I am a family physician with 39 years experience caring for patients and teaching medical students and family medicine residents.

Donald Trump’s executive orders and election have removed the sense of stability and security that many, but not all Americans had become accustomed to — much in the same way that a child relies on the safety provided by his or her parents in a home that feels safe and secure.

Most Americans have lived for years, secure in the knowledge that our government by design, although not always in practice for all people, respects the rule of law and operates according to ethical principles of fairness and the pursuit of the common good.

That has now changed as this Trump administration embarks on reshaping the design of government checks and balances.

There is undoubtedly a tremendous amount of stress being generated for millions of Americans who feel threatened financially, psychologically and societally. As a family physician, I have seen what stress can do to a person’s health. Stress  not only triggers flare-ups of underlying pre-existing conditions such as heart disease, emphysema, diabetes and other medical conditions but can also trigger serious episodes of mental illness including anxiety, depression, and even promote risks to oneself or others.

This is damaging governance. Job loss threatens healthcare affordability and sustainability for the individual and at great cost to the GDP of this country of lost productivity and output, certainly at odds with this administration’s purported claim to reduce the federal deficit. We must, as stated by Abraham Lincoln, preserve government “of the people, by the people, for the people.” Attacking diversity, equity and inclusion and gender affirming care is blatantly unethical and anti-democratic.

Estimates are that nearly 200, 000 individuals or four percent of the federal workforce will have their jobs terminated. Law allows for only 31 days of continued health coverage after job termination. Further maintenance of federal employee health benefits requires the individual to pay both the worker’s share and the government’s share  which would cost the employee for family coverage over $1,800 per month which is out of reach for most Americans.

This federal behavior will inevitably harm our most vulnerable citizens.

Longer term, the threatened defunding of the Department of Education , the Consumer Financial Protection Bureau and the National Institutes of Health “indirect funding” support for critical healthcare research will degrade the health of our nation. Imagine handicapping the CDC’s ability to prepare for future pandemics, or to identify and prevent widespread food source contamination. State Medicaid programs have been targeted for significant funding reductions that will potentially cause millions of low-income and disabled Americans to lose their health coverage.

It is always the goal to deliver high-value healthcare and avoid unnecessary expenses. We teach this every day as we train future family physicians.

In the beloved story “A Christmas Carol” by Charles Dickens, Scrooge states that regarding the vulnerable population, “If they would rather die, they had better do it and decrease the surplus population.” This callousness is reflected in our present day presidential leadership.

Diversity, equity, inclusion and the common good are the pillars of our democratic culture. We MUST raise our voices again and again to preserve these ideals. There is no other alternative.

Howard A Selinger M.D. is Chairman of the Department of Family Medicine at the Frank H. Netter M.D. School of Medicine at Quinnipiac University. The views expressed are his own and not necessarily the views or policies of the Netter School of Medicine or Quinnipiac University.