In less than two weeks since the new presidential administration assumed power, public health has become a major target, putting essential, life-saving work in jeopardy.

From official executive orders to behind-the-scenes directives, many of President Donald Trump's actions since taking office Jan. 20 have taken aim at public health, endangering funding, research, programming, communications and more. Some of the measures have already taken effect, while others have been slowed or overturned through legal challenges.

On Jan. 28, APHA and partners filed a motion for a temporary restraining order against one of the Trump administration's most potentially harmful actions: halting grants, loans and financial assistance from federal agencies, including those managed by the Centers for Disease Control and Prevention.

Freezing the funding, which would include grant monies already promised to recipients, would be "catastrophic," plaintiffs said in the motion, which was filed in U.S. District Court by Democracy Forward.

“From pausing research on cures for childhood cancer to halting housing and food assistance, shuttering domestic violence and homeless shelters, and closing suicide hotlines, the impact of even a short pause in funding could be devastating and cost lives," Diane Yentel, chief executive of the National Council of Nonprofits, said in a news release. "This order must be halted immediately before such avoidable harm is done."

A federal judge responded to the restraining order request on the same day, blocking the Trump order from taking effect, at least temporarily. Though the White House Office of Management and Budget issued a memo Jan. 29 rescinding its pause on federal assistance, White House Secretary Karoline Leavitt said the administration’s orders to review all federal funding remained "in full force and effect, and will be rigorously implemented."

More than 70% of CDC's budget supports public health and prevention work through thousands of state and local health departments, national public health partners and academic institutions. The White House actions left many in public health confused and concerned.

"At this time, we are unsure about any long-term impacts the federal freeze on aid will have on public health funding," Kentucky's Lexington-Fayette County Health Department said on Facebook in the wake of the Jan. 28 order, noting that the department "remains fully committed to providing world-class services to everyone who needs us."

DEI, reproductive health, gender affirmation also targeted
The funding order is just the latest in a flurry of measures by the Trump administration that undermine public health.

Days before, the administration reinstated the "global gag rule" on reproductive health care, which public health leaders say will defund and destroy access to vital services worldwide.

The policy eliminates billions in funding for services such as maternal health care, contraception, abortion and infectious disease control. The gag rule — which prohibits global health care workers that receive U.S. funding to even mention abortion — was in place during Trump’s first presidential term and overturned during former President Biden’s administration.

Planned Parenthood CEO Alexis McGill Johnson called Trump’s latest move “dangerous.”

“The global gag rule not only disrupts the delivery of health services in areas of the world that are most in need, it also rolls back progress in countries that have fought to advance access to health care and human rights,” McGill Johnson said in a news statement. “Elected officials should not be interfering in personal medical decisions, in this country or anywhere in the world."

In addition, Trump is acting on a campaign promise of mass deporting immigrants who are not U.S. citizens, jeopardizing the health, safety and stability of immigrant families. U.S. Immigration and Customs Enforcement raids have taken place in major U.S. cities, and a 2011 policy that prohibited ICE from entering safe harbors such as places of worship and schools was rolled back.

Trump's administration also suspended the U.S. Refugee Admissions Program, which puts the resettlement of thousands of refugees across the world in limbo. The U.S. Customs and Border Protection shut down thousands of appointments for border crossing hearings scheduled through its immigration app, marooning families waiting at the border, including those fleeing persecution or violence.

“We must put a stop to the years-long trend of playing politics and stoking fear with people’s lives to facilitate the adoption of increasingly draconian border and immigration policies that violate the human rights of people seeking safety,” Amy Fischer, director of Amnesty International USA’s Refugee and Migrant Rights Program, said in a Jan. 20 statement.

Trump’s Jan. 20 executive order targeting diversity, equity and inclusion may also have a chilling effect on the livelihoods of marginalized communities and the people who serve them. The order called for ending all federal policies, labor practices and contracted work designed to promote diversity, equity and inclusion. The rollback is a blow to programs that tackle disparities in employment and health, including work on environmental justice.

Rolling back DEI practices will "send our nation back to an era of rampant, state-sanctioned discrimination," and hurt diversity in the U.S. health workforce, Richard Besser, MD, president and CEO of the Robert Wood Johnson Foundation, said in a statement.

“Research shows that greater diversity among doctors improves health outcomes for people of color, disabled people, women, LGBTQIA+ patients and others whose identities have long been underrepresented in the health care field,” Besser said. “Plus, strategies aimed at reducing racial disparities in health care — such as maternal health and cancer care — lead to better outcomes for all patients.”

Gender-based equity is under further threat based on executive orders that claimed it is U.S. policy to only recognize two genders and disavowed the U.S. Supreme Court’s 2020 ruling in Bostock v. Clayton County that sex- and gender-based discrimination is illegal. Additional orders restrict bathroom privileges for transgender people, end federal funding to collect data on gender identity, and pull back on rights for equal housing for LGBTQ+ people. On Jan. 28, a Trump executive order opposed federal support for gender-affirming surgery or medications for people under age 19.

The orders will have swift impacts in the federal prison system and on identification document processing, according to the American Civil Liberties Union. Transgender inmates would no longer have access to gender-affirming care and would face an increased risk of assault and abuse, particularly transgender women who are transferred to men’s prisons. Transgender people would also no longer be able to update their visas or passports with their gender identity.

“Our community has fought for decades to ensure that our relationships are respected at work, that our identities are accepted at school and that our service is honored in the military,” Human Rights Campaign President Kelley Robinson said in a news statement. “Any attack on our rights threatens the rights of any person who doesn’t fit into the narrow view of how they should look and act. The incoming administration is trying to divide our communities in the hope that we forget what makes us strong. But we refuse to back down or be intimidated.”

The Trump administration has also started the process to remove the U.S. from the the World Health Organization and the 2015 Paris Agreement, a treaty among nations that have promised to enact policies that reduce greenhouse gas emissions and combat climate change.

The U.S. left the Paris Agreement during Trump’s first term and rejoined in 2021. Trump previously called for the U.S. to exit WHO in 2020 over criticisms of the international public health body’s response to the COVID-19 pandemic, but Biden reversed that decision before it took effect.

While the process to exit both the agreement and WHO would take over a year, the damage to climate change work would be long lasting. Last year was the hottest ever recorded globally, and the U.S. is only second to China in worldwide carbon emissions. Meanwhile, extreme weather events already cost the U.S. $150 billion annually, according to the National Oceanic and Atmospheric Administration.

International public health experts say scaling back U.S. involvement in WHO could also upend long-term efforts to prevent and treat infectious diseases, such as HIV/AIDS, and trace large-scale outbreaks that spread beyond borders.

Other actions by the Trump administration with the potential to harm public health include:
• Electric vehicles: A Jan. 20 order proposed eliminating federal tax credits that encourage Americans to purchase electric vehicles. Trump also rescinded Biden’s 2021 executive order that called for half of all vehicles sold by 2030 to be electric vehicles, which would have significantly reduced greenhouse gas emissions.

• Inspectors general: President Trump fired more than a dozen inspectors general on Jan. 25. The nonpartisan watchdog positions are responsible for identifying and preventing government mismanagement, waste and fraud at agencies such as the U.S. Department of Health and Human Services, Environmental Protection Agency, and Department of Labor.

• Death penalty: A Jan. 20 order called for the U.S. attorney general to seek the death penalty for anyone who murders a law enforcement officer and for any undocumented immigrant who commits a capital crime. It also called on the attorney general to make sure states have a supply of lethal injection drugs.
APHA has repeatedly denounced the use of the death penalty, citing an American justice system plagued with errors and misconduct that has led to the deaths of innocent people from mostly marginalized communities.

• Energy "emergency" and Alaska drilling: A Jan. 20 order called for ramping up production of oil and gas — including on federal lands — and to use the Defense Production Act to gain access to energy sources. It also called for opening up oil and gas drilling in Alaska’s Arctic National Wildlife Refuge. Environmental experts are concerned that expanding drilling will worsen the ongoing warming of the Arctic climate.

• Reducing the federal workforce: A Jan. 20 order by Trump directed agencies to require all of their workers to work in-person rather than remotely, which could cause large numbers of workers to quit or retire, and to freeze hirings. The White House also directly encouraged federal workers to retire on Jan. 28, offering them several months of paid compensation to do so. The U.S. public health workforce is already facing shortages, which could worsen because of the measures.

• Cessation of health communication: The administration ordered a blackout on public health communications, including CDC's Morbidity and Mortality Weekly Report, and suspended research grant reviews at the National Institutes of Health, putting scientific studies in jeopardy.

"The pace and depth of anti-public health actions taken by the administration has been unprecedented," APHA Executive Director Georges C. Benjamin, MD, told The Nation's Health. "Real lives are being put at risk. The consequences could be devastating."

Photo by Jacob Wackerhausen, courtesy iStockphoto