Public Health Under Attack: Continuity, Discontinuity, and History

Abstract How unprecedented is the current backlash against the public health enterprise? In this article, I explore prior attacks against public health practice in three exemplary domains: mass vaccination programs; air pollution control; and occupational safety. In all three domains, I argue that public health has been 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 onslaught is different, both in the ferocity and velocity of its actions, and in a new 21st-century context that it inhabits, with different legal precedents, cultural beliefs, communication practices, and political norms. Throughout, I also identify historical seeds of its current path in the late-20thand early-21st century.