It’s Clinton. When asked by Science Debate about public health, here’s what Clinton had to say (boldface mine):
America has witnessed enormous successes with some of its major public health initiatives, such as smoking cessation and water fluoridation. Yet, we have a long way to go to strengthen the public health system to provide adequate protection for our communities. Recent events like lead contamination in drinking water in Flint, Michigan, development of antibiotic resistant microbes, uncontrolled spread of Aedes mosquitos that spread tropical diseases like Zika, Dengue and Chikungunya, the growth of opiate addiction, and the continuing need to address HIV make clear the shortcomings of our public health system and the urgent need for improvements.
But despite these threats, we are not investing in public health preparedness and emergency response the way we should to keep our families and communities safe. A 2015 study found that spending on public health had fallen more than nine percent since 2008. And uncertain long-term budgets leave our public health agencies dependent on emergency appropriations—meaning that when Congress fails to step up, communities are left without the resources they need, vaccines languish in development, and more people get sick.
That is why as President, I will create a Public Health Rapid Response Fund, with consistent, year-to-year budgets, to better enable the Centers for Disease Control, the U.S. Department of Health and Human Services, the Federal Emergency Management Agency, state and local public health departments, hospital systems, and other federal agencies to quickly and aggressively respond to major public health crises and pandemics. I will also ensure that our government has strong leadership and is organized to better support and work with people on the ground facing public health challenges.
In addition, we need to do more to boost our preparedness for biological threats and bioweapons; to support research for new diagnostic tests, therapeutic treatments, and vaccines for emerging diseases; to build capacity in public health departments; to train the next cadre of public health professionals and ensure that public health and environmental health practices are standard to the educations of medical students; and to provide resources for states and local governments to plan for complex, multi-faceted public health threats, like the impacts of climate change, and build more resilient communities.
A minor quibble: biodefense has been shown to be a bust–though if it keeps wayward microbiologists off the streets and out of trouble, it’s good I suppose. Overall, though, Clinton gets that you get the public health system you do–or do not–pay for. The need for constant funding, as opposed to boom-and-bust cycles, is vital, as there is a long and sorry public health history of starting ambitious, important programs, only to cut them.
Clinton also implicitly realizes that we don’t have a single public health system, but public health systems plural at the local and state levels, and if those systems lack resources, then the system breaks down.
Meanwhile, Il Trumpe does not have ‘the best words’ (boldface mine):
The implication of the question is that one must provide more resources to research and public health enterprises to make sure we stay ahead of potential health risks. In a time of limited resources, one must ensure that the nation is getting the greatest bang for the buck. We cannot simply throw money at these institutions and assume that the nation will be well served. What we ought to focus on is assessing where we need to be as a nation and then applying resources to those areas where we need the most work. Our efforts to support research and public health initiatives will have to be balanced with other demands for scarce resources. Working with Congress—the people’s representatives—my administration will work to establish national priorities and then we will work to make sure that adequate resources are assigned to achieve our goals.
Despite Trump being portrayed as a radical change from the typical Republican, this is same old, same old Republican weasel speak for ‘yes, we’ll cut public health to provide tax cuts for the wealthy.”
Yes, we can always do better with the resources we have–such is the human condition. But right now, public health departments (including the CDC) are overstretched and underfunded. They need more resources, and in certain areas, more training and equipment, as well as the informatics infrastructure to quickly gather and disseminate information. Without those things, people will needlessly become ill–or die.
Regular readers will know I’m not the biggest Clinton fan, but on public health, there’s a real difference between the two candidates: one will help save lives, while the other will waste them.
The difference between the two matters.