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BEYOND THE ACA

Any list of the Obama Administrations key health gains must include groundbreaking achievements in
environmental health protection. The successful negotiation of the Paris Agreement on climate change,
formally ratified in October 2016, for the first time has set the global community on a low-carbon course.
Additionally, the Obama Administrations numerous initiatives to limit carbon and other forms of
pollution from power plants, cars, trucks, homes, and businesses are changing fundamentally how
Americans consume energy, enabling the nation to meet its environmental goals in ways that will save
countless lives. For example, the Environmental Protection Agencys 2013 regulation on National
Ambient Air Quality Standards for Particulate Matter will prevent thousands of premature deaths of
elderly and young children from cardiovascular and respiratory illnesses caused by soot pollution.

Smoking is still the nations leading cause of preventable death. The 2009 signing of the Family Smoking
Prevention and Tobacco Control Act, giving the US Food and Drug Administration authority to regulate
nicotine as a controlled substance, was only the most public evidence of progress. The 2009 federal
tobacco tax increase of 62 cents per pack, included in the reauthorization of the Childrens Health
Insurance Program, combined with the Tips from Former Smokers campaign launched by the US
Centers for Disease Control and Prevention, were among many initiatives that have contributed to major
declines in both adult and adolescent smoking rates, including a drop among adults from 20.6% in 2009
to 15.3% in 2015.3

Regarding nutrition and food policy, the Obama Administration has reformed essential federal nutrition
programs that provide a critical safety net for millions of American children and families. Lead by the US
Department of Agriculture, for the first time in decades, the most current dietary science is being applied
to nutrition programs. More than 50 million children now have healthier food environments at school.
Because of new food standards, nearly four million schoolchildren have access to nutritious meals each
day in summers, and eight million low-income women, infants, and young children receive improved WIC
food packages.

Unknown to the public has been massive upgrading and professionalization of emergency response
systems in the United States and globally. Two National Health Security Strategy Plans (NHSS), 2010 to
2014 and 2015 to 2018, have galvanized national efforts to minimize the health consequences of large-
scale emergencies in response to the deficiencies evidenced by the tragedies of the 9/11 terrorist attacks
in 2001 and Hurricane Katrina in 2005, to achieve a health-secure and resilient nation.4 The works
impact can be seen in the US governments response to national and global health security threats over
the past eight years such as the 2009 influenza pandemic (H1N1), Middle East respiratory syndrome
(MERS), the West African Ebola epidemic, and the current Zika virus threat. This new infrastructure
helped to address health security threats from recent international crises such as the 2010 Haitian
earthquake, the 2011 Japanese tsunami and nuclear power plan incident, and the 2013 Philippines
typhoon.

Space constraints do not permit a thorough presentation of the public health achievements and progress
by the Obama Administration. Such a full list would also describe: national and global progress in
addressing the HIV-AIDS epidemic; fundamental changes in behavioral health financing and access
including progress in addressing the advance of the opioid epidemic; adoption by numerous federal
agencies of social determinants of health approaches in housing by the US Department of Housing &
Urban Development and in transportation by the US Department of Transportation; major declines in
adolescent pregnancy rates; unprecedented attention to the health needs of lesbian, gay, bisexual,
transgender, and questioning communities; and much more.

CONCLUSIONS

Every Presidency leaves a unique record and legacy of accomplishments and shortcomings, of wins and
losses. Noteworthy during the Obama years has been the extraordinary number of initiatives, programs,
experiments, and demonstrations that have moved the needle toward greater access, quality, equity,
effectiveness, and efficiency in important matters relating to health care and public health. Wherever
Barack Obama lands in the historic hierarchy of significant and positive contributors to health, the
extraordinary efforts made by him personally and by his talented, dedicated, and principled
Administration have set a high bar and model for all who follow. The Obama era has been a
consequential eight years, and the Administrations impact has been overwhelmingly for the better for
the American people and for the people of the world.

Article information

Am J Public Health. 2017 January; 107(1): 2426.

Published online 2017 January. doi: 10.2105/AJPH.2016.303538

PMCID: PMC5308178

John E. McDonough, DrPH, MPAcorresponding author

John E. McDonough is with the Department of Health Policy and Management, Harvard T.H. Chan School
of Public Health, Boston, MA.

corresponding authorCorresponding author.


Correspondence should be sent to John E. McDonough, Professor of Practice, Harvard T.H. Chan School
of Public Health, 677 Huntington Avenue, Boston MA 02115 (e-mail: ude.dravrah.hpsh@hguonodcmj).
Reprints can be ordered at http://www.ajph.org by clicking the Reprints link.

Accepted October 16, 2016.

Copyright American Public Health Association 2017

Articles from American Journal of Public Health are provided here courtesy of American Public Health
Association

REFERENCES

1. Blumenthal D, Morone J. The Heart of Power: Health and Politics in the Oval Office. Berkeley, CA:
University of California Press; 2010.

2. Avery K, Finegold K, Whitman A. Affordable Care Act has led to historic, widespread increase in health
insurance coverage. ASPE Issue Brief. US Dept of Health and Human Services. September 29, 2016.
Available at: https://aspe.hhs.gov/sites/default/files/pdf/207946/ACAHistoricIncreaseCoverage.pdf.
Accessed October 11, 2016.

3. Early release of selected estimates from the National Health Interview Survey, 2015. National Center
for Health Statistics. Available at:
http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201605_08.pdf. Accessed October 11,
2016.

4. Assistant Secretary for Preparedness and Response. National Health Security Strategy and
Implementation Plan 20152018. US Dept of Health & Human Services. Pg. v. 2014. Available at:
http://www.phe.gov/Preparedness/planning/authority/nhss/Documents/nhss-ip.pdf. Accessed October
11, 2016.