the election outcome was announced, it was “like entering a twilight phase”.

One of her main concerns over the past four years has been the impact of Trump’s presidency on People of Colour. She also acknowledged that COVID-19 (like other epidemics) has had a disproportionate impact on Indigenous peoples in the US and worldwide.

Professor Rebecca Ivers, from the UNSW School of Population Health, was following the #CroakeyLIVE discussions, and remembered her horror at the possibility of a Trump win in 2016.

Addressing racism

Racial injustice in the US has been in the spotlight after the police killings of unarmed African Americans, including George Floyd and Breonna Taylor, and all panel members agreed that a Biden administration should address structural racism and inequality as a priority.

However, Finlay cautioned against expecting too much progress on race issues from a Biden presidency.

“Addressing systemic issues within any community is much more than an election cycle and requires bipartisan support over generations. No single person can address systemic and structural racism,” she said.

She also noted that given the setbacks in racial justice under Trump, a new administration would have to first focus on winning back ground that has already been fought for.

Wolpe described the Black Lives Matter (BLM) movement as a “potent political force” saying that “Americans want solutions to racial justice despite Trump’s law and order rhetoric.”

He believes that concerns about racial injustice should help a greater turn out to vote among African Americans which should assist Biden.

Wolpe was encouraged by Biden’s ability at a recent Town Hall meeting to describe what he would do for young black men if elected, including supporting home ownership, education and rehabilitation from incarceration.

He also noted that the role of the Attorney General will be crucial in efforts to address racial injustice, saying that “he or she can make the biggest tangible difference to the lives of Black Americans”.

The panel also discussed the impact of the Trump administration on Native American communities, who they said did not get as much attention in the media as African American issues.

Russell discussed the devastating impact of COVID-19 on First Nations peoples, especially the Navajo, due to the under-funding of their health system and lack of resources they have been allocated to protect themselves from the pandemic. She said she was encouraged by the policies on tribal nations on the Biden website but concerned that postal voting can disadvantage Native Americans living on reservations if they don’t have street numbers.

The panel also discussed the impact on Indigenous peoples of the Trump administration’s attack on environmental policies, including removing the requirement for environmental impact statements for mining and other interventions (see this piece from David Shearman for more information on Trump’s attack on the environment and the EPA).

Russell also noted that the Inuit also face discrimination and racism but are often forgotten in public debate.

The impact of the BLM movement in Australia was also discussed. Finlay described how BLM has engaged white people in Australia in a new way in racial justice issues. She described how racism kills Aboriginal and Torres Strait Islander people in ways that are not always obvious, such as through stress and anxiety and high rates of incarceration.

A Biden victory

The huge expectations on Biden to deliver change was raised, and the panel discussed how he could quickly lose the trust of the American people if he wins but does not deliver on their expectations.

One major problem for Biden, according to Russell, is if he does not win the Senate. This means that he will be hamstrung and won’t be able to achieve much, so she is hopeful he will win the White House and also control both the House and the Senate.

Wolpe is confident Biden is up to the top job, saying that “he has no charisma but he is a safe pair of hands when people are scared”.

One of Biden’s strengths, according to Russell, is that he is great at getting really good people to work for him, which should give people confidence in a future Biden administration.

She also pointed out his detailed election platform, including costed policies on COVID and a commitment to set up a commission looking at health inequalities.

A participant commented that both parties would be hampered in addressing the COVID-19 pandemic by the US health financing system which accentuates the inequity in access.

 US health system

The future of the Affordable Care Act (ACA) was also discussed.

Obamacare has become increasingly popular over the past four years, according to Russell, who described how many Americans are benefitting from the ACA and don’t want it to go.

She said Biden will support the ACA if elected but this support will not extend as far as providing Medicare for all, as was proposed by Bernie Sanders.

The panel also discussed how the Centers for Disease Control and Prevention has been sidelined and defunded during the Trump administration. Wolpe suggested that the CDC needs a trusted authoritative person to come in and rebuild it.

Finlay said she was “very frustrated” about the erosion of the CDC under Trump.

“It is really frustrating to see the dismantling of the CDC under Trump and shows what a lack of insight he has about the importance of frank and fearless expert health advice.”

(Since this event the NBC’s White House correspondent has reported that the Government Accountability Office has agreed to “conduct an investigation of the Trump Administration’s political interference at the CDC and the FDA, and to determine whether this interference has violated the agencies’ scientific integrity and communication policies.”)

Wolpe also described the impact of Trump’s policies on Planned Parenthood and other women’s health organisations that now refuse to take federal funding because of the strings attached which constrain their activities even in areas which have nothing to do with abortion

Finlay pointed out that the impact on access to safe abortion will be felt not just in the US but also in Africa and countries dependent on US aid.

Climate and global health

Sweet raised the immense repercussions of climate change, and speculated about the implications for Australian climate politics and policies if Biden is elected, given his commitment to climate action.

Wolpe said there is no doubt that if re-elected, Trump will continue to attack environmental controls, such as pulling out of the Paris accord and opening up Alaska to oil drilling.

The panel also discussed how Trump’s denial of climate change has changed the international dialogue on this issue and emboldened Australia and other countries in their resistance to effective action to address global warming.

The plan on climate put forward by Biden was described as being informed by, but ultimately different from, the Green New Deal.

The role of the states on climate change was mentioned, with the Panel noting that despite the Trump administration’s undermining of climate action, many of the states are committed to action on climate and many cities are working hard to reduce emissions.

Trump’s announcement that he wants to