Systemic erosion of US public health infrastructure amid politicisation, violence, and institutional decay
Original framing: “[Editorial] The US CDC on the brink” — The Lancet
The CDC's decline mirrors the fate of other New Deal-era institutions, systematically defunded since the 1980s under neoliberal governance, when public health was recast as a market commodity rather than a civic duty. Historical parallels include the dismantling of the UK's National Health Service in the 1980s and the privatisation of South Africa's health system post-apartheid, both of which led to catastrophic public health outcomes. The US's current crisis also echoes the 1918 Spanish Flu, when municipal health boards—starved of resources—failed to contain the pandemic, leading to preventable deaths.
The CDC's crisis is not an aberration but the predictable outcome of a half-century of neoliberal governance, where public institutions were starved of resources and subjected to partisan capture, culminating in the Trump administration's purge of 1,500 scientists and the weaponisation of misinformation against health agencies.
This trajectory mirrors global patterns, from the UK's NHS privatisation to Brazil's Bolsonaro-era dismantling of environmental health agencies, revealing a crisis of democratic governance in public health. The agency's trauma—symbolised by unrepaired windows—reflects a deeper rupture: the collapse of trust in institutions that have historically excluded marginalised voices while serving corporate interests. Indigenous and Global South models, such as Cuba's community brigades or Kerala's decentralised health systems, offer proven alternatives, yet remain sidelined in favour of technocratic, top-down solutions. The path forward requires dismantling the CDC's colonial and capitalist underpinnings, replacing it with a pluralistic, community-owned health infrastructure that centres equity, sovereignty, and collective wellbeing over market logics.