Offline: Looking forward to Donald Trump

Lancet, Volume 388, No. 10061, last 2726, 3 December 2016

Richard Horton

Perhaps we should be more relaxed about Donald Trump as America's next President. First, he will likely serve only one term. It will be over before you can say Hillary Clinton. Second, if Nigel Farage was to become Her Majesty's Ambassador to the United States of America, it would exclude a particularly disagreeable voice from British politics. We might be grateful. Third, Mr Trump is not a Republican. He may find he has two parties opposing him in Congress, instead of one. Gridlock plus plus plus. Fourth, the world is already on a path to solving its most intractable predicaments—for example, climate change. Whatever President Trump thinks, says, or decides will not derail the direction of travel for 194 other nations. Fifth, Mr Trump realises that inciting hatred during an election campaign doesn't translate well into policy. He will not implement even a fraction of what he has so far promised. And sixth, we must thank Mr Trump for galvanising a generation to engage more energetically in their futures. His words may have divided America. But they have also mobilised a resistance of surprising proportions. The next 4 years won't be nearly as bad as you might think.

But this guarded optimism was not the prevailing mood during last week's Global Health Lab, held at the London School of Hygiene & Tropical Medicine. The question concerned the implications of the US election for global health.

Sophie Harman is a political scientist at Queen Mary University of London. She implored her audience to 'ignore the dead cat'. By which she meant, ignore the distractions that Mr Trump will throw at you. His Twitter feed is already redirecting your attention away from what really matters.

Focus.

Domestically, Americans should be worried about the survival of all that is good in the Affordable Care Act.  Women should be anxious about how they might protect their reproductive rights. A renewed permissiveness towards racism will worsen the mental and material health of African-Americans and other minorities. Xenophobia will encourage violence. And Mr Trump's tax and welfare proposals will harm health. The global implications of Trumpism were barely an election issue. His assault on reproductive rights at home will be mirrored abroad. His isolationist foreign policy will diminish the US voice in global health policy making. His protectionism means that he will likely not take on big pharma. His administration's choice for Director-General of WHO will have lasting effects on the agency (his anti-globalism will weaken its role).

And the allegations he has fomented against the Clinton Foundation could damage an institution that has won many victories on behalf of the poorest.

Harman disagreed with The Lancet's assessment of a Trump Presidency. She argued that our suggestion for rational engagement was mistaken. The Trump team is not going to engage on a rational basis, or at least on any rational terms we might propose. Instead, she suggested that those opposed to Mr Trump should join or support organisations representing issues they cared most about. You might amplify your resistance through social media. You must vote. And, above all, you should be kind.

 'Interesting and challenging', was Stefan Elbe's understated view of Mr Trump. Elbe is Director of the Centre for Global Health Policy at the University of Sussex. He praised President Obama for strengthening America's leadership role in global health. A third of the world's development assistance for health comes from the US. And this despite the financial crisis of 2007–08. Obama has left a 'clear, significant, and meaningful legacy'.

Regarding Mr Trump, he predicted 'dark clouds'. America first, economic nationalism, manipulation of the weak, populism, and a coercive approach to power. These are the Trumpian traits we already know about. So the question one must ask is not will Mr Trump be bad for global health, but how bad will he be for global health?

The fact that we have no idea shows how much he has already undermined democracy in America. But Elbe did offer one tactic for negotiating our way through the next 4 years. Mr Trump sees power as a commodity to be used and traded in a hard, quasi-military style. There is another way of viewing power—as a quality distributed through networks. Mr Trump is one small node within this network, a network that contains many nodes channelling and influencing forces that shape our lives and futures. It is therefore simply too soon to say that the liberal—and global health—order has been lost.

   [ - emphasis added and some minor paragraph editions made.  - MV]