Trump’s Impact on American Health Goes Well Beyond Obamacare

In his slim 1976 treatise, The Role of Medicine: Dream, Mirage, or Nemesis?, the British medical historian Thomas McKeown carefully chronicles the decline in mortality in England and Wales over much of the 19th and 20th centuries—charting death rates for infectious diseases ranging from diphtheria to pneumonia. Particularly striking is the mortality trend line for tuberculosis, which falls precipitously from 1838 onward—decades before the bacterium responsible for the disease was identified (1882), and long before the advent of the first effective antibiotic therapy, streptomycin.

McKeown’s controversial thesis was that it wasn’t medical interventions that were most responsible for the decline in mortality (and subsequent flourishing of the population) in that region, but instead better sanitation, nutrition, and other “external influences.” “Society’s investment in health is not well used,” he said, if we focus our attention only on medical intervention.

When the UK reviewed its national health investment in the late 1990s, it was clear that McKeown’s thinking, for all the controversy, was alive and well. The 1998 Acheson Report, a government effort to reduce health disparities, offered 39 policy recommendations, from improved housing and education to maternal nutrition programs. Only three pertained specifically to traditional health care efforts. Worth reading on the same topic is Steven Schroeder’s terrific 2007 Shattuck Lecture in the New England Journal of Medicine.

I bring all of this up because my colleague Sy Mukherjee has written an important post this morning on Fortune.com. As Sy explains, the President-elect’s picks for various cabinet posts—apart from his selection of Rep. Tom Price to head the Department of Health and Human Services—could well have a significant effect on Americans’ health and well-being over the next several years.

For anyone who thinks the healthcare stakes in the coming months are limited to the fate of Obamacare, read Sy’s eye-opening piece.