The Health Consequences of Nonhealth Policies in a Time of Policy Disruption

The second Trump administration launched a number of actions in 2025 that directly affect the health of populations.One of the administration's first acts was to make substantial cuts to the US Agency for International Development and to begin an effort to fold what remains of the program, which had for decades supported international aid efforts that improved health in low-income countries, into the US Department of State. 1 This was followed by efforts aimed at changing how the National Institutes of Health supports health research and by reduction of staff at several Department of Health and Human Services agencies, including the Centers for Disease Control and Prevention, which is directly charged with safeguarding health in the US. 2,3The elevation of Robert F.Kennedy Jr as Secretary of Health and Human Services reflects a further challenge to population health, given his well-documented positions counter to established scientific consensus on issues that are health promoting, such as vaccination and water fluoridation. 4The scholarly and clinical communities concerned with health have responded robustly to these challenges, with a number of articles documenting how the proposed changes are harming, or may soon harm, health in the US and globally. 5,6Less well discussed, however, has been how a range of other actions that have been proposed by the current administration also threaten the health of populations.Central to understanding this, and to focusing on what matters to the health of populations, is a recognition that the core driver of population health is not clinical care.It is quality of air, water, and food, opportunities for exercise, livable wages, social networks, and social safety nets that keep people healthy and not in need of clinical care to begin with. 7These drivers of health, often called the social determinants of health, are more important to creating healthier populations than the provision of clinical care that helps restore people to health once they are sick.It is through this lens that it becomes clear that federal actions that influence policies that seem distal to health are, in actuality, driving population health-perhaps at a larger scale than policies that affect structures that we instinctively link with health.The range of nonhealth policies that affect health is broad.Take, for example, policies around nutrition and food systems.Food system policies-including agricultural subsidies, nutrition assistance, and school meals-are all associated with diet and, in turn, factors like obesity, diabetes, and other health indicators. 8,9For example, the Supplemental Nutrition Assistance Program, a federal food aid program, has been shown to reduce food insecurity and improve health among low-income families. 10While food policy is generally not discussed in the same public conversation as health policy, in many ways, the 2 are inseparable, and food policy is as directly linked to health as are policies that affect infectious disease control.A similar case can be made for a range of other nonhealth policies that affect health.Urban planning policies promote walkable neighborhoods, safe housing, and green spaces, all of which can encourage physical activity and reduce chronic disease. 11122]13 Transportation policy, like investing in public transit, can directly lead to fewer traffic injuries and improved air quality. 14,15Housing and zoning policies can influence physical and mental health.Stable housing is associated with less stress, lower risk of hypertension, and better mental health outcomes. 16,17Inclusionary zoning policies, coupled with efforts to remove exclusionary zoning laws, such as bans on multifamily housing, can reduce residential segregation and improve community conditions. 18Environmental and climate regulations similarly are often discussed as a separate category of policies but are, in fact, directly linked to health.The Clean Air Act that reduced emissions is estimated to have prevented hundreds of thousands of deaths in the US. 19The Inflation Reduction Act includes investments in climate that are expected to reduce air pollutants and, in turn, +