If one looks at the past century of back-and-forth changes between Republican and Democratic presidents, one sees a continuous and resounding commitment to scientifically based public health practice.

This commitment has reaped incredible achievements, including the control of infectious diseases, a steep decline in deaths from heart disease and stroke, safer and healthier foods, healthier mothers and babies, family planning, fluoridation of drinking water, recognition of tobacco as a health hazard and the elimination of more than 20 vaccine-preventable diseases.

But with the reelection of President Trump, and the prospect of Robert F. Kennedy Jr. assuming a major role in public health, many in medicine and public health have great concern over looming changes to decades-old practices and programs that protect us.

Never have proponents of fringe public health and scientific claims, including those of the anti-vaccine and closely linked anti-fluoridation movement, had a prominent seat in a presidential administration — a spillover effect of the culture wars that have invaded American politics and degraded expert opinion.

Amid the angst that many feel, it is important to recognize that even if effective public health recommendations are rolled back nationally, such changes will not have immediate effects. The momentum of effective public health action that has been broadly applied for years is long-lasting.

An ideological national public health change, however, means that public health direction will shift to state and local levels, and public health approaches will need to pivot and adapt to new times to protect us.

The federal government, through funding and the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention and the National Institutes of Health plays a role in developing and implementing public health policy.

Yet public health authority is the domain of the states, granted by the 10th Amendment, which states “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”

During the recent COVID-19 pandemic, which is regrettably being sanitized or forgotten, we saw this principle play out. Although there was guidance from the White House Coronavirus Taskforce, NIH and CDC, and hundreds of........

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