In the 2020 US election, we can choose a just future
Authors: Rhea W Boyd, Nancy Krieger, Camara Phyllis Jones
Journal: The Lancet (2020)

When US voters go to the polls (what few are left) or attempt to mail our ballots (with what remains of the US postal service) in the 2020 election, we are not simply choosing between two parties or posturing about partisan politics. We are making a choice about the future. On the one hand, are the dangers of white supremacy, authoritarianism, and nationalism—lethal threats to our democracy, our lives, and the viability of the planet. On the other hand, is a rebuke of racist, autocratic politics, and the mandate to create a more equal, just, healthy, and habitable nation and world. The choice is stark and the stakes are high. In terms of health, the current US administration has intentionally lied about the grave risks of COVID-19, failed to implement a coherent national pandemic strategy, hamstrung and underfunded public health agencies, initiated the process to withdraw the USA from WHO, reversed and weakened health regulations, attacked abortion and contraception access, eroded transgender health protections, and aired racist, anti-Asian, anti-science views.1Haberman M Trump admits downplaying the virus knowing it was "deadly stuff".The New York Times. Sept 9, 2020; Google Scholar, 2Krieger N Enough: COVID-19, structural racism, police brutality, plutocracy, climate change—and time for health justice, democratic governance, and an equitable, sustainable future.Am J Public Health. 2020; (published online Aug 20.)https://doi.org/10.2105/AJPH.2020.305886Crossref Scopus (172) Google Scholar, 3The LancetReviving the US CDC.Lancet. 2020; 3951521Summary Full Text Full Text PDF PubMed Scopus (31) Google Scholar, 4The EditorsScientific American backs Joe Biden.Sci Am. 2020; 323: 12-13Google Scholar, 5Thorp HH Trump lied about science.Science. 2020; 3691409Crossref PubMed Scopus (0) Google Scholar, 6Sanger-Katz M Weiland N Trump administration erases transgender civil rights protections in health care.The New York Times. June 12, 2020; Google Scholar, 7Popovich N Albeck-Ripka L Pierre-Louis K The Trump administration is reserving 100s of environmental rules. Here's the full list.The New York Times. July 15, 2020; Google Scholar Furthermore, the US administration under President Donald Trump has cut food stamps, denied climate change, jeopardised the 2020 Decennial Census, undermined Indigenous sovereignty, imposed discriminatory anti-Muslim travel bans, unleashed federal force on peaceful protesters, openly appealed to white supremacists, and separated immigrant families and caged their children.7Popovich N Albeck-Ripka L Pierre-Louis K The Trump administration is reserving 100s of environmental rules. Here's the full list.The New York Times. July 15, 2020; Google Scholar, 8Liptak A Census count can be cut short, Supreme Court rules.The New York Times. Oct 13, 2020; Google Scholar, 9Leadership Conference on Civil and Human RightsTrump administration civil and human rights rollbacks.https://civilrights.org/trump-rollbacks/Date: 2017–2020Date accessed: September 29, 2020Google Scholar, 10USA Today StaffRead the full transcript from the first presidential debate between Joe Biden and Donald Trump.USA Today. Sept 30, 2020; Google Scholar While Black and Indigenous communities, and people of colour more generally, are made vulnerable under the current US administration (panel), no one is fully immune to its harms. Ultimately, unfettered racism, truncated rights, anaemic protections, and the resource inequities these exposures create shorten lives. Anyone who doubts this needs to only consider the past 9 months.PanelSelection of Trump administration policies and proposals that disproportionately impact the health and wellbeing of Black and Indigenous communities and people of colourCivil rights•Undermined voter protections and worsened voter suppression•Rolled back civil and human rights protections, including prioritising conservative religious beliefs over sexual, reproductive, and LGBTQ rightsClimate•Cut Environmental Protection Agency funding and undermined and overturned environmental regulations•Withdrew from the Paris Climate Agreement and promoted coal and fossil fuels, including the Dakota Access PipelineCriminal justice•Reinstated the federal death penalty and stalled important criminal justice reforms•Increased prosecutorial discretion and enacted harsher sentences for offencesEconomy•Provided multiple tax cuts to the richest Americans and corporations•Before COVID-19, cut food stamps and welfare programmes, and further failed to provide adequate financial support to low-income households and small businesses during the pandemicEducation•Attacked affirmative action, reinforced school segregation, and decreased funding for public schools•Rescinded school discipline reforms that protected Black and Latinx students from criminalisationHealth care•Worked to overturn the Affordable Care Act, discouraged Medicaid expansion, limited Medicaid eligibility, and tried to cut funding for the Children's Health Insurance Program•Attempted to defund Planned Parenthood and undermined federal provisions for family planning and reproductive servicesHousing•Dismantled the Obama-era Affirmatively Furthering Fair Housing rule•Advocated for residential segregationImmigration•Enacted policies to discourage immigrants' use of public benefits, such as food stamps, Medicaid, and welfare•Rescinded humanitarian protections to immigrant families and blocked efforts to grant citizenship to individuals who were children when their parents arrived as undocumented immigrantsPublic safety•Worked to undo critical police reforms and encouraged police brutality•Dismissed the threat of domestic terrorism by white supremacists Civil rights •Undermined voter protections and worsened voter suppression•Rolled back civil and human rights protections, including prioritising conservative religious beliefs over sexual, reproductive, and LGBTQ rights Climate •Cut Environmental Protection Agency funding and undermined and overturned environmental regulations•Withdrew from the Paris Climate Agreement and promoted coal and fossil fuels, including the Dakota Access Pipeline Criminal justice •Reinstated the federal death penalty and stalled important criminal justice reforms•Increased prosecutorial discretion and enacted harsher sentences for offences Economy •Provided multiple tax cuts to the richest Americans and corporations•Before COVID-19, cut food stamps and welfare programmes, and further failed to provide adequate financial support to low-income households and small businesses during the pandemic Education •Attacked affirmative action, reinforced school segregation, and decreased funding for public schools•Rescinded school discipline reforms that protected Black and Latinx students from criminalisation Health care •Worked to overturn the Affordable Care Act, discouraged Medicaid expansion, limited Medicaid eligibility, and tried to cut funding for the Children's Health Insurance Program•Attempted to defund Planned Parenthood and undermined federal provisions for family planning and reproductive services Housing •Dismantled the Obama-era Affirmatively Furthering Fair Housing rule•Advocated for residential segregation Immigration •Enacted policies to discourage immigrants' use of public benefits, such as food stamps, Medicaid, and welfare•Rescinded humanitarian protections to immigrant families and blocked efforts to grant citizenship to individuals who were children when their parents arrived as undocumented immigrants Public safety •Worked to undo critical police reforms and encouraged police brutality•Dismissed the threat of domestic terrorism by white supremacists Home to only 4% of the world's population, the USA accounts for about a fifth of global COVID-19 deaths. Since February, 2020, we have buried more than 215 500 of our beloved neighbours, co-workers, family members, and friends.11The New York TimesCovid world map tracking the global outbreak.https://www.nytimes.com/interactive/2020/world/coronavirus-maps.htmlDate: Oct 14, 2020Date accessed: October 14, 2020Google Scholar The age-adjusted COVID-19 mortality rate among Black and Indigenous communities and people of colour in the USA is up to three times higher than among non-Hispanic white populations.12APM Research LabThe color of coronavirus: COVID-19 deaths by race and ethnicity in the US.https://www.apmresearchlab.org/covid/deaths-by-raceDate: Sept 16, 2020Date accessed: October 1, 2020Google Scholar Latinx and Black children account for an astounding 74% of COVID-19 deaths among people aged 21 years and younger in the USA.13Bixler D Miller AD Mattison CP et al.SARS-CoV-2–associated deaths among persons aged <21 years—United States, February 12–July 31, 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 1324-1329Crossref PubMed Scopus (129) Google Scholar As of Oct 3, 2020, more than 102 200 non-Hispanic white people have also died from COVID-19 in the country.14National Center for Health StatisticsDeaths involving coronavirus disease 2019 (COVID-19) by race and Hispanic origin and age, by state.https://data.cdc.gov/NCHS/Deaths-involving-coronavirus-disease-2019-COVID-19/ks3g-spdgDate: Oct 7, 2020Date accessed: October 13, 2020Google Scholar And every untimely death has occurred within the nation that spends more money on health care than any other country in the world.15Bradley EH Taylor LA The American health care paradox: why spending more is getting us less. Public Affairs, New York, NY2013Google Scholar More exposure and less protection—eg, from racism, resource inequities, inadequate housing, and occupational and environmental hazards—not genetic differences, drive premature mortality from COVID-19 and chronic illnesses such as heart disease and cancer.16Michaels D Wagner GR Occupational Safety and Health Administration (OSHA) and worker safety during the COVID-19 pandemic.JAMA. 2020; (published online Set 16.)https://doi.org/10.1001/jama.2020.16343Crossref PubMed Scopus (78) Google Scholar, 17Jones CP Coronavirus disease discriminates. Our health care doesn't have to.Newsweek. April 7, 2020; Google Scholar, 18Jones CP Levels of racism: a theoretic framework and a gardener's tale.Am J Public Health. 2000; 90: 1212-1215Crossref PubMed Scopus (1615) Google Scholar, 19Chen Y Freedman ND Rodriquez EJ et al.Trends in premature deaths among adults in the United States and Latin America.JAMA Netw Open. 2020; 3e1921085Crossref PubMed Scopus (18) Google Scholar To make matters worse, in the face of the nation's cavernous inequalities, widespread economic immiseration, and the highest unemployment rate since the Great Depression, the current administration has proffered a one-time payment of US$1200 to limited households while giving tax breaks to the nation's wealthiest elites.20Bureau of Labor StatisticsThe employment situation—August 2020.https://www.bls.gov/news.release/pdf/empsit.pdfDate: Sept 4, 2020Date accessed: September 29, 2020Google Scholar, 21Sloan A The CARES Act sent you a $1,200 check but gave millionaires and billionaires far more.ProPublica. June 8, 2020; https://www.propublica.org/article/the-cares-act-sent-you-a-1-200-check-but-gave-millionaires-and-billionaires-far-moreDate accessed: September 29, 2020Google Scholar Now, up to one in eight US households are food insecure.22The New York Times MagazineAmerica at hunger's edge.The New York Times Magazine. Sept 2, 2020; Google Scholar, 23US Census BureauMeasuring household experiences during the coronavirus pandemic.https://www.census.gov/data/experimental-data-products/household-pulse-survey.htmlDate: 2020Date accessed: October 6, 2020Google Scholar An estimated 30–40 million people could risk eviction in the coming months.24National Low Income Housing CoalitionThe COVID-19 eviction crisis: an estimated 30-40 million people in America are at risk.https://nlihc.org/sites/default/files/The_Eviction_Crisis_080720.pdfDate: Aug, 2020Date accessed: September 29, 2020Google Scholar And in July, 2020, the US gross domestic product had the largest drop on record. Yet a month later, the stock market peaked. All of this is not a coincidence. It is a consequence of racial capitalism, the profitability of inequality, and the deadly policies of the current administration.25Laster Pirtle WN Racial capitalism: a fundamental cause of novel coronavirus (COVID-19) pandemic inequities in the United States.Health Educ Behav. 2020; 47: 504-508Crossref PubMed Scopus (378) Google Scholar, 26The New England Journal of MedicineDying in a leadership vacuum.N Engl J Med. 2020; 383: 1479-1480Crossref PubMed Scopus (111) Google Scholar When it comes to this administration, "it is what it is".27Baker S Trump: Coronavirus is "under control". Axios.https://www.axios.com/trump-coronavirus-under-control-5f114a16-9952-428c-bc07-3cfa360b0977.htmlDate: Aug 4, 2020Date accessed: October 13, 2020Google Scholar But seeing it clearly is essential. When torrential rain flooded parts of Louisiana, extreme winds decimated parts of Utah, and the US western seaboard spent weeks aflame, it is important to see this administration's enshrinement of fossil fuels as accelerants for climate catastrophe.7Popovich N Albeck-Ripka L Pierre-Louis K The Trump administration is reserving 100s of environmental rules. Here's the full list.The New York Times. July 15, 2020; Google Scholar When Vice President Mike Pence asserted that "We will have law and order" as a condition of a second term of a Trump presidency, it is crucial to see the rise in hate crimes, white vigilante terror, and human rights abuses that have been a condition of the first term of this administration.28Epstein RJ Full transcript: Mike Pence's R.N.C. speech.The New York Times. Aug 26, 2020; Google Scholar, 29Hassan A Hate-crime violence hits 16-year high, F.B.I. reports.The New York Times. Nov 12, 2019; Google Scholar Seeing this clearly prevents tacit acceptance of a dangerous diversion. This type of diversion is how Indigenous dispossession becomes "discovery", "settlement", and "Columbus Day". It is how vigilante mob violence against Black communities become "race riots" with "fine people on both sides".30Gray R Trump defends white-nationalist protesters: "some very fine people on both sides".The Atlantic. Aug 15, 2017; Google Scholar In 2020, US voters can choose a just future by first confronting our past. The USA began as a slave-ocracy, built on expropriated land and Indigenous genocide. Its first ruling class were white colonisers. Its first enterprises were powered by slavery and premised on the ideology of white supremacy, environmental exploitation, and systems of governance, voter suppression, and policing that protected the right of the white, male, property-owning class to unilateral social, economic, and political control.31Anderson C One person, no vote: how voter suppression is destroying our democracy. Bloomsbury, New York, NY2018Google Scholar This is the bedrock on which the "founding fathers" built their attempt at democracy. It is plutocracy perched atop precarity. The current administration only makes that more evident. But while the "founding fathers" anchored their fledgling democracy in inequality, the expansion of US democracy owes its fragile progress to many forebearers, chief among them are the Indigenous, the formerly enslaved, and women. Starting from this fuller, more inclusive understanding of who we are as a nation and how we got here, the possibilities for who we can become and where we can go are profound. Racism saps the strength of the whole of society.18Jones CP Levels of racism: a theoretic framework and a gardener's tale.Am J Public Health. 2000; 90: 1212-1215Crossref PubMed Scopus (1615) Google Scholar And we each live within the limitations of the worlds we build for each other. But another world is possible. Building on that conviction, since May, 2020, Black Lives Matter, a Black-led, multiracial uprising for racial justice, has become one of the largest movements in US history.32Buchanan L Quoctrung B Patel JK Black Lives Matter may be the largest movement in US history.The New York Times. July 3, 2020; Google Scholar Together, demonstrators across the country are asserting that our collective losses are not inevitable and our nation's deep grief need not be immutable. So whether shrouded in a booth or the privacy of our own homes this November, US citizens who can vote must affirm these self-evident truths: white nationalism and authoritarianism imperil democracy; democracy and equality are co-constitutive; equality is essential to health; the social, economic, and political conditions necessary to advance equality safeguard the planet; and thriving societies require sustainable environments and equitable economies. All these issues are on the 2020 ballot. We hope US voters choose a just future. We declare no competing interests. The views expressed in this Comment are our own personal views and do not necessarily represent those of the institutions to which we are affiliated.