Public Health Under Attack: Continuity, Discontinuity, and History

How unprecedented is the current backlash against the public health enterprise? In this article, the author explores previous attacks against public health practice in three exemplary domains: mass vaccination programs, air pollution control, and occupational safety. The author argues that in all three, public health was remarkably durable throughout the 20th century, and that most controversies over its powers-or even direct onslaughts from hostile elected officials-have failed to overturn long-standing practices or institutions, even if implementation may be altered for the worse. Once public health traditions and the infrastructure that erects them become entrenched, they have remained difficult to fully eliminate. There are signs, however, that the second Trump administration's assault on public health is different, both in the ferocity and velocity of its actions and in the new 21st-century context it inhabits, with different legal precedents, cultural beliefs, communication practices, and political norms. Throughout, the author also identifies historical seeds of public health's current crisis in the late 20th and early 21st centuries.