A lot has been said about the Project 2025 initiative including some discussion of its implications for public health in the United States. Representing a significant collaboration of more than 100 conservative organizations in the United States, Project 2025 certainly carries weight even if its specific role in the new administration remains uncertain.
But what does the Project actually say about public health? I turned to Project 2025’s “Mandate for Leadership: The Conservative Promise” to ask just that. A detailed summary of priorities by agency is available here.
The Project 2025 Agenda
The document is a remarkably detailed work, with specific priorities broken out by department and agency. Public health is by its very nature far-reaching and likely to be impacted by many policies in the coming years. Here, I have specifically limited this discussion to the conservative priorities related to the Department of Health and Human Services. I have also made every effort to provide an objective summary of the priorities outline. And to use politically neutral language whenever possible. Any form of commentary, analysis, or fact-checking is left to the reader.
There are unquestionably two top priorities explicitly and repeatedly stated: 1) the elimination of abortions in the United States and 2) to significantly increase the emphasis on the role of the traditional, nuclear family. Though major emphasis is also placed on increasing the independence of the public health agencies from both political and industry influence, the report promotes a traditional view of gender as binary and permanent and recommends developing a “patient-centered and market-based” approach to healthcare funding, among other goals.
Redefining Public Health
While there has been significant discussion in recent years about what constitutes “public health,” the Project 2025 agenda calls for a narrow use of the term, distinguishing between core public health functions and political functions. The plan also suggests a distinction is needed between public health and human services. The latter of which are to be deprioritized. A prime example of the former is a call to divide the CDC into two agencies: a strictly epidemiological agency exclusively focused on data collection and reporting and an agency that enters more into the political sphere, aimed at improving the nation’s health through policy.
Structurally, the agenda calls for the consolidation of the roles of Assistant Secretary of Health and Surgeon General as well as their respective deputies. It also recommends the development of streamlined chains of command for USPHS officers. These officials would then have increased oversight. As one example, the report calls for greater requirements for the declaration or extension of a public health emergency.
A full slate of recommendations
Priorities for individual agencies varied widely but generally fell in line with the overall goals mentioned above. Many were also aimed at reversing specific actions taken by the Biden administration. Some goals will no doubt stir significant disagreement, such as the call to eliminate Head Start in its entirety. Others may have the potential for greater collaboration, such as calls to lessen the administrative workload on clinicians. It also proposes to restrict drug regulators from being immediately hired by pharmaceutical companies after reviewing their applications.
From the Project 2025 agenda text, “Mandate for Leadership: the Conservative Promise”:
“Under President Biden, the mission has shifted to ‘promoting equity in everything we do’ for the sake of ‘populations sharing a particular characteristic’ including race, sexuality, gender identification, ethnicity, and a host of other categories. As a result of HHS’s having lost its way, U.S. life expectancy, instead of returning to normal after the COVID-19 pandemic, continued to drop precipitously to levels not seen since 1996 with white populations alone losing 7 percent of their expected life span in just one year. Nothing less than America’s long-term survival is at stake.” (p. 449)
A detailed summary of priorities by agency is available here
The full report from Project 2025 is available here
Cole Ettingoff