Public Health Is Failing—And America’s Most Vulnerable Will Pay the Price

From rural communities to frontline workers, veterans to the unhoused, public health failures will hit those with the fewest resources first.

Public health crises don’t impact everyone equally.

When hospitals close, vaccines are delayed, food safety is compromised, and disease outbreaks spread, not everyone experiences the fallout the same way. Low-income, working-class, and rural Americans—those who often have the least access to healthcare—are the ones who suffer the most.

The CDC, FDA, HHS, and USDA should serve as watchdogs, ensuring basic protections for food, medicine, and disease prevention. However, under this administration, these agencies have been stripped of expertise and turned into tools for political and corporate interests.

The result?

• Rural communities lose hospitals, access to doctors, and food safety protections.

• Incarcerated populations face worsening medical neglect and disease outbreaks.

• Homeless and unhoused people lose access to vaccines, healthcare, and food aid.

• People with substance use disorders face barriers to treatment and higher overdose risks.

• Frontline workers are exposed to disease, unsafe conditions, and medical discrimination.

• Seniors and immunocompromised individuals become even more vulnerable to preventable illness.

• Veterans who rely on VA healthcare face delays, lack of mental health support, and food insecurity.

This isn’t just an attack on healthcare; it’s an attack on the most vulnerable people in our society.

Rural America: Fewer Hospitals, Fewer Doctors, More Health Crises

In many parts of the U.S., the nearest hospital isn't just minutes away—it’s hours away. The crisis of rural hospital closures is worsening, and this administration has done nothing to stop it.

Since 2005, over 180 rural hospitals have shut down, and more are expected to close due to public health funding cuts. For communities where a single hospital serves an entire region, this means fewer doctors, longer emergency response times, and an increased risk of death from preventable conditions.

Meanwhile, rural vaccine uptake is plummeting. With the CDC rolling back public health outreach and vaccine misinformation spreading unchecked, diseases like measles, flu, and COVID-19 are surging in rural areas.

And when it comes to food safety, the situation is even worse. With H5N1 spreading in livestock and USDA food safety inspectors being laid off, rural populations—who often work in agriculture or live near farms—are at the highest risk of exposure to zoonotic diseases.

The Bottom Line: As public health protections disappear, rural communities are left without hospitals, disease prevention measures, and food safety protections.

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Incarcerated Populations: The Perfect Storm for Disease Outbreaks

Prisons and jails have always been breeding grounds for infectious diseases. But with public health cuts and a weakened CDC, incarcerated individuals are being left to fend for themselves.

During COVID-19, outbreaks in prisons spread at four times the rate of the general population. And with pandemic response teams being dismantled, there is no plan in place if H5N1 or another virus spreads through correctional facilities.

At the same time, access to medical care in prisons is worsening. The privatization of prison healthcare has led to severe medical neglect, and now, understaffed prison clinics and public health rollbacks mean incarcerated individuals are more likely to suffer untreated illnesses or die from preventable conditions.

The Bottom Line: Medical neglect, overcrowding, and a lack of disease monitoring make prisons a public health disaster waiting to happen.

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Homeless & Unhoused People: No Safety Nets, No Healthcare

Public health isn’t just a policy issue for unhoused individuals—it’s a matter of survival. Homeless individuals are at higher risk for infectious diseases, foodborne illnesses, and chronic health conditions, but this administration’s actions are stripping away the few protections they have left.

With SNAP restrictions being expanded and WIC funding at risk, food insecurity among unhoused populations will skyrocket at the same time funding for humanitarian organizations offering food is being slashed. Meanwhile, the gutting of federal pandemic response programs means that if H5N1 spreads through shelters, there will be no coordinated public health response.

The Bottom Line: Unhoused individuals are being left with fewer food, healthcare, and disease prevention resources, making life on the streets even more dangerous.

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People with Substance Use Disorders: Less Treatment, More Overdoses

The opioid epidemic is still one of the worst public health crises in the U.S. But instead of expanding addiction treatment, the administration is pushing policies that will increase overdose deaths.

RFK Jr. has openly questioned the need for psychiatric medications, including addiction treatments. If these policies result in stricter regulations on methadone, Suboxone, and other harm-reduction treatments, many people in recovery could lose access to life-saving care.

At the same time, FDA deregulation could make the opioid crisis worse by allowing riskier, poorly tested drugs onto the market, just as loosened safety regulations contributed to the first wave of the opioid epidemic.

The Bottom Line: With fewer treatment options and looser regulations on dangerous medications, overdose deaths are likely to rise.

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Veterans: Mental Health Crisis & Medical Delays

Many veterans rely on VA healthcare and psychiatric medications, both of which are under threat.

• RFK Jr. has questioned the need for mental health drugs, which could reduce access to antidepressants, ADHD medications, and PTSD treatments.

• VA hospitals are already overwhelmed, and public health rollbacks will make wait times even longer. At the same time, DOGE cuts have hit the VA hard.

• Veterans experiencing homelessness will be hit hardest by food insecurity and healthcare funding cuts.

The Bottom Line: Veterans—especially those who are disabled, low-income, or unhoused—will face worsening mental health outcomes and medical neglect.

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Frontline & Low-Wage Workers: More Exposure, Less Protection

During the COVID-19 pandemic, frontline workers—nurses, grocery store employees, factory workers—kept society running. But now, public health protections are being stripped away, leaving them more vulnerable to future crises.

• H5N1 is spreading in livestock, and USDA deregulation means fewer inspections and worker protections.

• Retail, childcare, and healthcare workers—many of whom are women and people of color—are now at higher risk of exposure to measles, flu, and COVID-19 due to lower vaccination rates.

• With worker safety protections being rolled back, frontline employees have fewer options if their workplaces become dangerous.

The Bottom Line: Workers once considered “essential” are now being abandoned, with fewer protections against disease outbreaks and unsafe working conditions.

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Seniors & Immunocompromised Individuals: The Forgotten Victims of Public Health Neglect

A strong public health system isn't optional for seniors and those with weakened immune systems; it’s a matter of life and death.

But with H5N1 surveillance being deprioritized and vaccine hesitancy rising, the next major outbreak could be devastating for elderly and immunocompromised individuals.

Meanwhile, FDA deregulation means more untested medications hitting the market—a significant risk for seniors, who make up the largest group of prescription drug users.

The Bottom Line: Without strong public health leadership, seniors and immunocompromised people will face greater disease risks and fewer safeguards against unsafe medications.

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Public Health Failures Are a Policy Choice—And They Can Be Reversed

This isn’t just about budget cuts or politics. These public health failures will lead to real suffering, preventable deaths, and wider health disparities.

Follow Public Health Experts (Not Politicians)
Substack Writers to Read:

• Dr. Katelyn Jetelina (Your Local Epidemiologist)

• Virginia Sole-Smith (Burnt Toast)

• Dr. Céline Gounder (Public Health Watch)

Support Labor & Advocacy Groups

• National Nurses United (worker protections)

• Prison Policy Initiative (incarcerated healthcare)

• Harm Reduction Coalition (opioid crisis response)

• Veterans’ Health Advocacy Groups

If we do nothing, these public health failures will define the next decade. The time to push back is now.

Bibliography:

• National Institutes of Health (NIH). "Health in Rural America." NIH News in Health, March 2022. https://newsinhealth.nih.gov/2022/03/health-rural-america

• Rural Health Information Hub. "Healthcare Access in Rural Communities Overview." Rural Health Information Hub, November 2024. https://www.ruralhealthinfo.org/topics/healthcare-access

• Centers for Disease Control and Prevention (CDC). "Preventing Chronic Diseases and Promoting Health in Rural Communities." CDC, December 2024. https://www.cdc.gov/health-equity-chronic-disease/health-equity-rural-communities/index.html

• Prison Policy Initiative. "Public Health." Prison Policy Initiative. https://www.prisonpolicy.org/health.html

• National Institute for Health Care Management (NIHCM) Foundation. "Incarceration: A Public Health Crisis." NIHCM Foundation, August 2023. https://nihcm.org/publications/incarceration-a-public-health-crisis

• RAND Corporation. "Prisoner Reentry: What Are the Public Health Challenges?" RAND Corporation. https://www.rand.org/pubs/research_briefs/RB6013.html

• U.S. Interagency Council on Homelessness. "Homelessness Prevention Series: Spotlight on the Jail-to-Homelessness Pipeline." U.S. Interagency Council on Homelessness, October 2024. https://www.usich.gov/news-events/news/homelessness-prevention-series-spotlight-jail-homelessness-pipeline

• Equal Justice Initiative (EJI). "Prison Health Care Crisis Mounts as Incarcerated Population Ages." Equal Justice Initiative, May 2024. https://eji.org/news/prison-health-care-crisis-mounts-as-incarcerated-population-ages/

• Rural Health Information Hub. "Bridging the Gap: Addressing Health Inequities in Rural Communities." Rural Health Information Hub, September 2024. https://www.ruralhealth.us/blogs/2024/09/bridging-the-gap-addressing-health-inequities-in-rural-communities

• Centers for Disease Control and Prevention (CDC). "Motor Vehicle Safety in Rural America." CDC, April 21, 2023. https://www.cdc.gov/transportationsafety/rural/index.html

• U.S. Department of Veterans Affairs. "VA Study Documents Health Risks for Burn Pit Exposures." VA Research Currents, May 2024. https://www.research.va.gov/currents/0524-VA-Study-Documents-Health-Risks-for-Burn-Pit-Exposures.cfm

• Burke, Caitlin, et al. "The Health Status of the US Veterans." PubMed Central, January 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378995/

• Cypel, Yasmin, et al. "Care of the Military Veteran: Selected Health Issues." American Family Physician, November 2019. https://www.aafp.org/pubs/afp/issues/2019/1101/p544.html