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Trump’s environmental and occupational policies are the other public health disasters

President Biden faces steep challenges in undoing the damage done by the Trump administration’s rollback of regulations.

A miner walks toward the entrance of the Ramaco Resources Inc. Stonecoal Alma mine near Wylo, West Va., August 2017.Andrew Harrer/Bloomberg

When history looks back at Donald Trump’s administration, the COVID-19 pandemic — which has so far killed about 470,000 Americans — will be seen as the biggest public health disaster of his term. But there is another, quieter health crisis for which Trump also bears full responsibility: a wide-scale rollback of environmental and occupational safeguards that resulted in more than 22,000 deaths during his term alone.

From relaxing air pollution standards at coal-fired power plants and weakening fuel-economy rules for cars to allowing new uses of asbestos and weakening safety rules for underground miners, the damage done by Trump to Americans’ health has been profound. Unfortunately, the damage done by the former president will be lasting, and the consequences with us for decades. Yet few Americans realize the extent of this catastrophe because the information has been hidden by distractions and buried in the news cycle. On Thursday, a report in The Lancet, to which we both contributed, highlights just how devastating these decisions made by the previous administration have been.


Throughout his four-year term, Trump tried to nullify more than 100 environmental and occupational standards — rules and regulations that protect our air, clean up our water, and reduce the threat of global warming. Most important, these protections safeguard America’s greatest resources: our children and our workers. While court challenges blocked some of these actions, 84 regulations were ultimately nullified, including a rule designed to limit toxic emissions from major industrial polluters and another aimed at reducing pollutants at sewage treatment plants.

Before Trump took office, air quality in the United States had been improving steadily for 50 years, a triumph that saved thousands of lives and was the direct result of the landmark 1970 Clean Air Act. Yet as soon as Trump was sworn into office, this progress ended and air pollution levels began to increase. There were especially sharp increases in pollution caused by the small airborne particles (called PM2.5 pollution) that are released when fossil fuels burn. PM2.5 pollution causes heart attacks, strokes, lung diseases, and premature births. Predictably, deaths from these afflictions rose across the four years of Trump’s presidency.


America’s children have suffered greatly because of these rollbacks. The Trump administration refused to ban chlorpyrifos, a highly toxic insecticide that children are exposed to when eating fruits and vegetables. Chlorpyrifos is a member of the same chemical family as sarin, the toxic war gas that attacks the brain and nervous system. It is widely known to damage young children’s developing brains. In addition, Trump allowed tens of thousands of infants in the womb to be exposed to mercury from unchecked power plant emissions. These children could suffer lifelong brain damage, including reduced IQ scores, shortened attention spans, and an increased risk of neurological impairment.

The impact of Trump’s negligence also extends to America’s workers. He and his Labor secretary weakened occupational regulations, shredded safety programs, and cut back enforcement. As a result, deaths among miners, quarry workers, and oil and gas workers rose. One of the administration’s most egregious acts was to terminate a prevention program for silicosis — a lung disease caused by inhaled rock dust — even as reports of severe silicosis illnesses and deaths increased. The administration also refused to limit coal dust in underground mines.


During the COVID-19 pandemic, Trump turned a blind eye to the hazards of airborne infection facing essential workers. He refused to mobilize personal protective equipment for health care workers. He ordered meatpacking workers to stay on the job and refused calls to enforce safety measures in their plants, even though they labor long hours in densely crowded, fast-paced production lines where physical distancing is not possible.

Deaths per 100,000 attributable to air pollution by state and state’s political leanings, United States, 2019The Lancet Commission on public policy and health in the Trump era

Ironically, Midwestern and Southern states — Ohio, Arkansas, Kentucky, Indiana, Alabama, and West Virginia — that are the bulwark of Trump’s electoral base suffered the greatest increases in disease and deaths resulting from his administration’s environmental and occupational rollbacks. State-based regulation is weak in these states, and the mining and fossil fuel lobbies are strong. In contrast, pollution-related deaths rose at a much slower rate in states like California and New York, where strong state programs buffered the worst impacts of the federal rollbacks.

Deaths per 100,000 attributable to occupational diseases by state and state’s political leanings, United States, 2019The Lancet Commission on public policy and health in the Trump era

Trump portrayed the dismantling of environmental and occupational rules as opportunities to free industry — particularly the fossil fuel industry — from unnecessary shackles and to stimulate the economy. Yet missing from his distorted narrative is any consideration of the impacts of his deregulation on the health of America’s children or on disease and death in America’s workers.

Now the Biden administration must move aggressively to undo the damage done by Trump’s environmental and occupational rollbacks. Executive orders and stepped-up enforcement can quickly reverse the increases in air pollution and reduce occupational hazards. But overcoming the four-year delay in addressing climate change will be more difficult. It must move to start rapid, government-supported transition to wind, solar, and geothermal energy, and an end to the massive federal subsidies and tax breaks that prop up the fossil fuel industry at taxpayer expense.


With courageous leadership and a renewed sense of common purpose, President Biden and his team can move us past Trump’s environmental disaster and chart a course to protect the health of our planet and our people.

Dr. Phillip J. Landrigan is a pediatrician and epidemiologist who directs the Program for Global Public Health and the Common Good and the Global Observatory on Pollution and Health at Boston College. From 1985 to 2018, he served as professor and chair of Preventive Medicine and dean for Global Health at the Icahn School of Medicine at Mount Sinai in New York. Samantha Fisher is a senior data analyst at Boston College.