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The 2016 Election Results and Public Health

by David Tuller, DrPH  

For many years, Anthony Iton, MD, JD, has been an eloquent advocate for progressive public health policies in the San Francisco Bay area. A graduate of McGill University, the Johns Hopkins University School of Medicine, and the University of California, Berkeley, Boalt Hall School of Law, he served as director and county health officer for the Alameda County (California) Public Health Department, introducing innovative programs to reduce widespread health inequities. As a senior vice president at the California Endowment, a private health foundation that provides grants to community-based organizations throughout California, he is spearheading the philanthropy’s Building Healthy Communities initiative—an effort in 14 of the state’s most economically hard-hit cities to help residents fight for changes that will positively impact their physical and emotional well-being.

This week, as part of the UC Berkeley School of Public Health's Dean's Speaker Series, Dr. Iton is participating in a panel discussion on "Health in California under a Trump Presidency." The event is co-sponsored by the Graduate School of Journalism and Kaiser Permanente. Dr. Iton spoke with us before the event.

How do you define a healthy community?

A healthy community is an inclusive community where all members have an equal chance to participate in decisions about how the resources of the community are utilized. They also have social, political, cultural, and economic environments that are conducive to health and healthy behaviors, and that facilitate healthy opportunities for all, according to their needs.

Do you see the election results as threatening efforts to create healthy communities?

Yes, I do. I think the election was about two competing narratives. One was a narrative of exclusion that focused on identifying certain members of our communities and assigning them second-class status—immigrants, Mexicans, Muslims, African-Americans, women, and to some extent LGBTQ people. This narrative argued that we’re in a zero-sum competition with these “others,” and dehumanized them. The second narrative is a narrative of inclusion—the notion that we all need to be rowing in the same direction to be sure that the country is healthy and productive. We waste a lot of talent and gifts by not investing equally in all populations. We need to re-weave the social contract.

But something else we’ve been talking about for a while is the increasing mortality and the general decline in health status of the white working-class population. We’ve been arguing that it’s a byproduct of a battered social contract, as a consequence of globalization and the movement of manufacturing jobs offshore, as well as the increasing replacement of the human workforce with technology. Because there’s no meaningful social safety net, people plunge a great distance when they lose opportunity, and we’re seeing in the white working-class what has been going on in the Latino and African-American communities for decades.

How does what’s going on politically affect people as individuals, in terms of their own or their family’s health?

The most profound way might be in the notion of allostatic load, which is a way we assess chronic stress. When Barack Obama was elected president in 2008, a whole segment of the population all of a sudden felt their own sense of agency and potential had been elevated. The election of Donald Trump does the exact opposite. Now many who thought we were on a progressive path don’t see a clear way forward. The stress of dealing with that on a day-to-day-basis mounts up, it drives your cortisol levels up, and chronic cortisol levels impact your physiology dramatically. So the current change will produce higher levels of allostatic load in millions of people, and that’s an actual worry.

What is the role of your organization and other philanthropies in the current situation?

The first thing is, we have to participate in the national effort to protect and defend the social safety net—the Affordable Care Act, Medicare, Social Security, an immigration system that protects people. All of those things will be under attack federally.

The second thing is, we have to do remember that we’re a state that is very significant. It has a huge economy, and it’s a net contributor to the federal government. We have the minority leader of the House of Representatives [Congresswoman Nancy Pelosi, who represents San Francisco], we have influential California Republicans. We need to spend time working with them to make the California case for the kinds of changes we want to see.

The third thing is, we need to protect populations under threat: undocumented immigrants, Muslims, LGBTQ people, populations that have been directly targeted and ridiculed or dismissed by the president-elect.

The fourth thing is an umbrella for all of this. We need to continue to combat this narrative of exclusion that Trump and his administration seem to be intent on promulgating. We need to promulgate instead the narrative of inclusion, the California narrative, the narrative that allows us to protect the California dream.

This opinion does not necessarily reflect the views of the UC Berkeley School of Public Health or of the Editorial Board at

Also see Health Care Under Trump: The California Perspective.