The Future of Public Health

We all share a common goal: to live as long as possible in the best health possible. Public health is what we do as a society to meet that goal while contending with many challenges, including birth complications, infections, injuries, genetics, environmental agents, and aging itself. Healthcare and public health overlap—the former focusing on individuals and the latter on “all people and their communities”¹—and the two are partners in achieving the goals of an optimum quality of life and a long life expectancy.

Much of what is done in public health is routine and invisible. Restaurants are inspected, water and air quality are measured, vaccines are administered, population health is monitored, and preparedness is maintained. But inevitably, upsets at local, national, and global scales bring attention to what public health agencies do and why they are important. Here are just a few critical issues—both acute and long-term—that public health workers have contended with recently: environmental pollution by the East Palestine, Ohio, train derailment;² widespread water contamination by the “forever chemicals” (PFAS);³ the E. coli outbreak from contaminated onions served at McDonald’s;⁴ and the ever-rising prevalence of chronic inflammation–related health issues such as diabetes and heart disease.⁵ With such events, rapid and effective public health action is expected, making preparedness a priority for public health agencies. When solutions are found and the problem is ended, public health quickly fades back into the background.

But this somewhat idealized schema of how public health operates may have been permanently altered by the COVID-19 pandemic in the United States and perhaps in other countries. Public health’s invisibility is gone; it has become intensely politicized, and its evidence-based approaches are being questioned by critics (including politicians) and challenged by misinformation. With the start of the second Trump administration, changes in public health at the national level are certain, and spillover from the national to the state and local levels is likely.

This article provides a broad perspective on public health in the United States, moving from its historical origins to the present and anticipating how public health may be altered by the new Trump administration. I will address the transformative consequences of the COVID-19 pandemic and the call for reimagining public health in its aftermath.

Drivers of Health and Disease

In order to consider the role of public health, we need to start with how we understand health itself. Today, we view health across the life course as determined by myriad factors operating across levels—ranging from the molecular, such as genetics, to the global, such as multinational food corporations. It can be helpful to think about these determinants on an axis of organization from within the individual, building upward to the family, neighborhood, and community, on to the state and national levels, and ultimately to the global level. These myriad factors change across the life course and have greater effects during periods of susceptibility, including gestation and early life, adolescence, and older ages.⁶ (For a figure that illustrates these levels and adds some details, see go.aft.org/ist.)

Thinking about the factors that affect health as having multiple levels helps us to better understand the social determinants of health (SDOH), a term used to refer to factors causing health disparities among population subgroups. According to the Centers for Disease Control and Prevention (CDC), SDOH are “the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, worship, and age. These conditions include a wide set of forces and systems that shape daily life such as economic policies and systems, development agendas, social norms, social policies, and political systems.”⁷ For example, exposure to environmental pollutants may occur within the home, from nearby polluting industry, or from long-range transport (e.g., wildfire smoke). Food deserts affect neighborhoods, while the reach of structural racism affects people at every level. The SDOH are a prominent target of public health, as embraced in an influential paper calling for a Public Health 3.0 model.⁸ In this new model, local governments pioneer an approach in which public health leaders are empowered to “serve as Chief Health Strategists, partnering across multiple sectors and leveraging data and resources to address social, environmental, and economic conditions that affect health and health equity.”⁹

The impact of the SDOH on life expectancy is profound. An analysis of life expectancy trends in the United States from 2000 through 2021 identified 10 distinct race-geography groups within the United States, termed “the 10 Americas.” It found a life expectancy gap of 20.4 years between the lowest and the highest groups in 2021—an astounding 7.8 years more than in 2000.¹⁰ While COVID-19 widened the gap, it has been increasing since long before the pandemic. Where you were born and who you are matters—a lot.

What Does the Public Health System Do?

As shown in the figure below, the work of public health has been described as comprising three core functions: (1) assessment—gathering and analyzing data to identify problems and paths to solving them; (2) policy development—developing and implementing policies to mitigate problems; and (3) assurance—making certain that what needs to happen does happen.¹¹ Underlying these functions are 10 essential services that together support health equity, giving everyone “a fair and just opportunity to achieve good health and well-being.”¹² This paradigm (adopted in 1994 and updated in 2020) underlies the public health approach generally at the local, state, and national levels.*

Assessment

Assessment includes surveillance (the gathering, analysis, and communication of information on the health of populations) and research (the generation of new knowledge) about health hazards and root causes. In the United States and globally, numerous surveillance systems are in place, some for tracking cases of disease and others for tracking the health of populations.^† Public health research is largely supported and funded by the National Institutes of Health and the CDC and carried out in the academic and public health sectors. The research reaches from molecular (e.g., identifying vaccine targets) to population levels (e.g., evaluating large-scale interventions to advance health).

Policy Development

Policy development contains four services, with a starting point being creating, championing, and implementing policies, plans, and laws. The other three services set the foundation for success: communicating about the policies, gaining support for them, and enforcing them through laws and regulations. Many factors influence policy development, and many stakeholders influence directions taken. Unions are a powerful stakeholder in policy direction; through collective bargaining and advocacy for policies that promote economic and health equity, they help create healthier workforces, workplaces, and communities.¹³ Their impact may be amplified by collaborative action with healthcare and public health professionals and organizations.

Assurance

Assurance includes services to make certain that public health can do its job—having a skilled workforce and having the needed infrastructure in place—and do so equitably. It includes the critical service of ongoing evaluation and improvement as policies are implemented and as research and innovation bring new approaches. Assurance is dynamic, intended to continually make public health more effective as feedback is gathered and lessons are learned through surveillance. By its very nature, assurance could be enhanced through union activism, particularly to fight for adequate resources—including staffing.

10 Essential Services, More Than 3,000 Entities

Per the CDC, the 10 essential services comprise activities that “all communities should undertake,”¹⁴ but there is no clear system to ensure good faith efforts, much less strict compliance. A host of entities are involved, including federal agencies, around 3,000 local and regional public health departments, 59 state and territorial health departments, and tribal health departments.¹⁵ At the community level, social services organizations, law enforcement, healthcare organizations and professionals, and community organizations also have roles. But for the public, and even for many healthcare professionals, the roles of these various entities are opaque and not well understood. One complicating factor is that there is no hierarchy of authorities. In my home state of Colorado, for example, there are 56 autonomous county health departments and the Colorado Department of Public Health and Environment, which coordinates with the counties. The CDC has specific national regulatory authorities but does not have specific authorities over the states.¹⁶ At the global level, the World Health Organization (from which the United States is now withdrawing¹⁷) is in a similar position. It lacks authority over nations but has a critical role in providing guidance to and coordinating among nations around global public health matters.

Thus, while we in the United States refer to the “public health system,” the term is an optimistic misnomer for a fragmented and loosely connected set of entities that do not integrate across the diverse agencies charged with maintaining and advancing public health. The lack of structure has long been recognized, as has the impact of that lack of structure when we face challenges that reach beyond local and state boundaries. In 2022, the Commonwealth Fund Commission on a National Public Health System called for greater coordination, including establishing a high-level position within the US Department of Health and Human Services to oversee the development of the national public health system.¹⁸ Such sweeping reorganization is needed, but it is unlikely to occur in the short term because of two factors I’ll discuss in more detail: the aftermath of the COVID-19 pandemic and the Trump administration.

The COVID-19 Stress Test

My favorite book about pandemics is John Barry’s The Great Influenza, first published in 2004 almost nine decades after the end of the Spanish flu, which killed 50 to 100 million persons worldwide.¹⁹ With the lens of a historian, Barry offers a remarkably insightful review of what happened with one of the world’s worst pandemics. In an afterword, he describes one of its most critical lessons: the need for informed leadership.

The COVID-19 pandemic, now largely controlled with effective vaccines, posed a memorable stress test for public health and healthcare. Lessons learned are accumulating, and the pandemic may have indelibly marked public health, positively and negatively. Numerous accounts and analyses of the pandemic have now been published; some are memoirs that retell the pandemic’s events with the biases of those involved in trying to control it,²⁰ while others offer factual descriptions.²¹ However, the equivalent of The Great Influenza has yet to be written.

Here, I offer my thoughts about lessons learned from COVID-19. Deficiencies of public health were exposed under the stress of the pandemic: inadequate numbers of personnel, some lacking adequate training; antiquated data systems in many jurisdictions, leading to tardy and incomplete epidemic tracking; and inadequate expertise or capacity for using contemporary communications channels, slowing responses to the tsunami of misinformation.

The three core functions shown in the figure above are useful for a retrospective look at what happened during 2020–2022, the crisis years of the pandemic. Assessment functioned as it should. Case reporting captured the entry of the SARS-CoV-2 virus and COVID-19 rapidly after the pandemic emerged in China, although the CDC did falter in its initial efforts to provide diagnostics for identification of the virus. Research took place at a staggering pace, with thousands of papers placed in preprint archives, and countless lives were saved by having efficacious vaccines within a year of the pandemic’s start.

Policy development was initially challenged by limited evidence on SARS-CoV-2, particularly around the mode of transmission from person to person and by the need for swift action with a rapidly spreading and lethal virus. The measures taken were enforced with various legal authorities. Communication and education were challenging throughout the pandemic, and the public was sometimes confused by seemingly inconsistent messaging, such as the initial calls not to use respiratory protection (so that it would be available to healthcare personnel) that were eventually replaced by mandates to wear masks. Over time, community support was eroded by the consequences of epidemic control measures, such as schools transitioning to remote and hybrid learning, and the influence of misinformation.

Assurance had a rocky start because the public health workforce, inadequate even for the everyday challenges before the pandemic, was initially overwhelmed. Although policies were continually refined as more was learned about SARS-CoV-2, rising and politically inspired opposition to public health measures limited their efficacy. Public health did not and perhaps could not provide equal protection to all against the risks of COVID-19. While much of the population was able to shelter at home and continue to work, many essential workers could not, including healthcare workers, service workers, and grocery store employees.²² Reflecting the SDOH, mortality was generally higher in those with lower incomes, among whom Black, Latinx, and Native American people are disproportionately represented in the United States.²³ The elderly were at high risk for more severe disease, particularly those in assisted-care facilities.²⁴ These inequities were sadly reflected in mortality statistics.²⁵

The politicization of public health during the pandemic was unprecedented and may be lasting. The appearance of Dr. Anthony Fauci before the House Select Subcommittee on the Coronavirus Pandemic in 2024 presented a caricature of the political divide around science and public health that widened because of the pandemic.²⁶ As the pandemic progressed, political affiliation became a determinant of what some public health agencies did and how they were supported (or not) by local officials. It also affected the public’s response to disease control measures, including use of respiratory protection and adherence to vaccination recommendations. Politicization had measurable consequences. For example, one study examined excess mortality in Ohio and Florida between March 2020 and December 2021 by political affiliation. From May 2021 on, when vaccination was available, the excess death rate among Republican voters was 43 percent higher than among Democratic voters.²⁷

Reimagining Public Health

In response to lessons learned from the COVID-19 pandemic, there have now been many calls for the transformation and reimagination of public health.²⁸ With colleagues from Johns Hopkins University and Washington University in St. Louis, I coauthored one of the first of these papers, published in the fall of 2020.²⁹ Although the paper was published only 11 months into the pandemic, the vulnerabilities and failings of public health were already evident and offered a strong imperative for reimagination. We called for the careful assessment of lessons learned and for broad deliberations that would provide a blueprint for transforming our public health system.

With public health professor Ross Brownson at Washington University in St. Louis, I revisited the reimagining of public health in 2024 with three more years of lessons learned from the pandemic.³⁰ We identified seven areas, shown in the table below, that should guide public health transformation. These seven areas are not new public health matters but need heightened attention with the insights from the COVID-19 pandemic.

In considering priorities, Brownson and I saw urgency around the complementary matters of accountability and politicization and polarization. There needs to be heightened understanding of the importance of public health and what it does. Politicization may be reduced by more effective communications to decision-makers, politicians, and the public generally, but new and more powerful messaging is needed for that purpose. Success in delivering messages on public health will require careful tuning to the political ears of the recipients—and to the most effective venues and methods by which to make those messages heard. We fear that the politics of the COVID-19 pandemic will spill over into fundamental public health measures, including vaccination. Consider the arrival of another pandemic caused by an infectious agent in a politicized public health environment; political forces might drive strategies away from a grounding in evidence, with potentially disastrous consequences.

We also prioritized modernization of data systems, a need made clear by the COVID-19 pandemic. In Colorado, there were challenges in bringing together data from healthcare systems to track cases of COVID-19. For contact tracing, Colorado lacked a system that could be used by all of its 56 public health agencies, leaving some to resort to cumbersome manual systems. National reporting was similarly limited, leaving the CDC with lagging data. Fortunately, an innovative team at Johns Hopkins University implemented a system that scoured the country for the data needed to track the pandemic and made it available on a nearly real-time basis.³¹ Our call for data modernization is made at a transformative moment with the emergence of artificial intelligence (AI) as a tool for sorting through massive quantities of data to find the signals that will drive actions.

Public health agencies need the systems and tools to capture and analyze data and sufficient personnel with the skills of cutting-edge data scientists. The public health workforce was battered by the COVID-19 pandemic: it had already declined by 40,000 jobs in the aftermath of the Great Recession, and it further shrank by tens of thousands of workers during the pandemic. Additionally, only 14 percent of the public health workforce holds a public health degree.³² There is an urgent need to restore the workforce and to enhance its skills.

Brownson and I also prioritized adding climate change and health to the scope of public health. The consequences of climate change for public health are already evident: more severe and frequent heat waves and storms, wildfires and worsening ozone air pollution, drought and food insecurity, coastal flooding, and forced migration. These are not new issues, but their severity and immediacy are new, as is the need for effective adaptation strategies. Responsibility for some adaptation measures lies with government and within public health agencies, such as disaster preparedness, heat wave warnings and provision of venues for cooling, and guidance on protection against air pollution and airborne infectious agents.

Finally, achieving health equity remains the central goal. Given the complementary nature of public health and healthcare, and given healthcare’s individual focus, striving for health equity is arguably public health’s most important function. After all, “no one is safe until we are all safe.”³³

The Trump Administration and Public Health

As this paper was finalized in March 2025, the second Trump administration’s teams in public health and healthcare (US Department of Health and Human Services Secretary Robert F. Kennedy Jr., a to-be-determined CDC director, and US Food and Drug Administration Commissioner Dr. Martin Makary) and in environmental protection (US Environmental Protection Agency Administrator Lee Zeldin) were almost assembled. The picks made clear the future administration’s stance on science and its role in the coming years, with records of doubting well-established scientific findings, including climate change from greenhouse gas emissions and the necessity of vaccination, while advancing discredited ideas, such as the long-debunked assertion that vaccines cause autism. At the start of the first Trump administration, I coauthored a paper titled “The Trump Administration and the Environment—Heed the Science.”³⁴ My coauthors were two former EPA assistant administrators from the Reagan and Obama administrations. Our warnings, of course, went unheeded, and the second Trump administration will likely deviate even further from science-based approaches than the first. Unfortunately, our first recommendation remains on-target:

We believe that evidence-based decision making on the environment should not be abandoned. Reasoned action and acknowledgment of scientific truth are fundamental to democracy, public health, and economic growth. Scientific evidence does not change when the administration changes.

As Trump’s second administration begins with making dramatic cuts to the federal government and to federal funding for research, the nation’s public health capabilities are being diminished, leaving the country unprepared for crises. Erosion of evidence-based and lifesaving public health measures—vaccination is the exemplar—will lead to avoidable disease and deaths. The anticipated emphasis on fossil fuel extraction and utilization, now summarized by the call to “drill, baby, drill,” will cause predictable environmental damage, especially since commitments to reduction of greenhouse gases made under the Paris Agreement have already been abandoned.³⁵ The consequences of climate change are no longer theoretical—they are visible and palpable.

What’s Next?

“Making predictions is difficult, particularly about the future,” as the old saying goes. But some things about the future of public health are certain: (1) public health is and will continue to be a critical societal activity; (2) crisis preparedness is essential because “stuff happens”; (3) public health needs to be reimagined and rebuilt after the COVID-19 pandemic; (4) communication strategies are needed to counter the misinformation and disinformation threatening health; and (5) the cynical politicization of public health must be stopped. Continued transformation of public health was needed before the COVID-19 pandemic; that need is more acute now.

Who will lead this transformation, and how? Given anticipated biases against public health at the national level throughout the Trump administration, tackling the seven challenges Brownson and I outlined will have to happen primarily at the local and state levels, where trust may be built with less encumbrance by politicization. Here, healthcare and public health professionals and their unions have particularly important roles to play—first and foremost by building alliances to advance individual and community health. While legislative and policy changes at the state and local levels are not easy, they can be driven by smaller coalitions and progress faster than at the federal level. Healthcare and public health professionals and their unions can be powerful advocates—especially when they extend their alliances to include community groups. And even though we’d like to reimagine public health with a sweeping overhaul, the table above is full of small actions we can all take now. For example, storytelling by trusted figures—especially nurses, who are the top-ranked professionals for honesty and ethical standards³⁶—can make a difference by both calling for investments by policymakers and opening the minds of those who have been drawn in by misinformation.

Healthcare professionals are natural allies because they have firsthand knowledge of the consequences when public health efforts are less than robust. And working together to advocate for and establish a reimagined public health system—and the funding to support it—reflects the shared goal of healthcare and public health professionals: building a better, longer, healthier life for all. 

Jonathan M. Samet, MD, MS, a pulmonary physician and epidemiologist, is a professor of epidemiology and occupational and environmental health with the Colorado School of Public Health, where he previously served as dean. He was elected to the National Academy of Medicine (Institute of Medicine) of the National Academies of Sciences in 1997 and received the David Rall Medal for his contributions in 2015.

*For a more detailed look at how public health operates, see “The Tobacco Epidemic: An Example of Public Health in Action” at aft.org/hc/spring2025/samet_sb. (return to article)

^†Surveillance using artificial intelligence (AI) tools is anticipated but has not yet proved successful in practice. (return to article)

Endnotes

1 American Public Health Association, “What Is Public Health?,” apha.org/what-is-public-health.

2. J. Funk and P. Orsagos, “A Year After a Train Derailment in Ohio Spilled Hazardous Chemicals, Health Fears Persist for East Palestine,” PBS News, February 2, 2024, pbs.org/newshour/nation/a-year-after-a-train-derailment-in-ohio-spilled-hazardous-chemicals-health-fears-persist-for-east-palestine.

3. United States Geological Survey, “Tap Water Study Detects PFAS ‘Forever Chemicals’ Across the US,” July 5, 2023, usgs.gov/news/national-news-release/tap-water-study-detects-pfas-forever-chemicals-across-us#:~:text=At%20least%2045%25%20of%20the,by%20the%20U.S.%20Geological%20Survey.

4. Centers for Disease Control and Prevention, “Investigation Update: E. coli Outbreak, Onions Served at McDonald’s,” November 13, 2024, cdc.gov/ecoli/outbreaks/investigation-update-e-coli-o157-2024.html.

5. R. Pahwa, A. Goyal, and I. Jialal, Chronic Inflammation (Washington, DC: StatPearls Publishing, August 7, 2023), ncbi.nlm.nih.gov/books/NBK493173.

6. T. Glass and M. McAtee, “Behavioral Science at the Crossroads in Public Health: Extending Horizons, Envisioning the Future,” Social Science & Medicine 62, no. 7 (April 2006): 1650–71.

7. Centers for Disease Control and Prevention, “Social Determinants of Health (SDOH),” January 17, 2024, cdc.gov/about/priorities/why-is-addressing-sdoh-important.html.

8. K. DeSalvo and G. Benjamin, “Public Health 3.0: A Blueprint for the Future of Public Health,” Health Affairs, November 21, 2016, healthaffairs.org/content/forefront/public-health-3-0-blueprint-future-public-health.

9. K. DeSalvo et al., “Public Health 3.0: A Call to Action for Public Health to Meet the Challenges of the 21st Century,” Preventing Chronic Disease 14 (September 7, 2017): E78.

10. L. Dwyer-Lindgren et al., “Ten Americas: A Systematic Analysis of Life Expectancy Disparities in the USA,” The Lancet 404, no. 10469 (December 7, 2024): 2299–2313.

11. S. Thacker, J. Qualters, and L. Lee, “Public Health Surveillance in the United States: Evolution and Challenges,” Morbidity and Mortality Weekly Report 61, no. 3 (July 27, 2012): 3–9.

12. Centers for Disease Control and Prevention, “10 Essential Public Health Services,” May 16, 2024, cdc.gov/public-health-gateway/php/about/index.html.

13. J. Leigh and B. Chakalov, “Labor Unions and Health: A Literature Review of Pathways and Outcomes in the Workplace,” Preventive Medicine Reports 24 (August 2, 2021): 101502; and B. Malinowski, M. Minkler, and L. Stock, “Labor Unions: A Public Health Institution,” American Journal of Public Health 105, no. 2 (February 2015): 261–71.

14. Centers for Disease Control and Prevention, “10 Essential Public Health Services.”

15. R. Crowley, S. Mathew, and D. Hilden, “Modernizing the United States’ Public Health Infrastructure: A Position Paper from the American College of Physicians,” Annals of Internal Medicine 176, no. 8 (July 18, 2023): 1089–91.

16. Centers for Disease Control and Prevention, “CDC and ATSDR Regulations by Topic and Program,” August 13, 2024, cdc.gov/regulations/about-regulations/regulations-by-topic.html.

17. S. Stolberg, “Trump Withdraws U.S. from World Health Organization,” New York Times, January 22, 2025, nytimes.com/2025/01/20/us/politics/trump-world-health-organization.html.

18. Commonwealth Fund Commission on a National Public Health System, Meeting America’s Public Health Challenge: Recommendations for Building a National Public Health System That Addresses Ongoing and Future Health Crises, Advances Equity, and Earns Trust (New York: Commonwealth Fund, June 21, 2022), commonwealthfund.org/publications/fund-reports/2022/jun/meeting-americas-public-health-challenge.

19. J. Barry, The Great Influenza: The True Story of the Deadliest Pandemic in History (New York: Viking, 2024).

20. D. Birx, Silent Invasion: The Untold Story of the Trump Administration, Covid-19, and Preventing the Next Pandemic Before It’s Too Late (New York: Harper, 2022).

21. L. Wright , The Plague Year: America in the Time of COVID (New York: Penguin Books, 2021); and D. Quammen, Breathless: The Scientific Race to Defeat a Deadly Virus (London, UK: The Bodley Head, 2022): viii.

22. R. Billock, A. Steege, and A. Miniño, “COVID-19 Mortality by Usual Occupation and Industry: 46 States and New York City, United States, 2020,” National Vital Statistics Reports 71, no. 6 (October 2022): 1–33.

23. V. McGowan and C. Bambra, “COVID-19 Mortality and Deprivation: Pandemic, Syndemic, and Endemic Health Inequalities,” Lancet Public Health 7, no. 11 (November 2022): e966-e975; and Economic Policy Institute, “Income, Poverty, and Wealth” in Racial and Ethnic Disparities in the United States: An Interactive Chartbook (Washington, DC: June 15, 2022), epi.org/publication/disparities-chartbook/#incomecharts.

24. A. Dyer et al., “Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update,” Journal of the American Medical Directors Association 23, no. 9 (September 2022): 1590–1602.

25. J. Faust et al., “Racial and Ethnic Disparities in Age-Specific All-Cause Mortality During the COVID-19 Pandemic,” JAMA Network Open 7, no. 10 (October 11, 2024): e2438918.

26. US House of Representatives Committee on Oversight and Government Reform, “Hearing Wrap Up: Dr. Fauci Held Publicly Accountable by Select Subcommittee,” June 4, 2024, oversight.house.gov/release/hearing-wrap-up-dr-fauci-held-publicly-accountable-by-select-subcommittee.

27. J. Wallace, P. Goldsmith-Pinkham, and J. Schwartz, “Excess Death Rates for Republican and Democratic Registered Voters in Florida and Ohio During the COVID-19 Pandemic,” JAMA Internal Medicine 183, no. 9 (September 1, 2023): 916–23.

28. Commonwealth Fund Commission on a National Public Health System, Meeting America’s Public Health Challenge.

29. R. Brownson et al., “Reimagining Public Health in the Aftermath of a Pandemic,” American Journal of Public Health 110, no. 11 (November 2020): 1605–10.

30. J. Samet and R. Brownson, “Reimagining Public Health: Mapping a Path Forward,” Health Affairs 43, no. 6 (June 2024): 750–58.

31. Johns Hopkins University & Medicine, “Coronavirus Resource Center,” March 10, 2023, coronavirus.jhu.edu.

32. J. Leider et al., “The State of the US Public Health Workforce: Ongoing Challenges and Future Directions,” Annual Review of Public Health 44 (2023): 323–41.

33. S. Gilbert and R. Hatchett, “No One Is Safe Until We Are All Safe,” Science Translational Medicine 13, no. 614 (October 6, 2021): eabl9900.

34. J. Samet, T. Burke, and B. Goldstein, “The Trump Administration and the Environment—Heed the Science,” New England Journal of Medicine 376, no. 12 (March 23, 2017): 1182–88.

35. N. Perez and R. Waldholz, “Trump Is Withdrawing from the Paris Agreement (Again), Reversing U.S. Climate Policy,” National Public Radio, January 21, 2025, npr.org/2025/01/21/nx-s1-5266207/trump-paris-agreement-biden-climate-change.

36. L. Saad, “Americans’ Ratings of U.S. Professions Stay Historically Low,” Gallup, January 13, 2025, news.gallup.com/poll/655106/americans-ratings-professions-stay-historically-low.aspx.

37. J. Samet and R. Brownson, “Reimagining Public Health.”

[Illustrations by Mike Austin]