Saturday, October 19, 2019

Government Increasingly Promoting Sectarianism-Based Health Policy

Traditionally, physicians and other health care professionals are taught to put the care of the individual patient first.  Patients deserve care according to their own values as best they can be realized.  Physicians whenever possible should avoid substituting their own values for those of the patient.  In particular, they should avoid imposing their own religious beliefs on those of patients.

In the US, we live under a Constitution whose First Amendment states "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof."

Thus it is concerning that under the Trump administration we have seen efforts apparently meant to orient government agencies involved with health care and public health to a particular set of religious beliefs.  We summarized here instances in which appointments to government agencies seemed to be based on appointees' religious view, and/or in which appointees seemed to be promoting health policies based on their personal religious beliefs.  These included instances of appointees arguing against the adoption of children, and making assertions that "intersex patients do not exist, that contraception causes cancer and violent death, that pornography is a major public health hazard."

This year, we have seen more evidence that the administration has been appointing people to health care or public health related leadership positions based on their religious views, and promoting sectarianism-based health care and public health.

More Appointments Apparently Based on Religious Views Rather than Health Care or Public Health Expertise

In May, Reuters published an article entitled "the foot soldiers in the Trump-Pence religious health movement."  Its introduction stated

With Donald Trump’s election in 2016, Vice President Mike Pence emerged as a force in reshaping American health policy. Aligning the policy with Pence’s evangelical Christian principles, the administration stocked the Department of Health and Human Services and other federal agencies with a cadre of pro-life staff members.

The implication is that the appointments were made according to the appointees' religious beliefs, rather than their knowledge of or experience in relevant health care or public health spheres.

It included capsule biographies of several people heretofore unknown to me.


Position: Former head of Domestic Policy Council; now nominated as ambassador to the United Nations mission in Geneva.

Background: Bremberg, a health policy expert, served as co-chair of the HHS transition team that stocked the agency with religious conservatives before serving as chief of the White House policy operation. He drafted the expanded Mexico City policy that imposes anti-abortion rules on billions in U.S. health aid.


Position: HHS, Counselor for Human Services Policy

Background: A former HHS official under the Obama administration and director of the U.S. House Pro-Life Caucus, Wynne worked for the Knights of Columbus, a Catholic service organization, before rejoining HHS. She served on the transition team, helped bring in other anti-abortion activists and participated in attempts to prevent pregnant immigrant girls from obtaining abortions.


Position: Chief of Staff, Office of the Assistant Secretary for Health

Background: A former interim legislative director at Susan B. Anthony List, an anti-abortion group, Valentine helps supervise the Title X grant program. With other anti-abortion advocates in the office, he tried to end the Teen Pregnancy Prevention Program, [more about contraception than abortion] a move blocked by the courts.


Position: Senior policy advisor, HHS Office of Global Affairs

Background: The former president of a Washington group that championed 'sexual risk avoidance,' or abstinence as an alternative for birth control, Huber wrote a paper that said Christians should promote 'God’s sexual guidelines to life' in sex education and public health policy. Huber worked on the attempt to kill the Teen Pregnancy Program, and now works on international health policy.


Position: Chief of Staff, Office for Civil Rights

Background: An abortion opponent and former Justice Department attorney, Bell was staff director for a House panel that investigated Planned Parenthood [which provides contraception services, cancer screening, and other health services in addition to providing abortions] for selling baby parts, an inquiry that grew out of a controversial video sting operation.


Position: Deputy general counsel, HHS

Background: As senior counsel at the Alliance Defending Freedom, an organization that defends religious conservatives, Bowman was part of a 'life litigation project,' working on cases against the contraception mandate in Obamacare. He himself has been arrested for demonstrating outside abortion clinics.

Note that these appointees advocacy of religious beliefs about health care were not limited to their views on the highly controversial topic of abortion, but also were directed against, for example, provision of contraception and other family planning services.


Position: Former head of the Office of Refugee Resettlement, now senior advisor at the Center of Faith and Opportunity Initiatives

Background: When Lloyd ran the office responsible for caring for young migrants, he tried to block some of the underage women from having abortions, sparking court battles. A lawyer, Lloyd helped found a firm that worked on cases based on Catholic doctrine on birth control and abortion. 'The law is pagan territory,' he has written. 'Look no further than no fault divorce, legalized abortion on demand, and gay marriage as confirmation.'

I can find no information suggesting that any of the people above has direct experience or training in biomedical science, medicine, other health professions, or public health.  Note that in previous posts we had mentioned several of the people appearing in this article: Katy Taalento, Diane Foley, and Roger Severino. Others we had noted as apparently unqualified members of the Trump "beach head teams," but without knowledge of their sectarian focus.

More Administration Action Promoting Sectarianism-Based Health Policies

Several relevant articles have appeared this year.  In March, the Washington Post reported on efforts to promote policies oriented specifically to evangelical Christian and Catholic beliefs.   In summary,

In the first year of the Trump administration, Christian social conservatives placed in high-level jobs — [Valerie] Huber [see above] among them — focused mostly on U.S. policy. They were highly successful, pushing through a religious exemption to the Affordable Care Act’s birth-control mandate, prioritizing abstinence-only sex education and imposing what critics call 'gag rules' on family planning groups receiving $286 million in the United States and up to $7.4 billion around the world that prohibit them from referring for abortions.

Now, they are seeking to spread those views to the rest of the world by building a coalition of nations that would wield clout beyond the Trump administration.

In May, another Reuters article noted

the quiet, behind-the-scenes influence of Vice President Mike Pence, who has been driven throughout his political career by his evangelical Christian beliefs to restrict abortion and prioritize the rights of religious conservatives.


Under the direction of two secretaries recommended by Pence, the Department of Health and Human Services has moved to slash funds from teen pregnancy-prevention programs, curb abortion both in the United States and abroad and strip civil protections for transgender patients.

The administration has emphasized abstinence programs, led by appointees who believe contraception harms women, and pushed to cut government funds for Planned Parenthood – a longtime cause for Pence while he was in Congress. Planned Parenthood, a national network of healthcare providers, offers infertility services, contraception and abortions.

Again, the focus goes way beyond the controversial abortion issue:

In Kenya, services are already being reduced, said Jedidah Maina, director of the Trust for Indigenous Culture and Health, which offers programs on sexual and reproductive health and operates a health services hotline. One partner organization no longer provides free healthcare for the impoverished, and another was forced to reduce HIV services, she said.

In Peru, the reproductive-rights advocacy group PromSex said it was unable to apply for a grant to combat human trafficking from the U.S. Agency for International Development because it fights for access to abortion. In a November 2017 email obtained by Reuters, a USAID contracting officer said if the group 'were carrying out activities or planning to carry out any activity related to family planning methods, it could not commit itself with the Government of the United States.'


Christine Dehlendorf, director of the Person-Centered Reproductive Health Program at the University of California, San Francisco, said HHS cancelled two grants for ongoing research into contraception. One was restored through litigation.

Dehlendorf said she lost about $800,000 in funding for a study of how well medical providers meet women’s contraception preferences, which included natural family planning methods favored by some conservatives. There was 'no reason to eliminate it other than a lack of a general desire to meet women’s reproductive health needs,' Dehlendorf said.

Top Administration Leaders Advocating Government Establishment of Religion

Recently, two top Cabinet Secretaries gave speeches in their official capacities advocating government oriented to particular religious beliefs, conservative Christian principles.  One was Attorney General William Barr, as reported by Mother Jones on October 12, 2019, decried the influence of people who do not believe in organized religion

'This is not decay,' Barr said. 'This is organized destruction. Secularists and their allies have marshaled all the forces of mass communication, popular culture, the entertainment industry, and academia in an unremitting assault on religion & traditional values.'


In his address Friday, Barr thundered against what he described as a 'moral upheaval.' 'Virtually every measure of social pathology continues to gain ground,' he said. 'Along with the wreckage of the family we are seeing record levels of depression and mental illness, dispirited young people, soaring suicide rates, increasing numbers of alienated young males, an increase in senseless violence and the deadly drug epidemic.'

So he seemed to imply that the cure for depression, mental illness, and drug abuse is ... conservative Christian religion.  Again, here is sectarianism-, not evidence-based health policy.  Note that the article also stated,

Barr’s depiction of a war between the non-religious and people of faith shocked legal experts, who saw Barr’s defense of religious freedom as an assault on the First Amendment’s protection against the government’s establishment of any religion.

In an editorial in the NY Times, Paul Krugman wrote in reference to Barr's speech

how inappropriate it is for Barr, of all people, to have given such a speech. The Constitution guarantees freedom of religion; the nation’s chief law enforcement officer has no business denouncing those who exercise that freedom by choosing not to endorse any religion.


And he didn’t just declare that secularism is bad; he declared that the damage it does is intentional: 'This is not decay. It is organized destruction.' If that kind of talk doesn’t scare you, it should; it’s the language of witch hunts and pogroms.

Meanwhile, Secretary of State Mike Pompeo was even more explicit about how he deliberately establishes his religion in his government work, as reported by the Times of Israel also on October 12,

In his official capacity as America’s top diplomat, US Secretary of State Mike Pompeo delivered a speech on Friday on 'what it means to be a Christian leader' during a State Department event, prompting criticism that he crossed the line denoting the separation of church and state.

Addressing the American Association of Christian Counselors in Nashville, Tennessee, Pompeo emphasized what he deemed the main components of Christian leadership.

'I want to use my time today to think about what it means to be a Christian leader, a Christian leader in three areas,' he said. 'First is disposition. How is it that one carries oneself in the world? The second is dialogue, talking. How is it that we engage with others around the world? And third is decisions, decisions that we make.'

By the way, just to underline that this was an official speech, not just Pompeo speaking personally about his religious beliefs, the transcript of the speech is now on the official US State Department website here.

The Times of Israel quoted

Aaron Keyak, the former head of the National Jewish Democratic Council, [who] questioned the propriety of Pompeo’s using his platform to promote a particular religion.

'There’s obviously no issue with the secretary of state being a leader, nor his being a proud Christian,' Keyak told The Times of Israel. 'But it’s a problem that Secretary Pompeo thinks it’s appropriate to put those two words together and hold an official State Department event on being a Christian leader.'

'He’s an American leader, who is also a practicing Christian,' Keyak went on. 'Him talking as a Christian leader and billing it as such is an affront to our separation of church and state.'


As we said before, basing health care and public health decisions on political ideology or religious belief seems worse than just basing them on money, which had become prevalent in the dysfunctional US health care system. In some cases, the resulting mission-hostility seems to translate into violations of the US constitution.  For example, making health care decisions based on a particular religion's beliefs could be harmful for patients or citizens who do not share these beliefs, plus violate the Constitution's guarantee of freedom of a government establishment of religion.

For years, I thought that health care dysfunction was primarily about individuals and private organizations, including but not limited to pharmaceutical, biotechnology and device companies; hospitals and hospital systems; insurance companies, academic medical institutions; physicians and their practices; etc, etc, etc.  Consequently, I thought these individuals and organizations needed better awareness of health care dysfunction to provoke them to improve matters.  I thought of the government as being involved, but mainly because of well-intentioned, sometimes bumbling government actions and policies that often had unintended effects, and sometimes excess coziness with the health care industry.  While I knew that the government was subject to regulatory capture and various leadership problems, its role in health care dysfunction, at least in the US, seemed almost secondary.

But in the Trump era, there is a new (ab)normal.  All the trends we have seen since our last discussion of health care reform are towards tremendous government dysfunction, some of it overtly malignant, especially in terms of corruption of government leadership of unprecedented scope and at the highest levels, and overt influence of government-favored political ideology and religious beliefs on health care policy and other policies and actions.

I hope that our update above will add to the urgency pointing health care and public health professionals, patients, and all citizens towards a much more vigorous response.  US health care dysfunction was always part of the broader political economy, which is now troubled in new and dangerous ways.  We do not have much time to act.

If not now, when?

If not us, who? 

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