Public health, pandemic response, and the 2020 US election.

From a health perspective, the upcoming US election could be the most consequential in our lifetimes. Before the COVID-19 pandemic, the USA already had a modest standing across many global health measures: among 11 industrialised nations, the USA ranked last in life expectancy and highest in suicide rates, had among the highest number of hospitalisations for preventable causes, and had the highest rate of avoidable death.1The Commonwealth FundUS health care from a global perspective, 2019: higher spending, worse outcomes?.https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019Date: Jan 30, 2020Date accessed: September 10, 2020Google Scholar Moreover, the USA has the highest numbers of uninsured people in the developed world: one in four individuals report foregoing care because of out-of-pocket costs, even if they are insured, and one in four do not take needed drugs because of prescription costs.2Kaiser Family FoundationNearly 1 in 4 Americans taking prescription drugs say it's difficult to afford their medicines, including larger shares among those with health issues, with low incomes and nearing Medicare age.https://www.kff.org/health-costs/press-release/poll-nearly-1-in-4-americans-taking-prescription-drugs-say-its-difficult-to-afford-medicines-including-larger-shares-with-low-incomes/Date: March 1, 2019Date accessed: September 10, 2020Google Scholar Fatal opioid overdoses nearly doubled between 2010 and 2018, from 38 000 to 67 000 deaths.3National Institute on Drug AbuseOverdose death rates.https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-ratesDate: March 10, 2020Date accessed: September 10, 2020Google Scholar Existing health disparities include a life expectancy for Black Americans 3·5 years lower than for white Americans; for Native Americans, life expectancy is 5·5 years lower.4Indian Health ServiceDisparities.https://www.ihs.gov/newsroom/factsheets/disparities/Date: October, 2019Date accessed: September 10, 2020Google Scholar People from ethnic minority populations receive worse care than do white Americans for chronic non-communicable diseases such as kidney disease5Epstein AM Ayanian JZ Keogh JH et al.Racial disparities in access to renal transplantation: clinically appropriate or due to underuse or overuse?.N Engl J Med. 2000; 3431537Crossref PubMed Scopus (442) Google Scholar and cardiovascular disease,6Kressin NR Petersen LA Racial differences in the use of invasive cardiovascular procedures: review of the literature and prescription for future research.Ann Intern Med. 2001; 135: 352-366Crossref PubMed Scopus (314) Google Scholar and inequalities in treatment are seen for those who are pregnant and for children.7Smedley BD Stith AY Nelson AR Unequal treatment: confronting racial and ethnic disparities in health care. National Academies Press, Washington, DC2003Google Scholar Furthermore, the USA has underinvested in public health initiatives such as local, county, and state public health assistance, global and emerging infectious disease programmes, and the Strategic National Stockpile.8US Department of Health and Human ServicesStrategic National Stockpile.https://www.phe.gov/about/sns/Pages/default.aspxDate: Sept 1, 2020Date accessed: September 10, 2020Google Scholar The budget for the US Centers for Disease Control and Prevention (CDC) has fallen by 10% over the past decade,9Farberman R The impact of chronic underfunding of America's public health system: trends, risks, and recommendations.https://www.tfah.org/report-details/2019-funding-report/Date: 2019Date accessed: September 10, 2020Google Scholar adjusting for inflation, and the budget for the Health Services and Research Administration is US$10·7 billion,10Department of Health and Human ServicesJustification of estimates for Appropriations Committees: overview of budget request.https://www.hrsa.gov/sites/default/files/about/budget/budgetjustification2017.pdf#page=11Date: 2017Date accessed: September 10, 2020Google Scholar which is a tiny amount compared with the $3·6 trillion spent on health-care expenditures nationally.