The United States is supposed to be a representative democracy. We elect decisionmakers to represent us and make decisions in our interest. But as state legislatures have become more responsive to a smaller, wealthier, and healthier subset of voters, they have restricted access to health care for the broader population and have failed to address many health and environmental challenges within the communities they govern. The most vulnerable populations have, consequently, experienced worsening public health disparities. At the federal level, environmental and public-health policies, and the science these policies depend on, are being dismantled at an unprecedented rate—exacerbating existing inequities and opening the door to even greater harm.