US Public Health System Progresses Blindly Amid Significant Budget Cuts

Essential public health research in the United States is experiencing severe cutbacks following extensive layoffs among government employees responsible for key national data systems. These datasets, which track a wide variety of factors from births to substance use, have informed health policy for many years. Without this data, effectively identifying and responding to health challenges will become nearly impossible.

“It’s akin to boarding a plane without a speedometer or altimeter; you have no idea of your altitude or distance to the nearest airport,” remarks Susan Mayne, the former Director of the U.S. Food and Drug Administration’s Center for Food Safety and Applied Nutrition.

During his second term, President Donald Trump has actively sought to shrink government size, with the Department of Health and Human Services (HHS) becoming a primary target. The agency’s workforce was slashed in March, reducing from 82,000 employees to 62,000. In October, an additional 1,100 layoffs were announced, though a court order temporarily halted them due to the ongoing government shutdown.

Most layoffs have affected human resources, IT, and communication departments; however, some critical public health research staff have also been impacted. HHS has not responded to inquiries from New Scientist. The full extent of the layoffs affecting public health surveys remains unknown, though at least five cases have been identified thus far.

The National Survey on Drug Use and Health (NSDUH) was one of the first to feel these impacts. In April, HHS terminated all 17 people working on this vital study, disrupting the only national survey on drug use, addiction, and mental health. For over fifty years, the NSDUH has guided policymakers in directing funds to regions most affected by these issues. Although the latest report was released in July with the help of contractors from RTI International, the future of the survey remains uncertain. “All our planning will ultimately be for naught. Who at HHS will now steer the investigation?” asked former NSDUH director Jennifer Honig on social media, in a post.

In September, the government also terminated the Household Food Security Report, which tracks food insecurity nationwide, claiming: in a statement, “These redundant, expensive, politicized, and irrelevant studies only stoke fear.”

Yet, this report has enjoyed bipartisan backing for decades. Georgia Machel from the National WIC Association, a nonprofit that supports the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), remarked, “Programs like WIC depend on this national data to comprehend the full scope of hunger and food insecurity, allowing us to allocate resources effectively,” Machel added in her statement.

Recently, HHS is reported to have disbanded the National Center for Health Statistics (NCHS) and laid off about 100 staff members. As noted by a Washington D.C.-based nonprofit advocating for open data and evidence-based policy, data infrastructure includes many employees from the National Vital Statistics System, which monitors births, deaths, and the leading causes of mortality and maternal issues across the United States.

Furthermore, the entire team administering the National Death Index has also faced these layoffs, according to former NCHS director Charles Rothwell. This database contains essential identifying information about every death in the U.S., including individual names, addresses, causes of death, and often Social Security numbers, enabling comprehensive tracking. “This is the only dataset like this accessible,” states Rothwell.

Because it contains sensitive information, the report will not be published but will assist other researchers and institutions with long-term studies. For instance, the Department of Veterans Affairs collaborates with officials to analyze mortality among veterans versus non-veterans. Researchers also utilize the data to ascertain whether participants have died or simply relocated, which is vital for aging studies like the Health and Retirement Study that evaluates the wellbeing of older Americans. As Rothwell highlighted, disruptions to the National Death Index could have ripple effects on various public health studies.

According to New Scientist, citing a recent court ruling, NCHS stated it is “not currently taking steps to implement or manage” staffing cuts. However, there was no reply regarding whether action would be taken once the government shutdown concludes, or how existing databases would be maintained.

In October, an employee responsible for the National Health and Nutrition Examination Survey (NHANES) was also dismissed. This research initiative is one of the most thorough evaluations of health, nutrition, and disease in the nation, facilitating mobile clinics that conduct blood tests, urine assessments, bone density evaluations, and oral health examinations to oversee diet, environmental exposures, and disease spread. “This truly lays the groundwork for nutrition and public health policy,” says Mayne. Moreover, it informs national dietary guidelines, environmental regulations, and food label developments. “Lacking accurate data about our population’s health and nutrition means we cannot properly prioritize public health initiatives,” she asserts.

The Data Foundation reports that HHS appears to have reversed its decision regarding layoffs for NHANES staff. However, the initial elimination of these roles remains alarming, as does the fate of personnel involved in other significant public health inquiries. These data sets fundamentally shape U.S. public health policy; any weakening or elimination of them could lead to systemic failures.