US public health system is flying blind after major cuts

Critical public health surveys in the US are facing deep cuts after a series of layoffs hit government employees working on key nationwide data systems. These datasets, which measure everything from births and deaths to nutrition and substance use, have guided health policy for decades. Without them, it will be nearly impossible to identify, monitor or respond to health threats across the country.

“It is like trying to fly a plane and you have no speed gauge, you have no altimeter, you don’t know your elevation, you don’t know how far it is to the nearest airport. You have none of the information that you need,” says Susan Mayne, a former director of the Center for Food Safety and Applied Nutrition at the US Food and Drug Administration.

During his second term, President Donald Trump has made a concerted effort to shrink the US government. The US Department of Health and Human Services (HHS) has been one of his administration’s main targets. In March, the agency’s workforce fell from 82,000 employees to 62,000. Roughly 1100 additional layoffs were announced in October, though a court order temporarily paused these amid the ongoing government shutdown.

Most of the cuts have targeted staff in human resources, information technology and communications, but some have hit those running crucial public health surveys as well. HHS didn’t respond to New Scientist’s questions about the total number of layoffs, so it is unclear how many public health surveys have been affected and to what extent. So far, at least five have been impacted.

The National Survey on Drug Use and Health (NSDUH) was one of the first on the chopping block. In April, HHS terminated all 17 people running it, crippling the country’s only nationwide survey of drug use, addiction and mental health. For more than half a century, it has helped policymakers allocate funding to regions most afflicted by these problems. The latest report still came out in July, thanks to contractors from RTI International, an independent research institute tasked with collecting NSDUH data. But it isn’t clear what will happen next year. “Eventually all of the planning we did will run out. Who at HHS, then, will influence the direction of the survey?” said former NSDUH director Jennifer Hoenig in a social media post.

Then, in September, the government ended the Household Food Security reports, which monitor food insecurity throughout the country, claiming in a statement that “these redundant, costly, politicised and extraneous studies do nothing more than fear monger”.

However, the survey has received bipartisan support for decades, said Georgia Machell at the National WIC Association, a non-profit supporting the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). This government programme provides low-income families with food assistance and nutrition education. “Programs like WIC rely on these national-level data to understand the broader picture of hunger and food insecurity in our nation, allowing resources to be directed where they are most needed,” said Machell in a statement.

Most recently, HHS gutted the National Center for Health Statistics (NCHS), terminating about 100 positions, according to the Data Foundation, a Washington DC-based non-profit organisation advocating for open data and evidence-informed policy. This includes most of the staff behind the National Vital Statistics System, which tracks births and deaths across the US and monitors the country’s leading causes of deaths and maternal mortality rates.

The entire team running the National Death Index was also affected, says former NCHS director Charles Rothwell. This little-known database contains identifying information about every death in the US, including the person’s name, place of residence, cause of death and, in many cases, their social security number, which allows for robust tracking. “This is the only dataset like this available,” says Rothwell.

Because it stores highly sensitive data, it doesn’t publish any reports. Instead, it assists other agencies and researchers conducting long-term studies, says Rothwell. For instance, the Department of Veterans Affairs works with its staff to compare deaths among veterans and non-veterans. Researchers outside of government also use it to confirm whether their participants have died or simply moved elsewhere. This is especially pertinent for long-term studies of older adults, such as the Health and Retirement Study, which monitors the well-being of ageing Americans. As such, a blow to the National Death Index will have knock-on effects across a range of public health surveys, says Rothwell.

HHS told New Scientist it “is not currently taking actions to implement or administer” the NCHS layoffs, citing the recent court order. However, it didn’t respond to questions about whether it would do so once the government shutdown ends, and if so, how it will maintain these databases.

Employees responsible for planning the National Health and Nutrition Examination Survey (NHANES) were also laid off in October. This survey is one of – if not the – most comprehensive assessments of health, diet and illness in the US. It deploys a fleet of mobile clinics to conduct blood and urine testing, bone density scans and oral health examinations to monitor diet, environmental exposures and the prevalence of illness nationwide. “It really sets the foundation for nutrition and public health policies,” says Mayne. For instance, it informs national dietary guidelines, environmental regulations and even updates on food labelling. “If we don’t know what is happening in the population with regard to health and nutrition, we don’t know where to prioritise our public health work,” she says.

HHS appears to have reversed terminations of NHANES staff, according to the Data Foundation. But the fact these positions were cut in the first place is deeply concerning – and the same goes for those working on other major public health surveys. These datasets steer public health policy in the US. Weaken or remove them, and the entire system could come crashing down.