EUGENICS AND PUBLIC HEALTH—TOGETHER AGAIN

Emily K. Abel

Most people assume that eugenics and public health have always clashed. Eugenics is a philosophy advocating selective breeding and the elimination of traits considered “undesirable.” In the late nineteenth- and early twentieth centuries, the ideology encouraged forced sterilization and racial segregation in the United States; the Nazis then used it to justify their death camps. Public health, by contrast, promotes health equity and social justice. And, indeed, many eugenicists in the early twentieth-century condemned public health policies that enabled “defective” people to survive. As late as 1932, a speaker at the International Congress of Eugenics in New York declared that “sanitation, hygiene, and State medicine” were “attempts to secure an ever increasing survival rate for the least competent types” and that “this interference with Natural Selection [is] disastrous.”

But eugenics and public health have often co-existed. Eugenic principles infused public health work in the United States at the turn of the twentieth century. And eugenics is again on the rise—especially among the very people who are charged with protecting the nation’s health.

Many public health luminaries embraced eugenic ideology a century ago: William Welch, the renowned doctor who founded the Johns Hopkins School of Hygiene and Public Health, served as vice-chairman of the Scientific Board of Eugenics Record Office in 1910. The same year John N. Hurty, the president of the American Public Health Association, helped to ensure the passage of Indiana’s eugenic sterilization law, the first in the nation. Rupert Blue, Surgeon General between 1912 and 1920, promoted laws for the compulsory sterilization of “defectives.” Hugh Cumming, who followed Blue as Surgeon General, was a member of the advisory council of the American Eugenics Society and an organizer of the Second International Eugenics Congress.

Eugenic principles also were central to the Ellis Island medical inspections conducted by the U.S. Public Health Service beginning in 1891. Physicians had instructions to exclude all immigrants with a “loathsome or a dangerous contagious disease.” Two conditions that fell within that category were “feeble mindedness” and tuberculosis. Howard A. Knox, an assistant surgeon at Ellis Island in 1912, published an article in the Journal of Heredity titled “Tests for Mental Defects: How the Public Health Service Prevents Contamination of Our Racial Stock by Turning Back Feeble-minded Immigrants.” Although Robert Koch’s discovery of the tubercle bacillus shattered the belief that TB could be directly inherited, many medical experts accepted the conclusion of the British eugenicist Karl Pearson that people inherited a predisposition to the disease. Pearson focused on Jews, a major immigrant group passing through Ellis Island.

A variant of Pearson’s argument was that the prevalence of TB among African Americans and Native Americans demonstrated that they were primitive people who never had been exposed to the disease and thus never had developed immunity. In a discussion of tuberculosis in the Southwest, Ernest A. Sweet, a former Public Health Service employee, wrote in a 1915 article in Public Health Reports: “The Mexicans are possessed of an extremely low racial immunity, which is probably due to the large admixture of Indian blood. Their resistance has never been developed, because they have never fought the infection through successive generations. Just as in children the susceptibility decreases as age increases, so in races the further removed they are from civilization, the more susceptible they are to the disease.” Sweet also argued that tuberculosis advanced especially rapidly among Mexicans: “Recoveries are exceedingly rare, most physicians confessing never to have seen one, and the course is almost invariably progressively downward. A person will be about his work apparently well, suffer from a hemorrhage, and in four months will be dead.” By contrast, Sweet concluded, Mexicans who were “less contaminated by Indian blood” exhibited “far more resistance to the disease.” Public health officials in the Southwest frequently called attention to Mexicans’ “lowered resistance.”

The kind of eugenics we are seeing today is less visible, and thus perhaps more insidious, than the eugenics of the past. In 1991, the historian Nancy Leys Stepan coined the term “soft eugenics” to describe a eugenics that rejects forced sterilization, racial segregation, and mass deaths in favor of less coercive methods of ensuring the survival of the fittest, such as “personal choice” and social pressures.

The response to the Covid pandemic by many people who are now in Trump’s administration illustrates soft eugenics. Rebuffing the aides who urged him to take advantage of his own bout with the virus to display empathy, Trump used it instead to portray himself as a strong man who could vanquish any disease. As the death toll mounted, especially among African Americans, Latinos, and Native Americans, he told a reporter that no one should be afraid of Covid because “with time it goes away. And you’ll develop—you’ll develop herd—like a herd mentality. It’s going to be—it’s going to be herd developed, and that’s going to happen. That will all happen.”

Trump appears to have been talking about herd immunity, which became the official White House policy. Proponents of herd immunity argue that if enough people who contract the virus survive, immunity will spread through the community and vaccines will not be needed. The problem is that the strategy works well for some diseases, but not others. It failed miserably in Sweden, the one country that allowed Covid to run its course; the mortality rate in Sweden was higher than that in many other countries, including the United States.

Martin Makary, now head of the Food and Drug Administration, wrote an article in the Wall Street Journal in February 2021 promising that the United States would reach herd immunity within two months. Jay Bhattacharya, the current director of the National Institutes of Health, was one of the three signatories to the notorious “Barrington Declaration,” which argued that schools and universities should teach in person, “young low-risk adults” should return to the office, cultural activities should resume, and restaurants and other business should open. Elderly people and those with chronic conditions should receive “focused protection,” which was never adequately explained. The Los Angeles Times editorial board wrote that Covid “herd immunity” was “just another way to say, ‘Let people die.’”

A recent Guardian article points out that Robert F. Kennedy, Jr., the Secretary of the Department of Health and Human Services, practices soft eugenics when he focuses exclusively on individual responsibility. Ignoring medical care as well as the conditions in which people live and work, he is “at best indifferent, and at worst welcoming, of the idea that those who don’t heed his counsel might die.” Casey Means, the wellness champion who has been nominated to be Surgeon General, is more explicit. “It is, without exaggeration, a Darwinian moment for America,” she wrote in an article she co-authored with her brother. “Americans must build personal immunity defenses through radical changes in diet and exercise, or risk getting sick and dying.”

Slashing health and social services for vulnerable populations both at home and abroad also aligns with soft eugenics. At the time of writing, the public is waiting anxiously to learn how steeply Republicans will cut Medicaid and the Affordable Care Act. Whatever they decide, the consequences will be disastrous. In April, the National Bureau of Economic Research released a report concluding that adults who enrolled in Medicaid after the ACA expanded access were 21 percent less likely to die each year than those who did not enroll. Senator Joni Ernst’s statement that “we are all going to die” in response to constituents challenging Medicaid cuts illustrates the callousness of Trump’s regime toward people who are poor and sick.

Although Secretary of State Marco Rubio insists that “no one has died” as a result of the dismantling of the U.S. Agency for International Development, the data prove otherwise. As Nicholas Kristof writes in the New York Times, “The only debate is whether to measure the dead in the thousands, tens of thousands, or hundreds of thousands.” Kristof cites an economist who estimates that people are dying at the rate of 103 per hour as a result of the end of U. S. humanitarian assistance.

Most Americans who know that eugenics once had a dishonorable presence in public health history assume it is safely locked in the past. But some public health officials and political leaders have partnered with eugenics yet again. We now must fight to expose and extirpate that ideology wherever we find it.

Sources

Paul Lombardo, “Eugenics and Public Health: Historical Connections and Ethical Implications,” in The Oxford Handbook of Public Health Ethics, ed. Anna C. Mastroianni et al. (Oxford University Press, 2019), 642-652.

“Coronavirus ‘Herd Immunity” Is Just another Way to Say, ‘Let People Die, Los Angeles Times,’” September 2020.

Derek Beres, “Maga’s Era of ‘Soft Eugenics’: Let the Weak Get Sick, Help the Clever Breed,” Guardian, May 5, 2025.

Nancy Leys Stepan, The Hour of Eugenics: Race, Gender and Nation in Latin America (Cornell University Press, 1996).

Casey Means and Grady Means, “Healthy Food: The Unexpected Medicine for COVID-19 and National Security,” The Hill, April 21, 2020.

Marc Lipsitch, et al., “Great Barrington Declaration's Herd Immunity Strategy Won't Work to Stop the Coronavirus,” Washington Post, October 15, 2020.

Marty Makary, “We’ll Have Herd Immunity by April,” Wall Street Journal, February 18, 2021.

Sarah Kliff and Margot Sanger-Katz, “As Congress Debates Cutting Medicaid, a Major Study Shows It Saves Lives,” New York Times, May 16, 2025.

Annie Karni, “Defending Medicaid Cuts, Ernst Tells Iowans, ‘We All Are Going to Die,’” New York Times, May 30, 2025.

Nicholas Kristof, “Really, Secretary Rubio? I’m Lying about the Kids Dying Under Trump?” New York Times, May 31, 2025.

Emily K. Abel is professor emerita at the UCLA-Fielding School of Public Health. Her most recent book is Gluten Free for Life: Celiac Disease, Medical Recognition, and the Food Industry (NYU Press, 2025).