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The author considers the U.S. presidential election of 2024 as a public health issue. He discusses an editorial on the Web site of the American Civil Liberties Union which calls for public health because the authoritarian plans proposed by the former president and current presidential candidates are serious, the integrity of elections, and domains in which a victory by chauvinist, racist, religiously fanatic, and xenophobic far-right forces would have disastrous public health consequences.

In 1931, Edgar Sydenstricker, the former statistician of the US Public Health Service, challenged the common belief that the 1918 influenza outbreak had affected "the rich and the poor alike." Using data from 112,317 participants in a 1918 US national survey, he observed that, on the contrary, both morbidity and mortality from the flu had been higher among the poor than among the rich. To explain these differences, Sydenstricker stratified the analyses by 2 measures of affluence collected in the survey: "economic status" (from "very poor" to "well-to-do") and household crowding (i.e. number of people per household room). Economic status was associated with influenza attack rates within categories of crowding, but not the opposite, suggesting that characteristics of poverty other than "household congestion" were the culprit of the poor's higher influenza burden. Attack rate ratios for influenza in infants and older adults were greater for the poor or very poor. Sydenstricker reanalyzed an already 12-year-old data set in the context of the Great Depression to build the evidence base relating poverty to ill health. For this purpose he used a stratification approach to assess confounding, mediation, and interaction before the concepts were formally named. [ABSTRACT FROM AUTHOR]