In 1966 the Rev. Dr. Martin Luther King Jr. made a profound and prescient statement about health injustice, calling it “the most shocking and inhumane” form of inequality. Sixty years later, after notable efforts to right that wrong by expanding access to health care, most notably with the Affordable Care Act, health injustice is escalating in the United States. Our collective physical and mental health is deteriorating. Our public health infrastructure is being dismantled before our very eyes. Our health care system is on the brink of collapse.
This year in particular, as the Trump administration continues its assault on King’s legacy, there will be lots of commentary about what he would have thought and said about the current domestic and global state of affairs. But when it comes to our collective national health, King’s words remain as timely as ever.
My research shows that health injustice is most pronounced among the most marginalized — immigrants, people of color, the poor. Our leaders’ policy decisions are at the crux of this injustice, permeating every part of our society.
As a sociologist who has explored the impact of health reform on health care access over the last decade, my research shows that health injustice is most pronounced among the most marginalized — immigrants, people of color, the poor. Our leaders’ policy decisions are at the crux of this injustice, permeating every part of our society. The result is lower life expectancy, more illness, social isolation and overall pessimism about our society.
Our physical and mental health is spiraling. Americans’ health outcomes are the worst among peer countries. Preventive and chronic conditions are particularly dire. We are seeing higher rates of cancer among young adults, women are dying in childbirth at unacceptable rates and gun violence still claims too many lives.
Our mental health is in similar decline, with rates of addiction, depression and social isolation increasing. The current sociopolitical climate, with its endless loop of made-for-reality-television plots and traumatic developments at home and abroad, and the descent of our democracy into fascism, is making matters worse, leaving many Americans in a state of despair for our present and future. “There’s no way not to lose sleep at night or to not have a high level of stress or anxiety,” an immigrant health care advocate told me in 2019 during the first Trump administration.
Put simply, we are not well.
But as our nation gets sicker, we won’t be able to turn to our health care system. It remains unaffordable for most Americans, with costs and premiums skyrocketing. While politicians were playing chicken with Americans’ lives during last year’s government shutdown, subsidies for the Affordable Care Act expired — and an estimated 20 million middle-class Americans are expected to lose coverage. Trump’s Big Beautiful Bill is bringing significant cuts to Medicaid for nearly eight million lower-income, young adult and elderly Americans.
This accompanies a rising shortage of various types of health care professionals. Physicians, nurses and other medical staff are stressed and burnt out, with some leaving the profession. A provider I interviewed in 2016 shared that keeping up with the demands of the job “can be emotionally draining…At the end of the week, I feel like several trucks ran over me. It was really exhausting.”
To compound the shortage, the Trump administration’s hardline immigration policies are making the recruitment of international primary and specialty care physicians nearly impossible. When Americans need medical help, we often have long wait times of at least three months to be seen. In that period, less severe medical diagnoses can become more emergent.
The most marginalized among us bear the brunt of health and health care inequality. Race, class and legal status have shaped health care access since the development of our current health care system in the 1940s. Under the Trump administration, these disparities are increasing dramatically.
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The vilification of immigrants, especially non-white ones, is most stark for obtaining care. A Salvadoran pastor I interviewed in 2016 observed, “It’s better to be a dog than an immigrant, when it comes to going to the hospital, because if you find a dog that has been hurt, we will accept it in any animal hospital. But an immigrant will be rejected.” That reality has only deteriorated since, with U.S. citizens finding themselves similarly excluded from health care.
The nation’s collective health outcomes are being made worse by the dismantling of our public health infrastructure and trust in science as the basis of medical guidance.
Secretary of Health Robert F. Kennedy Jr.’s recent decisions ending vaccination guidelines for children, limiting vaccine availability and changing nutritional guidelines will result in the spread of preventable communicable diseases and higher rates of chronic conditions like diabetes, high blood pressure and cardio-related conditions. These actions stand in stark contrast to the legacy of his father, Sen. Robert F. Kennedy, who worked alongside King, despite their sometimes strained relationship, to advocate for civil rights and economic justice, both of which are key for advancing health justice.
There are policy solutions to advancing health justice even in this socio-political climate. With government funding set to run out on Jan. 30, our elected officials in Congress should be motivated to avoid another shutdown.
First, Congress could improve health care access by reinstating the expired Obamacare subsidies. There remains bipartisan support for doing so. With enough political will, the Big Beautiful Bill’s detrimental Medicaid cuts could even be reversed. After the legislation passed the House in June, some lawmakers acknowledged not fully reading or understanding the impact of its substantial cuts. Others even proposed bills to reverse the Medicaid cuts.
Next, to improve our collective mental health, Congress could challenge the Trump administration to rescind $1.9 billion in funding cuts for vital substance use and mental health grants. To address the physician shortage, Congress could also pass the Resident Physician Shortage Reduction Act of 2025, which would increase the number of Medicare-funded residency slots, particularly in rural and underserved regions.
Despite the Trump administration’s hardline immigration policies, there is also bipartisan support for reauthorizing the Conrad program, which lapsed before the last government shutdown. This 30-year program has allowed international medical graduates already in the country to remain here if they commit to practicing for three or more years in medically underserved areas.
Such action is unlikely in our current environment. In the meantime, we must recognize that while policies like these are necessary to advance health justice, they alone are insufficient to arrive at such a lofty goal. For this, we should look to King for hope and guidance on persevering amid adversity.
“Power is love implementing the demands of justice,” King said. As clichéd as it may seem, we need love to recognize our common humanity — and to transform the callous hearts and minds of many in the halls of power where decisions on policy are made. Like him, I am convinced that health and all injustice can be cured with love.
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