The American Civil Liberties Union (ACLU) has warned that the outcomes of the coming presidential election may include the activation of state national guards to deport millions of immigrants, the gutting of reproductive freedoms through a nationwide abortion ban, the creation of a police state in which anyone viewed as an ‘enemy’ is surveilled, and law enforcement is further empowered to use lethal force. Additional outcomes could include undermining the integrity of elections and deploying the military to crush protests. I will review the historical evidence of the dire public health consequences resulting from weakened democracy and the lack of fair representation in bodies that determine how a population protects itself from various harmful health determinants. I will also discuss ways in which public health can safeguard itself against these threats.