America’s public health system is flying blind after major budget cuts

Crucial public health investigations in the United States are facing significant cuts after a round of layoffs hit government employees working on key data systems nationwide. These data sets, 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’s like trying to fly an airplane and you don’t have an airspeed indicator, you don’t have an altimeter, you don’t know your altitude, you don’t know how far the nearest airport is. You don’t have any of the information you need,” says Susan Mayne, former director of the Center for Food Safety and Applied Nutrition at the U.S. Food and Drug Administration.

During his second term, President Donald Trump made a concerted effort to shrink the U.S. government. The US Department of Health and Human Services (HHS) is one of his administration’s main targets. In March, the agency’s workforce fell from 82,000 employees to 62,000. About 1,100 additional layoffs were announced in October, although a court order temporarily suspended them due to the ongoing government shutdown.

Most of the cuts have targeted human resources, information technology and communications staff, but some have also affected those who conduct crucial public health investigations. HHS did not respond New scientistquestions about the total number of layoffs, so it’s unclear how many public health investigations were affected and to what extent. So far, at least five have been affected.

The National Survey on Drug Use and Health (NSDUH) was one of the first to be developed. In April, HHS fired all 17 people who ran it, crippling the nation’s only national survey of drug use, addiction and mental health. For more than half a century, it has helped policymakers allocate funds to regions most affected by these problems. The latest report was released in July, thanks to contractors RTI International, an independent research institute responsible for collecting NSDUH data. But we don’t know exactly what will happen next year. “Eventually, all the planning we’ve done will run out. Who at HHS will then influence the direction of the investigation?” said former NSDUH Director Jennifer Hoenig in a social media post.

Then, in September, the government shut down the Household Food Security Reports, which monitor food insecurity across the country, saying in a statement that “these redundant, costly, politicized and unnecessary studies do nothing but sow fear.”

However, the survey has had bipartisan support for decades, said Georgia Machell of the National WIC Association, a nonprofit supporting the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). This government program provides low-income families with food assistance and nutrition education. “Programs like WIC leverage this national-level data to understand the broader picture of hunger and food insecurity in our country, helping to direct resources where they are needed most,” Machell said in a statement.

Most recently, HHS gutted the National Center for Health Statistics (NCHS), eliminating about 100 positions, according to the Data Foundation, a Washington, D.C.-based nonprofit that advocates for open data and evidence-based policy. That includes most of the staff behind the National Vital Statistics System, which tracks births and deaths across the United States and monitors the nation’s leading causes of death and maternal mortality rates.

The entire team that runs the National Death Index has also been affected, said former NCHS Director Charles Rothwell. This little-known database contains identifying information about every death in the United States, including the person’s name, location, cause of death, and, in many cases, Social Security number, allowing for reliable tracking. “This is the only dataset of its kind available,” says Rothwell.

Because it stores very sensitive data, it does not publish any reports. Instead, it helps other agencies and researchers conducting long-term studies, Rothwell says. For example, the Department of Veterans Affairs works with its staff to compare deaths of veterans and non-veterans. Researchers outside the government also use it to confirm whether their participants have died or simply moved elsewhere. This is particularly relevant for long-term studies of older adults, such as the Health and Retirement Study, which monitors the well-being of aging Americans. As such, a hit to the national mortality index will impact a range of public health investigations, Rothwell says.

HHS said New scientist it is “not currently taking any action to implement or administer” the NCHS layoffs, citing the recent court order. However, he did not answer questions about whether he would do so once the government shutdown ends, and if so, how he would maintain those 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 disease in the United States. It deploys a fleet of mobile clinics to conduct blood and urine tests, bone density scans and oral health exams to monitor diet, environmental exposures and disease prevalence nationwide. “It really lays the foundation for nutrition and public health policy,” Mayne says. For example, it informs national dietary guidelines, environmental regulations, and even updates to food labeling. “If we don’t know what’s happening in the population when it comes to health and nutrition, we don’t know where to prioritize our public health work,” she says.

HHS appears to have reversed layoffs of NHANES staff, according to the Data Foundation. But the fact that these positions were eliminated is deeply concerning – and the same goes for those who work on other major public health investigations. These data sets guide public health policy in the United States. Weaken or remove them, and the whole system could collapse.