On May 15, President Trump attempted to kill not just two, but three birds with one tweet, simultaneously denouncing the Media and the Mueller investigation, and crowing about his approval ratings. “Can you believe that with all of the made up, unsourced stories I get from the Fake News Media, together with the $10,000,000 Russian Witch Hunt (there is no Collusion), I now have my best Poll Numbers in a year,” he wrote. “Much of the Media may be corrupt, but the People truly get it!”

At just 45 percent, Trump’s approval rating is the second-lowest of any American president at this point of his tenure since World War II. This headline figure, however, masks a remarkable degree of disagreement in how Republicans and Democrats view the president’s sixteen months in office. While 90 percent of Republicans approve of Trump’s performance, just 8 percent of Democrats agree.

In some ways, this is not surprising. Most would agree that Trump is a polarizing figure, and the polarization of American politics is not a new phenomenon. What is new in recent years, and has accelerated in the Trump era, is the degree to which members of the major political parties despise one another. As a physician, I have become alarmed by this development, as it is putting America’s health at risk.

Political affiliation is a lens by which we interact with the world. With just one word, “Democrat” or “Republican,” we reduce our complexity as individuals into a single word that conveys the majority of our political and social beliefs to others. But while our political identities allow us to connect with like-minded individuals, they also promote division.

Over the past few decades, Americans have sorted themselves according to their politics. Political affiliation is a good predictor of whether an individual prefers to live in the city or the country. Our friends and partners tend to belong to the same political party as we do. Even our entertainment preferences differ based on our political identities.

Division has bred mistrust among members of opposing political parties. In the run-up to the 2016 presidential election, majorities of Democrats and Republicans reported feelings of anger and frustration towards Americans of the opposing party. But it didn’t stop there: 41 percent of Democrats and 45 percent of Republicans viewed the opposing political party’s policies as a threat to the well-being of the United States. In contrast, only 38 percent of Republicans viewed Russia, a hostile foreign power, as a threat to the country in 2017.

As a result, we are no longer able to effectively work with each other to address the nation’s problems. This has serious policy implications, as the most-polarized Congresses have historically produced significantly less legislation than the least-polarized Congresses. It should be no surprise that the current 115th Congress is on pace to enact the fewest number of laws in decades.

As gridlock has become the norm in Washington, the federal government has been unable to address legitimate public health emergencies. Even as nearly one in eight Americans lack health insurance coverage and costs soar, lawmakers have been unable to fix the Affordable Care Act. As tens of thousands of Americans die annually from opioid overdoses, no transformative federal policies have emerged to tackle the crisis. And despite the growing toll of school shootings, Congress has yet to pass any meaningful gun control legislation.

The growing divide between Democrats and Republicans on environmental spending has undermined the government’s ability to reduce toxic emissions, which threatens the well-being of every American. And since the parties cannot compromise on policy, swings in political control have become particularly important. Major carbon-limiting initiatives, like a tax or a cap and trade system, have been political non-starters. And the effectiveness of the Environmental Protection Agency’s pollution regulations to protect against respiratory disease has become dependent on the political party in power. The Trump Administration’s embrace of lax environmental policies, for example, is likely to lead to the deaths of an additional 80,000 Americans over the next decade.

Even when our government does come up with policy solutions, their efficacy is often limited. Polarization encourages brinkmanship, in which both sides disavow compromise and adopt maximalist positions designed to appeal to their respective bases. The 2013 government shutdown, for example, reduced economic output by billions of dollars and cost 120,000 jobs. The 2011 debt ceiling crisis, in which Republicans threatened to trigger a default on the United States’ debt until the last moment, raised interest rates, sapped consumer confidence and raised the risk of recession.

These actions showed a blatant disregard for America’s health. Policymakers were willing to put livelihoods at risk to accomplish purely partisan goals. Damaging the economy risks higher unemployment, which has been linked to higher rates of anxiety and depression, poorer health, and higher mortality rates.

Given the clear negative effects of polarization on our political process and health, it is worth addressing the problem as soon as possible. While there are no easy solutions, we could pursue some common-sense reforms. Policies to boost voter turnout, like doing away with unnecessary voting restrictions and implementing automatic voter registration, would prevent the most extreme voters from electing their preferred candidates. Ending gerrymandering would encourage the election of more centrists to Congress. And reducing the role of money in politics would allow the American people to take back control of the political process.

The hyperpolarization of American politics is compromising our government’s ability to enact effective legislation to address our most urgent public health crises. If we want to protect Americans from the consequences of inaction, we need to make a change.

Voters in American presidential elections seem to agree. Both Barack Obama and Donald Trump won promising change. But the polarized governments they presided over, unable to compromise, only reinforced the status quo. If voters really want lasting change, perhaps it is time for them to rethink their congressional votes in November. Their health could depend on it.

Kunal Sindhu is a medical resident and can be reached on Twitter @sindhu_kunal.

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