So many remarkable stories have been told and will continue to be told about the stunning blue wave that swept across the United States this week, heralding a seismic shift in politics, and for health and wellbeing in the United States and globally.
The election of Dr Abdul El-Sayed to the Senate from Michigan is one such story, a standout moment from this week for many.
Professor Kent Buse tells the story like this: “An epidemiologist who rebuilt Detroit’s health department after the city’s bankruptcy had reduced it to a contracted-out service will become the first Muslim in the chamber. His political origin story is Flint: he has said he ran for office after watching state cost-cutting poison the children his department served. Few legislators arrive knowing, first-hand, that health is decided upstream of the clinic.
“What makes his victory instructive is how he won. He did not run a health campaign promising better services. He ran a power campaign that happened to be about health. His platform fit in one sentence: money out of politics, money in your pocket, Medicare for All. He refused all PAC money, called out the insurers, monopolies, and super PACs profiting from a system that bankrupts the sick, and withstood record outside spending against him.
“He showed voters who was making them poor and sick, and they rewarded him for it. The health field should study his campaign, because it is thinking politically about health, executed at scale.”
Croakey asked health and political commentators for their views on the implications of the election results for health, globally and in the US. Their reflections are published in full below, with some several thousands of words from:
Professor Kent Buse: “Restore America’s global health commitments”.
Michelle Isles: “Focus on building public confidence in public health, including for vaccinations”.
Professor Martin Hensher: “Now is not the time to relax.”
Professor Melissa Haswell: “It will be wonderful to see the USA webpages and extremely valuable research programs re-emerging; they make a huge contribution to knowledge, identification of risks, ideas for solutions and capacity to address the huge challenges we face.”
Bruce Wolpe: “This was the last chance to save America’s democracy. The road back will be long and difficult, but the country, at least for now, wants to see a better future.”
Alison Verhoeven: “I hope it also inspires Australians to reject the anger, division and bigotry which has crept into our society in recent years.”
Dr Lesley Russell: “It will take time and effort to undo all the damage Trump as wrought thus far.”
Professor Rebecca Ivers AM: “This will be a good time to carefully evaluate where investment is best placed to maximise impact, both domestically and globally.”
Veronica Le Nevez: “making progress on climate remains the biggest and most fraught global challenge we face today.”
Dr Simon Judkins: “There is now some hope that we, as a global community, might be able to secure a safer future for our children.”
Dr Alison Hoeger: “It is difficult to realistically expect that this Congress will take any meaningful steps to address one of the most horrific public health/child mortality catastrophes of our age.”
Dr Jo Flavel: “It is the election of candidates who will be more in touch with the day to day lives of voters that gives me hope rather than what party they belong to…”
Penelope Smith: “We must centre solidarity, leaving no one behind.”
Health won an election this week
Kent Buse, Professor of Health Policy, Monash University Malaysia.
Q: If you could give advice to the new Congress about what to do now for US and global health, what would it be?
I worry that a majority may be mistaken for an imminent transformation. The new Congress needs to read the mandate for what it is. Voters did not use the vocabulary of public health; they voted on prices: groceries, rent, insurance premiums, prescriptions. But a cost-of-living election is a health election by another name, because nothing drives American households into poverty and sickness quite like the cost of staying well. So my advice is threefold, in order of proximity to the ballot box.
First, act on the costs that voters were vocal about. Take on the consolidation among insurers, hospital chains, and pharmacy benefit managers that keeps prices high; legislate on drug pricing and medical debt. This is where the mandate is explicit.
Second, rebuild the domestic institutions that keep health affordable. The gutting of the Centers for Disease Control, the National Institutes of Health, and federal health data was sold as efficiency; it was a false economy, because prevention and evidence are what stop small problems becoming expensive ones. Restore the agencies, and legislate their independence so they cannot be dismantled again by executive whim.
Third, the part voters didn’t ask for but every voter needs: restore America’s global health commitments. The President’s Emergency Plan for AIDS Relief (PEPFAR) and the capacities lost with USAID cost a rounding error of the federal budget and protect the same households from the next pandemic and the next resistant infection. Pathogens do not respect borders, and neither should prevention. Voters asked for a government that governs. Give them one, at home and abroad.
Q: Do you expect the outcome will enable global progress on regulation of Big Tech?
Not on its own. Both parties are deeply entangled with tech capital; the lobbying architecture that kept platforms unregulated through four administrations did not lose this election, and a veto sits in the White House until 2029.
Expecting this Congress to legislate serious constraint on the industry that bankrolls them both is a triumph of hope over political economy.
However, the election changes the terrain. Oversight returns: hearings, subpoenas, and sunlight on how platforms profit from health mis- and disinformation, from the attention economy that is corroding adolescent mental health, and from AI systems generating plausible falsehood faster than any institution can verify it.
We have called this the abundance paradox: information multiplies whilst the capacity to verify it erodes. This widening gap between what is generated and what can be trusted is now a determinant of health as surely as tobacco or ultra-processed food, and it demands the same response: treat the industry as a commercial determinant, regulate upstream, and refuse the fiction of self-regulation.
The rest of the world need not wait for Washington. Australia’s minimum-age law for social media and the EU’s Digital Services Act show regulation is possible when legislators choose publics over platforms. Progress will come from a coalition of the willing, with the US Congress, at best, no longer blocking the road.
Q: What is a standout moment for you from the results?
The election of Abdul El-Sayed to the Senate from Michigan. An epidemiologist who rebuilt Detroit’s health department after the city’s bankruptcy had reduced it to a contracted-out service will become the first Muslim in the chamber. His political origin story is Flint: he has said he ran for office after watching state cost-cutting poison the children his department served. Few legislators arrive knowing, first-hand, that health is decided upstream of the clinic.
What makes his victory instructive is how he won. He did not run a health campaign promising better services. He ran a power campaign that happened to be about health. His platform fit in one sentence: money out of politics, money in your pocket, Medicare for All. He refused all PAC money, called out the insurers, monopolies, and super PACs profiting from a system that bankrupts the sick, and withstood record outside spending against him.
He showed voters who was making them poor and sick, and they rewarded him for it. The health field should study his campaign, because it is thinking politically about health, executed at scale.
His immediate priority should not be a Medicare for All bill that cannot survive a presidential veto before 2029. It should be putting the system itself on trial: oversight hearings on consolidation among insurers, hospital chains, and pharmacy benefit managers; defence of federal health data and scientific agencies; appropriations to rebuild the institutions whose dismantling drew him into the race. Build the evidence, the coalition, and the public case now, so the legislation is ready when the window opens.
And he should organise beyond the usual suspects: nurses’ and health workers’ unions; the anti-monopoly and democracy-reform movements, since money in politics is the upstream determinant of nearly everything else; and, where interests align on drug pricing and corporate concentration, the populist right. Health won an election this week. The law can wait for 2029; the case for it cannot.
https://healthscaping.substack.com/p/public-health-docs-storm-the-senate
Repair the damage
Michelle Isles, CEO of the Climate and Health Alliance, writing from Türkiye
Q: What is your immediate response to the results?
I was relieved to see the results that the US Democrats have won the majority in both the Senate and Congress. The Republican Party, led by President Trump, has proven to be very harmful to the US population and other nations. Trump’s signature moves have proven unpopular during this mid-term election: funding wars, serving the rich as working class cost of living skyrockets, unravelling public services that focus on environment and health evidence and leading with hate and divisiveness, particularly through ICE agents.
Q: What is a standout moment for you from the results?
The resounding win in both houses was a clear message to President Trump that his actions have hurt even the most devoted Republican voters (noting Texas flipped for the first time). The candidates who won were culturally diverse yet tuned into the people they were seeking to represent. Community organising models were employed where candidates knocked on doors, stood on street corners and went where communities meet.
One of the standout candidates and now Senate-elect for Michigan, doctor and public health leader Abdul El-Sayed, who led on “Medicare for all”. It is extraordinary that a wealthy country like the US does not have universal healthcare and as costs rise, access to health is becoming less affordable. El-Sayed ran his campaign without corporate donations (and therefore vested interests), and cut through the explicit discrimination he faced from the Republican Party.
Q: If you could give advice to the new Congress about what to do now for US and global health, what would it be?
There has been a lot of damage caused by the Trump Administration that has cut essential evidence-based services in the US and across the world.
Firstly, focus on building public confidence in public health, including for vaccinations. The US is seeing record cases of measles and with growing uncertainty, stoked by the Republican party, the US may see further public health risk.
Restore the public institutions that focus on health and climate science. The defunding of the US National Weather Service has already impacted preparedness; for example, 100 people were killed in Texas from the devastating fourth of July flash flood in Texas. Early warning systems save lives and many countries previously relied on US funded services to prepare for climate events,
Ensure the Clean Air Act continues to have teeth to curb the direct heath harms to citizens from industrial pollution and greenhouse gas emission release that is driving climate change.
US citizens urgently need universal healthcare, now is the time to make the investment.
Rejoin the World Health Organisation; global cooperation on health and climate change is critical at this juncture.
Q: What are the challenges and opportunities for global health and security from the outcomes?
President Trump remains an unpredictable leader who has little regard for the US constitution and international law. I do not believe that Trump will be a lame duck.
However, the deliberate rebuilding of public institutions focused on evidence, the access to the budget and scrutiny from the Democrats should slow, if not stop, investment in war and health harming infrastructure.
Q: Do you expect the outcome will have any impacts upon the upcoming COP31 negotiations? If so, how?
As the US is no longer a party to the UNFCCC focus, it will not have immediate impacts. Although culturally and through the action agenda it does matter because it will garner new energy from civil society, philanthropy and business to progress solutions and remind leaders to act in service to their constituents not corporate and fossil fuel interests.
Q: Will the results have any bearing upon Australian politics – for example the upcoming Victorian election?
In the last month we have seen Brazil maintain a progressive President, Serbia’s Parliament won by a student majority and now a significant hit to the power of President Trump. On 7 November, New Zealand will go to the polls and decide on the current conservative minority leadership that has systematically rolled back key parts of its climate policy framework; divested from renewables, unravelled environment protection laws, rejected localised planning laws for mining and ramped up fossil fuel burning. These decisions have left New Zealand vulnerable to rising costs of fuel and climate impacts that are being felt often, including through the landslide in Poneke/Wellington earlier this year.
In Victoria, there have been few voices on climate change; Labor reiterating existing commitments and the Greens advocating for urgent action. Under a Liberal/NP/One Nation coalition, the ten-year Treaty process and legislation would be undone despite the huge equitable leaps for community wellbeing that has already achieved. Renewable energy development led by former Minister Lily D’Ambrosio MP would also be wound back.
One Nation has aimed to mirror President Trump’s anti-immigration sentiment as a distraction to undo any investment in clean, healthy environments, which is counter to the vested interests of their shared billionaire sponsors. However, One Nation’s votes are already dropping and this will likely continue in the aftermath of the Democrats “people powered” win.
Expect the unpredictable
Professor Martin Hensher, Leader of the National Centre for Transformation in Emergency Response and Resilience in the School of Paramedicine and Public Safety at the University of Tasmania
The striking results of the US mid-term elections should give us all renewed confidence that ordinary people care about democracy, corruption and inequality – in America and elsewhere. These elections saw not just a Democrat takeover of both Houses of Congress (itself an increasingly rare outcome in recent decades), but a slew of states and cities flipping to Democratic governors and mayors.
It’s at this state and local level that we might see real change most clearly – whether that is through more and more localities emulating the pragmatic approaches to well-being policy pioneered by Zohran Mamdani in New York, or in a greater confidence to resist unpopular federal actions (such as refusing cooperation with federal agencies like ICE), or vetoing unpopular data centre developments.
But it is important to be realistic about the limits to change over the next two years. The one person who was not actually on the ballot – even if his deep unpopularity can be seen everywhere these results – was Donald Trump. Barring death or a severe health crisis, he will remain President until January 2029.
Complaints about the power of the “imperial Presidency” long pre-date Trump, with political scientists acknowledging a steady accumulation of executive power over the last century. Trump and those around him – including his loyalists in the Supreme Court – have been nothing if not meticulous in further accumulating and consolidating presidential power and “executive privilege”.
The new Democrat majority Congress – which will only be seated in January, of course – will be able to do much to hold Trump and his appointees to more rigorous and open scrutiny. The new Congress can almost certainly slow down and impede some of the Trump administration’s agenda; it can quite possibly claim a few scalps from amongst Trump’s most egregiously incompetent and corrupt enablers; and can potentially put long-term limits on funding and future overseas wars.
Elements of a defeated Republican party may become increasingly willing to line up with Democrats to challenge Trump as they seek to make themselves electable in 2028. Just as important, a Democrat majority Congress (with many new Democratic members coming from the party’s left) may be more willing to tackle the oligarch and billionaire class more directly, whether in AI and tech or other industries.
Yet – sadly – Congress alone is most unlikely to be able to begin any significant processes of rebuilding what the Trump Administration has destroyed. Federal health and research agencies, gutted and staffed with loyalists, are all unambiguously part of the Executive branch of government – answering to the President. Congress cannot re-establish the abolished USAID, even if it can allocate funds to overseas development assistance; Congress cannot by itself undo the chainsaw work of DOGE. All of that reconstruction can only happen under a new President.
We must also be ready for unpredictable outcomes. Trump and his closest advisors must be expected to challenge and fight every effort to rein them in, by fair means or foul; they already have a strong track record of effectively ignoring unfavourable court rulings, even as they have benefitted from many Supreme Court decisions in their favour this term. Trump’s deep attachment to tariffs should be acknowledged – he has talked about them for 40 years – and I believe it would be foolish to expect any major let-up in the US-led disruption of global trade rules and systems.
So my tip is for a good deal of US-led global chaos to continue and perhaps intensify, even while some of the most awful domestic policies of the Trump Administration come under increasing scrutiny and control. Nations like Australia need to accelerate and intensify their cooperation with neighbours and other middle powers, and be more willing to explicitly and directly challenge the chaos-making of the Trump administration.
The outcome of the 2028 Presidential election is still two years away, and very much not a given. We can take heart that American democracy is alive and well.
But now is not the time to relax. Whoever wins in 2028, the United States they inherit will not be what it once was, and the onus will be on the new President to undo the international damage their predecessor has caused, not on other countries to hope for the best and trust in future American beneficence.
Prioritise children’s futures
Professor Melissa Haswell, QUT
Q: What is your immediate response to the results?
Hope and elation. Last time I remember feeling that elated is when I was with over hundred people at an election night gathering for our independent candidate Ellie Smith for the Dickson electorate and the news of the Opposition Leader’s defeat arrived much sooner than expected, showing that the people of my electorate and across Australia flatly rejected negative dividing politics, the power of billionaires and biased media to influence our choices, and the fantasy of nuclear energy solving the climate crisis.
Even then, as now, I am aware that there are many hurdles we are still standing against in the country taking a truly appropriate and strong stance against fossil fuel expansion here and combatting apathy in emergency.
This time the good news arrived as I sat with a roomful of people at a Coal Seam Gas and Health Conference in Chinchilla, Queensland, as we heard gripping stories about enduring life over a decade in the gas fields, dealing with health symptoms, frustration and powerlessness, fear and uncertainty about the safety of their air and water. Simultaneously Queensland’s Premier was spruiking the joys of planning and aligning legislation towards mass expansion of drilling and fracking for oil in the Taroom Trough near Miles which he considers a ‘generational opportunity’.
Given the current state of our planetary health, the extreme lessons we are likely to learn very soon about the consequences of overheating our oceans and a three degree super El Nino, and the absolute, urgent need for breakthrough global cooperation, moments like the landslide in the US revealing that people are thinking and taking democratic action to protect themselves are precious, even if they haven’t reached Australia yet.
Q: What is a standout moment for you from the results?
My first glance at The New York Times signalling the massive shift certainly stood out, but the moment extended into good news after good news about the quality and diversity of candidates winning across the country. The first Black female mayor of Atlanta, three female First Nations leaders representing their states in government…
Q: If you could give advice to the new Congress about what to do now for US and global health, what would it be?
I can only dream that the new Congress would adopt a doctrine that centres and prioritises the futures of all children of America and around the world, urging Americans to look into the eyes of a child and let a feeling of care and responsibility for their future overwhelm and guide them.
Recognise and repeatedly tell the American people that the last two years of the Trump Presidency have severely damaged the prospects of a decent and healthy future, even for themselves and even more for their children and grandchildren. Alert and remind people at every opportunity that all the demolition of environmental protection from chemicals, biodiversity protection and climate change to appease the fossil fuel industry and billionaires investing in fossil fuels by their president represents the dismantling of protection of their health and lives.
Make it crystal clear that this dismantling deliberately opened the flood gates for the coal, oil and gas and plastics, LNG and petrochemical industry to drive early cancers, heart and lung disease, intellectual impairment, extreme heat, flooding, hurricanes, coastal inundation. etc. Open people’s eyes to that fact that climate change is the great exacerbator of cost of living rise, inflation, food insecurity, insurance costs, energy costs, housing damage and shortages, mass migration and conflict – all bad enough today, but becoming unthinkable in a >1.5 degree warmer world without immediate action.
Q: What are the challenges and opportunities for global health and security from the outcomes?
These will not come easy over the next two years. However, there is much that can be done, now that the hearts of Americans are captured by visions of a reestablishment of a responsible government. It will take time and the next election to gain the power needed for significant reform.
So now is the time for Democrats to listen and learn how to truly hear their constituents, get the facts from independent experts to develop comprehensive solutions and use exceptional communication methods integrating both to get messages across for the next election in 2028. By now, the Democrat party will have hopefully learned the lessons of past mistakes, recognised and stand ready to beat misinformation and act for the people, not party politics.
Q: Do you expect the outcome will have any impacts upon the upcoming COP31 negotiations? If so, how?
Not directly, but certainly it will send a shiver down the spines of fossil fuel kings and investors that people have awakened.
Q: Do you expect the outcome will enable global progress on regulation of Big Tech?
Already the United States is extremely aware and taking to the streets on hyperscale datacentres as they experience, communicate and report the painful range of potential consequences of living near them and fear the potential consequences.
I’m not sure about the whole world, but these are signs of this gaining voice in Australia – where close partnerships are being established with gas companies – and even the stock market is sending very loud messages. The Prime Minister has made some statements, but I think universities could do much better in doing the accounting on greenhouse gas emissions, water consumption, materials extraction and waste generation and warning the Australian people what externalities come along with the bold glossy promises of AI, both here and overseas.
Q: How can the US now rebuild its health and medical institutions and infrastructure and commitment to evidence-informed health policy?
I feel confident that the incoming and very well qualified new Congress and Senate, with the ‘STEM’ wave, will be able to slow the downslide of science and medicine, and it will become safer for universities to regain their loud, critical voice against the false information. People obviously have become aware that they are not being told the truth, so the new politics will need to reclaim the narrative and use the trust afforded to the Democrats to make things right.
But again, I don’t see much forward progress possible in the short term as the Executive Branch remains intact but huge potential to gain big ground for the 2028 elections.
Q: Will the results have any bearing upon Australian politics – for example the upcoming Victorian election?
Very interesting question, the risks are clearly flashing loudly as some quite amusing steps to distance from cosy relationships are being taken. As for the Victorian election, we can only hope people are awakening to the realisation of danger from sliding into the same hole of voting for people operating blindly on grievance responders as the US did.
Q: Do you have any thoughts for how the results could inform public health and health equity advocacy in Australia or elsewhere?
It will be wonderful to see the USA webpages and extremely valuable research programs re-emerging; they make a huge contribution to knowledge, identification of risks, ideas for solutions and capacity to address the huge challenges we face.
People are tired of division
Bruce Wolpe, political analyst
Q: What is your immediate response to the results?
The scope and scale of the Democratic victory is truly astonishing. It has been clear for months that the House would revert to Democratic control. But the party will go from 214 seats to around 260 – a majority of over 40. The average midterm gain against the president’s party is 24. A true historical over-performance.
It evokes the majority Obama had when Congress enacted the Affordable Care Act –Obamacare. This means dramatic legislation against Trump can be passed. But it is the Senate where Democrats sealed their control over the Senate by victories in Texas, Kansas, Iowa, South Carolina, and North Carolina. And at this writing with a lead in Mississippi (!)
Q: What is a standout moment for you from the results?
Texas – because of James Talerico’s crushing margin that was generated not only by the Democrat’s character and message, but by Trump’s complete over-reach of his power. Because Trump felt that the long serving Republican Senator, John Cornyn, was not loyal enough. Cornyn would have romped into another term. Instead, Trump went with a radical Trump populist. And he was decisively defeated. Adding to this special victory were Democratic gains of Senate seats in states Trump carried in 2024 by double digits: Kansas, South Carolina, and Iowa.
Q: If you could give advice to the new Congress about what to do now for US and global health, what would it be?
Restore the international health institutions and their funding that were obliterated by Trump and Elon Musk in the first months of Trump’s second term, especially the Agency for International development (USAID). Congress should reaffirm its existence and ability to do this critical work in order to prevent the deaths of millions in sub-Saharan Africa from HIV/AIDS, malaria, nutrition and tuberculosis.
Q: What are the challenges and opportunities for global health and security from the outcomes?
A modest recoup – strong support in Congress but Trump and Secretary of State Rubio have little interest or commitment to these agencies. Trump may well veto a restoration of USAID funding. But the pressure to restore these programs needs to be very loud and visible.
Q: Do you expect the outcome will have any impacts upon the upcoming COP31 negotiations? If so, how?
No – it’s too early to capture the changes that will unfold in Washington as Trump becomes a lame duck. By COP32, the prospects for the US to commit to intelligent leadership on climate will be visible, and that will strengthen the movement to fight global warming.
Q: Do you expect the outcome will enable global progress on regulation of Big Tech?
As long as Trump has veto power over Big Tech regulation, little progress will be made in the US, and that will curb the effectiveness of global efforts. However, as resistance grows to where data centres are placed and the constraints they will be under on use of power and water, these issues will continue to strengthen.
Q: How can the US now rebuild its health and medical institutions and infrastructure and commitment to evidence-informed health policy?
It will be interesting to see how the new House and Senate in Congress conduct vigorous oversight of Health and Human Services Roberrt F. Kennedy Jr. The congressional hearings will be very dramatic and highlight his extremist views that are endangering the lives of millions of Americans. He may well face impeachment.
Q: Will the results have any bearing upon Australian politics – for example, the upcoming Victorian election?
Too early to say. But everyone will be attuned to the continuing interaction of Pauline Hanson and Gina Rinehart with Trump – and what they bring home to Australia from Mar-a-Lago.
Q: Any other thoughts or issues on your mind?
This midterm election has resulted in a check being placed on Trump’s exercise of power. This was the last chance to save America’s democracy. The road back will be long and difficult, but the country, at least for now, wants to see a better future.
EJ Dionne, a columnist for The New York Times, expressed this right after the elections:
“And you sense in the country – and it turns out way outside the Democratic base, into Republican territory – that people are really sick and tired of the way politics has been carried out in the last year and a half, and particularly in the second year of this Trump second term. People are tired of the division. They’re tired of wasting time. They’re tired of stupidity and ballrooms and wars. And I think that’s very deep in these results.”
And the other slogan that’s been in my head all year is the old John F. Kennedy quote: ‘Let’s get our country moving again.’”
Rejecting politics of anger, division and bigotry
Alison Verhoeven, health policy expert and a director of Croakey Health Media
Q: What is your immediate response to the results?
Like many people around the world, I felt huge relief that Americans turned out in huge numbers to reject Donald Trump and his dangerous politics. The damage he has caused both within the United States and internationally has been immense.
While this result will not see an immediate end to many of the problems Trump has been responsible for (inflation, higher fuel prices, international instability, the war in the Middle East, the lack of support for Ukraine, ICE raids, terrible health policies, the list goes on), it heralds optimism that Americans may once again seek to be good citizens in the world, allowing us all to breathe a little easier.
Q: What is a standout moment for you from the results?
Seeing voters in traditionally conservative states reject the politics of anger, division and bigotry gives me faith that the United States may have a positive future. I hope it also inspires Australians to reject the anger, division and bigotry which has crept into our society in recent years.
Q: If you could give advice to the new Congress about what to do now for US and global health, what would it be?
Invest in your own people by ensuring that health policies are informed by science and evidence. Invest in global health by supporting the work of agencies like the World Health Organization and by recognising that wealthy countries must do more to support people living in less fortunate circumstances through funding for international aid programs.
Q: What are the challenges and opportunities for global health and security from the outcomes?
Aggressive international policies that create war and don’t pursue peaceful objectives are harmful to us all. Early indications are that senior Republicans attribute the electoral losses to the war in the Middle East.
There is an opportunity for Republicans to reject excessive militarism if they wish to preserve ambitions for a Republican presidency in 2028. Whether they will step up to this challenge remains to be seen. Likewise the coziness Trump has sought with Putin and his aggression towards China undermine global security. Reining this in would be a positive step forward.
Q: Do you expect the outcome will have any impacts upon the upcoming COP31 negotiations? If so, how?
I doubt there will be a positive (or any) impact on upcoming COP31 negotiations.
Q: Do you expect the outcome will enable global progress on regulation of Big Tech?
I hope there is more progress on regulation of Big Tech, including better regulation of data centre growth, social media and AI; and taxation of the massive profits being earned by US tech companies.
The attempts by Elon Musk and other Big Tech leaders to ‘buy’ the US election failed dramatically. It’s time for these corporate cowboys to be brought under more scrutiny and control, something which the US Congress may now be able to do.
Q: How can the US now rebuild its health and medical institutions and infrastructure and commitment to evidence-informed health policy?
In the short-term, I think it’s probably unlikely there will be significant changes to US health policy, given the veto powers invested in the presidency. What may be harder for Trump will be the appointment of unqualified, poorly informed leaders into significant health policy roles. This will be of benefit to us all.
Q: Will the results have any bearing upon Australian politics – for example the upcoming Victorian election?
I doubt that the Victorian election will be significantly impacted by the US election results, although it may cause some political leaders to reconsider the wisdom of the politics of anger and division, noting that it was not a long-term winning strategy.
It will also be a bit more difficult to convince voters that all our current problems are caused by the incumbent Labor government, when internationally, inflation and higher fuel prices have been so clearly linked to Trump’s war in the Middle East.
Statement by Travis Lovett, Executive Director, Centre for Truth Telling and Dialogue – University of Melbourne
Decades of repair ahead
Adjunct Associate Professor Lesley Russell, author of The Health Wrap column and a member of Croakey Health Media
Q: What is your immediate response to the results?
A huge sigh of relief that some semblance of political sanity and democratic norms have returned and that there will finally be some restraints on Trump et al.
Q: What is a standout moment for you from the results?
The realisation that the Democrats who will now take over as Members of Congress (in both the House of Representatives and the Senate), as state governors and as representatives in state legislatures look like today’s America: a diverse array of people in their thirties and early forties; lots of women (including the first Gen Z woman elected to Congress) and people of colour (including at least two Native Americans); people from the LGBTQ community; a former Paralympian who uses a wheelchair; and the first Muslim Senator.
Q: If you could give advice to the new Congress about what to do now for US and global health, what would it be?
Focus on why the voters elected you and work to address their concerns and needs (that almost certainly means putting US issues ahead of global issues).
Try to avoid getting caught up in retaliatory partisan politics and investigations of Trump and his Cabinet. Issues like impeachment may be warranted, but legislative actions must be the first order of business.
If voters don’t see improvements in their concerns around affordability of and access to healthcare quickly, they will take their anger and frustrations out again at the ballot box in 2028.
Compromises will be necessary – between those who want Medicare for All and those who want incremental improvements; between those who see the need to do more for the developing world and those who see the numbers of Americans who go without healthcare, between the Democrats who control the legislative bodies and the Republicans who control the White House and the Administration.
Small progress is better than no progress.
Q: What are the challenges and opportunities for global health and security from the outcomes?
Too many other urgent issues to be addressed; the lack of qualified personnel in the relevant US agencies; Trump et al will still have a big say in where and how the money goes; it will take time and effort to undo all the damage Trump as wrought thus far.
Q: Do you expect the outcome will have any impacts upon the upcoming COP31 negotiations? If so, how?
No impact. It will still be the Trump Administration that runs the show (if they even attend!).
Q: Do you expect the outcome will enable global progress on regulation of Big Tech?
Perhaps, in the long run. Voter disquiet about data centres will likely be the first thing that is addressed. That might burst the AI bubble, or send it overseas.
But Big Tech will still be buying access to the White House and the Congress with massive lobbying efforts.
Q: How can the US now rebuild its health and medical institutions and infrastructure and commitment to evidence-informed health policy?
A huge task – one that will likely take decades. And how do you do that with Trump and Kennedy and others still around? Just getting back the money will be the easiest part – then the expertise which has been lost. But how to restore public trust?
See How Trump is dismantling America’s Scientific Research Machine for an indication of the size of the task.
See Larry Gostin: Rebuilding Public Trust in Science-Based Health Policy
Q: Will the results have any bearing upon Australian politics – for example the upcoming Victorian election?
I expect to see Trumpist elements emerge from One Nation and others on the right.
Q: Do you have any thoughts for how the results could inform public health and health equity advocacy in Australia or elsewhere?
It should remind us that public health and health equity are easily undermined, but that when political candidates speak out in support of their value, voters respond.
Here I would also pick up on what Jacinda Ardern has to say about the role of empathy in politics (it’s a sign of strength, not weakness) and how Talarico in Texas used this so well.
Follow the evidence
Scientia Professor Rebecca Ivers AM , Deputy Dean, Global Engagement and External Education, Faculty of Medicine and Health, UNSW and a director of Croakey Health Media
Q: What is your immediate response to the results?
This does feel like a major shift in the political landscape in the US, or at least a recognition from the US population that the current Government isn’t following through on promises to ensure Americans have a better standard of living.
Of course, this doesn’t necessarily mean things will dramatically change. Trump is still the President with veto provisions, he still holds significant executive powers, and this does not mean that the Democrats have carte blanche in terms of reversing many of the changes that were made in the last two years. Having said that, there is a palpable sense of relief and indeed jubilation from my US public health colleagues.
Q: What is a standout moment for you from the results?
Great to see the diverse range of people elected – First Nations people, Latinos, black leaders elected. It feels like a very clear national repudiation of the Trump-led clampdown on DEI across the whole country (nice explainer on this here).
Q: If you could give advice to the new Congress about what to do now for US and global health, what would it be?
To follow the evidence. This will be a good time to carefully evaluate where investment is best placed to maximise impact, both domestically and globally. There have been so many programs that have been systematically dismantled that it is not going to be easy, or indeed possible to reverse.
Hundreds of data collections have been closed down or modified (see https://dataindex.us/terminations-tracker for a list) so understanding where the biggest need is will be important in terms of restitution.
Taking advice from the CDC and other public health experts will be key as recommended by others.
Globally, the close down of US Aid was abrupt and disruptive for global health but other donors have also filled the breach so careful assessment of intent and needs will be critical.
Q: Will the results have any bearing upon Australian politics – for example the upcoming Victorian election?
It is likely that the results will have an impact in Australia – seeing US repudiation of the Trumpian agenda, including the language of hate and division (also becoming increasingly prevalent here), should send a strong message to political parties in Australia about what is acceptable to the community, and what they value.
Return evidence to policy making
Veronica Le Nevez, Co-Director of Impact and Engagement, Impact & Engagement, George Institute for Global Health
Q: What is your immediate response to the results?
Hope and relief.
Q: What is a standout moment for you from the results?
It was fantastic to see so many candidates with a health or social policy background – I’m hoping that will help to reset the US Government’s approach to these issues and start to restore the role of evidence in policy making.
Q: If you could give advice to the new Congress about what to do now for US and global health, what would it be?
For a wealthy country, the US has a very low safety net for healthcare. Many people can’t afford even the most basic level of care. Restoring Medicaid and affordable healthcare has to be the absolute priority.
On global health, there needs to be a re-evaluation of the decision to withdraw from the global health architecture. Global health engagement does not need to be a binary, all-or-nothing approach – there is room for the US to shape and influence the next generation of global health systems and priorities. Collaboration is a net positive – it helps to reduce global health threats everywhere, and therefore lowers the risk of future pandemics to the US as well.
Q: What are the challenges and opportunities for global health and security from the outcomes?
The opportunity is for conversation – with a new Congress that includes health professionals, there is an opportunity for global health issues to be heard by people with influence in the US government.
The challenges remain the same.
Q: Do you expect the outcome will have any impacts upon the upcoming COP31 negotiations? If so, how?
I don’t expect the congressional elections will impact COP31. The policy of the Administration has not changed, and making progress on climate remains the biggest and most fraught global challenge we face today.
However, it will be interesting to see how a reshaped Congress changes the posture of the US administration on a range of global issues over time, and whether quiet preparations will now begin for a potential re-engagement post 2028.
Q: Do you expect the outcome will enable global progress on regulation of Big Tech?
Similarly, I don’t expect that we will see immediate progress globally but I expect that the new Congress will take a lot more interest in issues like data centre planning and regulation domestically.
Q: How can the US now rebuild its health and medical institutions and infrastructure and commitment to evidence-informed health policy?
The first thing it needs to do is restore expertise to policy making institutions. The loss of expertise from the CDC and other key health policy and surveillance organisations has left the US dangerously ill-equipped to face health threats.
The second thing is to reinvest in research – the significant drop in investment in research funding means that there is less effort going towards solving health challenges, including finding better prevention and treatment of disease. Unless both of these are addressed, health outcomes will go backwards.
Q: Do you have any thoughts for how the results could inform public health and health equity advocacy in Australia or elsewhere?
There were some very articulate candidates in this election making a strong case for public health policy and outcomes. They showed that even in a crowded policy landscape full of other pressing concerns, a clear and compelling message that reflects the concerns of people in the community is powerful.
Thank heavens!
Dr Simon Judkins, emergency medicine physician, member of Croakey Health Media
Q: What is your immediate response to the results?
I was very excited by the results. It shows that, despite the corruption, the gerrymandering, the extraordinary amounts of money spent trying to influence the outcomes, that people power can still win. I hope that this, on the back of results in Brazil, Serbia and Hungary, shows that the many people still want fairness, opportunity, kindness….
Q: What is a standout moment for you from the results?
There were many… I think hearing the victory speeches from Ossoff, Talarico and El-Syaed, and Andrews were inspiring. And the diversity amongst the Dems winners is so encouraging, so inspiring/
Q: If you could give advice to the new Congress about what to do now for US and global health, what would it be?
Re-invest in global health programs, public health in the US and climate action. Clearly, the majority of Americans have been sold a false narrative. They need to understand what the US has done for the world and what the impacts of withdrawing from international programs means to so many millions.
I would also suggest that there are plenty of billionaires in the US who could spare a little bit of money, through a fairer tax program, which will pay for all of this…
Q: Do you expect the outcome will have any impacts upon the upcoming COP31 negotiations? If so, how?
Not sure…there is a glimmer of hope that the US may change its position of climate action. Clearly, with an empowered Trump administration, they would have been steamrolling through, trying to derail action on climate and support their fossil fuel mates and investments. Now, there is a possibility there may be a change
I think it may be too soon for that change, but the world needs a change of position in the US and that needs to happen fast. A turnaround on climate action, supporting renewables and decreasing fossil fuel use by the US will have enormous impacts.
Q: Do you expect the outcome will enable global progress on regulation of Big Tech?
I hope we will see a significant pause and time to review. Clearly, much of the groundswell included a push back against big tech and data centres. The other part of this will be the ongoing push back against Starlink, Facebook etc.
The world has realised that having some sovereignty, in energy, in defence, in AI, tech and finance is incredibly important as it was realised that the US is not a reliable partner.
Q: How can the US now rebuild its health and medical institutions and infrastructure and commitment to evidence-informed health policy?
This will take a huge turnaround. The US health system is broken. Trump is still two weeks away from announcing a health plan. However, I think that is a bigger lie than Iran being two weeks away from having a nuclear weapon. Both are enormous lies, made to benefit Trump and his ambitions for power.
The US people need to understand that public health is a good thing… hopefully a change in government and an independent media can get that message across. The majority of the US people deserve better. They have been lied to and ripped off for way too long.
Q: Will the results have any bearing upon Australian politics – for example the upcoming Victorian election?
I hope people will understand that three-word slogans, parties without policies, politics based on hate and division is not the way forward, and that a protest vote is not a solution… and all the examples we have seen of populist politics across the globe are failing people, enriching a few, but ultimately, coming undone with enormous consequences.
Q: Do you have any thoughts for how the results could inform public health and health equity advocacy in Australia or elsewhere?
The US health system has been a policy free zone for both of Trump’s presidencies. Big businesses have made mega profits, CEOs have got richer, while millions have lost access to healthcare.
Losing expertise and experience, and replacing that with ideology and idiocy has seen the rise of infectious diseases not seen in decades, misinformation on an unprecedented scale and healthcare in the US being corrupted for profits….no regulation, no evidence, no controls…. and the population suffers. It is an extraordinary failure of government and governance.
Q: Any other thoughts or issues on your mind?
Thank God there has been a change. There is now some hope that we, as a global community, might be able to secure a safer future for our children…
A challenge of legitimacy
Dr Alison Hoeger, public health researcher
Q: What is your immediate response to the results?
Due to the structure and processes of the US Congress, the results are unlikely to result in any tangible outcomes, domestically or internationally, due to the lack of Presidential veto-overriding majority. Trump has already expressed willingness to utilise this veto power, but many of his major undertakings have avoided Congress anyway by way of ‘Executive Orders’, which can be implemented immediately and only halted via challenges in the courts, which can be time-consuming.
Q: What is a standout moment for you from the results?
The loss of longtime Senator Susan Collins of Maine was a pivotal moment given her deciding role in the confirmation of anti-abortion Supreme Court Judges, who overturned Roe vs Wade in 2022. Susan Collins had long positioned herself as a ‘pro-choice’ Republican, and claimed the judges in question had promised not to overturn Roe vs Wade. The loss of abortion access in many states, in some instances even when the mother is facing death, continues to impact millions.
Q: What are the challenges and opportunities for global health and security from the outcomes?
One challenge this Congress faces is that neither Democrats nor Republicans have much legitimacy when it comes to public health, domestically or internationally. Health insurance companies spent over $3 million in donations to Congress this election cycle, more or less evenly split across the two parties.
Over 50 percent of Senate donations went to candidates in states with the lowest life expectancy. The second largest donation overall, in excess of $70,000, went to Rep. Hakeem Jeffries, who has already announced this week that the new Congress will not be pursuing so-called Medicare for All, which is essentially what Australia has.
In terms of global health and security, this Congress also faces a challenge of legitimacy in terms of the number of candidates that accepted donations from Israel-associated political action committees (or PACs). More than $80 million donations from Israeli-associated PACs were accepted by Democrats in this election cycle, despite that the UN Human Rights Council determined Israel has committed genocide in Gaza for several years.
In fact, the number of those in this new Congress that did not accept Israeli-associated PAC donations is very few. Thus, it is difficult to realistically expect that this Congress will take any meaningful steps to address one of the most horrific public health/child mortality catastrophes of our age.
Q: How can the US now rebuild its health and medical institutions and infrastructure and commitment to evidence-informed health policy?
This is unlikely as there is no veto-proof majority.
Q: Do you have any thoughts for how the results could inform public health and health equity advocacy in Australia or elsewhere?
I know South Carolina well, and the election of a paediatrician who has campaigned against the power of private health insurers was absolutely shocking to me. This highlights the breaking point that the US faces in terms of healthcare access.
I think the concept of not having free access to healthcare when you need it most is largely incomprehensible to most Australians – and those in Australia advocating a shift to a more ‘US-model’ of healthcare access may be more wary to do so.
Q: Any other thoughts or issues on your mind?
Congress has no legitimacy in advocating for human and animal health while also funding a genocide.
Sustain social movements for lasting change
Dr Jo Flavel, public health academic
My immediate response was relief and cautious optimism. The election results are at least partly a reaction to the impacts on daily living conditions from the actions of the Trump Administration.
I say cautious because the newly elected Senators, Representatives, Governors etc have a responsibility to show voters they can govern for those who elected them.
Mamdani’s example is illustrative: his administration is demonstrating the value of competence coupled with social dignity, taking assertive action on housing, food affordability, tackling the social determinants of health and showing that democracy can deliver for the population.
The Democrats need to do more than just obstruct harmful actions, they should follow Mamdani’s example. If they fail to do this, any perceived gains from the midterms risk being lost in two years.
I think a really important point is that a focus on a party to deliver for public health can fail and there are examples of that here in Australia. Social inequality is still growing in Australia as well as in the US with flow on effects on health.
It is not as simple as getting Democrats elected in the US and all will be solved. Candidates and elected politicians must be held to account here as well as in the US to act in the interests of those who elected them.
The election of Amy Acton, Abdul El-Sayed and James Talarico are standouts for me. These are not career politicians, they come from public health and education backgrounds. It is the election of candidates who will be more in touch with the day to day lives of voters that gives me hope rather than what party they belong to, but they must be able to advocate for and govern for those voters rather than just along party lines.
There are opportunities for security, for global health, for climate, and regulating Big Tech with the new Congress now able to block further plans that would wreak damage and harm the environment and health of the population in the US and beyond. With Trump still being President there will be barriers to undoing the damage of the past two years.
The social movements that yielded the midterm results need to be sustained, continuing over the next two years and beyond to ensure that the results from the midterms can be harnessed to produce lasting positive change that will enable ambitious action for climate, global health, regulation of Big Tech. This will require visible actions from the new Congress that benefit the population and not just vested interests.
Returning to my point above, the new Congress needs to show they can deliver so that social movements can be bolstered by this to mobilise voters in 2028 to support the candidates that will continue to deliver and build lasting action for health in the US and globally.
Centre solidarity
Penelope Smith, public health researcher
Q: What is your immediate response to the results?
Disbelief, relief, concern.
Disbelief: When I first checked the results on the Age website early afternoon on Tuesday I didn’t trust what I was seeing. As a result, I then opened three more news websites. Throughout the afternoon I would flick between them all to check and despite them being consistently the same, I continued the behaviour. It seemed like something beyond the possible was occurring.
Relief: The human face of life in America was front and centre for me, fed by my social media and media choices. The collection of stickers at the memorials of those killed by ICE is what I will never forget (my equal standout moment with the one below). I admit to not understanding how changes can be made to ICE but this seemed like something now possible. That perhaps now this behaviour could be stopped.
Concern: The nervousness that lives in the media, fed by commentators but also evidence from before, of what might he do and when and how will it happen.
Q: What is a standout moment for you from the results?
I am deeply affected by my watching of Planet America on ABC and a couple key Instagram accounts. As result of this I was specifically watching five individuals as I had been influenced to believe that these five were a type of sign.
Texas (Talarico), Michigan (El Sayed), South Carolina (Andrews), Ohio (Acton and Brown). I spent a lot of time basically checking in on these races.
Individually these wins stand out, but there is something more powerful collectively here that tells a story.
Q: If you could give advice to the new Congress about what to do now for US and global health, what would it be?
I agree with the commentators reflecting that there is a risk in getting too focused on hearings to hold individuals to account. I do think these matter though – but so does changes that will improve lives on the ground. Balance and strategy are what is needed here.
Q: Do you expect the outcome will enable global progress on regulation of Big Tech?
While this is not my area of expertise or skill, it really stood out to me the significant money that Elon Musk (in Texas) and Cryptocurrency sector (in Ohio) invested in defeating the Democrat candidate standing. While these wins aren’t just about Big Tech, they do give an indication of public sentiment and provide a type of mandate.
Q: How can the US now rebuild its health and medical institutions and infrastructure and commitment to evidence-informed health policy?
It is not as simple as going back to what was there before. Investment is needed to rebuild not only to return to previous levels of care, but to go beyond. From both within Australia and outside, I am much more aware of the work required legislatively and legally to keep institutions and broader infrastructure protected. Investment is needed in this during the rebuilding period.
Q: Will the results have any bearing upon Australian politics – for example the upcoming Victorian election?
From a personal view on Tuesday evening, I must admit to letting a little hopeful thought creep in. Perhaps this election outcome would give an indication to the Far Right in Australia that things had changed. I was unsure about this feeling until I saw that the One Nation party have removed all references to Trump. This gives evidence of the impact.
Victoria is my home state. As a person of colour undertaking a PhD in skilled migration, living in the electorate of Indi, I am terrified. The word choice is real and deliberate. So many people and organisations are working so hard to push back and invite people into spaces of solidarity. I know many are tired and running out of energy. In the last two weeks though Brazil, Serbia and now USA are showing us what is possible. But we must centre solidarity, leaving no one behind.
Q: Any other thoughts or issues on your mind?
I have two friends in New York who work in sectors unpopular with Donald Trump and his supporters. One is in delivery of public health programs in HIV and STI, and one is a sex worker, film maker and activist. I messaged both on the day to check in and see how they are. The latter expressed extreme relief. The human face really matters in this to me. You see it all over social media. This is a very different type of celebration, we need to recognise that.
I heard a commentator say that there really wasn’t a unified Democrat campaign. He seemed to be critical in his statements. It did make me think how much I had noticed the place-based elements this time. I think there is something important here.
See Croakey’s archive of articles on the Trump Administration
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