A few years after he left government, former U.S. Undersecretary of Defense for Policy Doug Feith shared with me a fascinating and revealing anecdote about the George W. Bush administration’s September 2002 National Security Strategy (NSS). This was the infamous document that declared “the United States will, if necessary, act preemptively” to prevent or forestall “rogue states and terrorists” who “rely on acts of terror and, potentially, the use of weapons of mass destruction.”

According to Feith, neither he nor Pentagon chief Donald Rumsfeld had commented on or even read the NSS — which served as the intellectual pretext for the invasion of Iraq six months later — before it appeared on the White House website. In other words, the two civilian officials most responsible for overseeing the most consequential and catastrophic foreign-policy decision in the past quarter century did not contribute to the strategic guidance that justified that decision.

This disconnect between the careful formulation of policy guidance and actual policymaking is worth keeping in mind when reading the Trump administration’s own NSS, which was released today. The NSS is intended to provide strategic yet prioritized guidance from which national security agencies base their own guidance documents, budgets, directives, and policies.

In reality, however, every NSS published since Congress mandated them under the Goldwater-Nichols defense reorganization legislation of 1986 was either quickly forgotten or never implemented in any meaningful way in the first place. Foreign policy always proceeds at its own idiosyncratic pace: Wars of choice are chosen, alleged allies go their own way, unforeseen threats emerge, and congressional appropriators refuse to provide predictable funding — and nobody consults the NSS along the way.

That’s just as well, because such documents are always marked by a large “say-do gap” — a gap between its grand ambitions and the practical value of its guidance. The Trump administration’s NSS is an egregious example. President Donald Trump, in his introductory letter, pledges to “put the safety, interests, and well-being of our citizens first,” and the very first chapter — or “pillar,” as the document has it — proclaims that the United States will “protect the American people, the American way of life, and American interests.” However, almost nothing in the 68-page document deals with the actual domestic threats, risks, and systemic harms that Americans experience every day.

For example, noncommunicable diseases like heart disease, respiratory illnesses, cancer, and diabetes kill almost 2.5 million Americans each year and cost hundreds of billions of dollars in health care costs and lost productivity. Sugary drinks alone kill an estimated 25,000 Americans annually. The good news is that these threats are largely preventable based upon behavior, lifestyle choices, and evidence-based preventative policies. Smoking, the most statistically significant risk factor for noncommunicable diseases, collapsed from 33 percent of adults in 1980 to just 15 percent today, because the cost per pack increased, workplaces and restaurants became smoke-free, and creative public education programs work. There is nothing about noncommunicable diseases in Trump’s NSS, even though they prematurely kill 88 percent of all Americans who die each year.

Or consider the 175,000 to 250,000 Americans who are estimated to be needlessly killed each year by medical errors, such as misdiagnosis, overtreatment, or infections acquired while in hospitals. This is an astonishingly high number of preventable deaths that gets no attention in government documents that claim “protecting the American people” is the nation’s highest priority.

President Trump could commit his administration to significantly reducing this third leading cause of death for Americans for little cost and through commonsense regulatory measures. According to a 2017 Journal of the American Medical Association study, 32,000 deaths could be prevented every year simply by encouraging male physicians to adhere to the same clinical guidelines and evidence-based practices as their female counterparts. Or consider that the Affordable Care Act, which Trump and congressional Republicans want to repeal or weaken, has reduced the number of “hospital-acquired conditions” by 21 percent, saving more than 125,000 lives since the law went into effect. But, the NSS makes no mention of this real threat, because that is not the sort of national security narrative permitted in Washington, D.C.

The Trump NSS also mentions terrorists 58 times, and pledges to “defeat jihadist terrorists,” just as all previous NSS documents have done since 9/11. Over the past 16-plus years, jihadis have killed 103 Americans within the United States, while right-wing terrorists have killed 68. During that same time period, drug-induced deaths have more than tripled, with over 59,000 Americans dying in 2016, while America’s suicide rate has risen by 25 percent, resulting in 43,000 deaths annually.

There will be 20 9/11s-worth of drug-induced deaths this year, but the NSS only mentions opioids once — in relation to transnational criminal organizations. But saving lives lost to drugs today does not require defeating drug traffickers, but rather committing more money and access to drug treatment, mandating greater federal regulation of prescription painkillers, and creating jobs — every one-percentage-point increase in unemployment in American counties since 1999 resulted in a 3.6 percent increase in that county’s opioid death rate and a 7 percent increase in overdose visits to emergency rooms. Trump’s NSS assumes that America’s drug problems are exclusively based upon the supply, rather than the insatiable demand from Americans themselves.