President Trump’s efforts to reshape diversity, equity, and inclusion in public health are igniting controversy, especially within the CDC, as employees were instructed to avoid terms like “health equity,” “race,” and “disparity” in performance evaluations. This move, seen as part of Trump’s broader agenda against what he calls “woke ideology,” has prompted disputes regarding the importance of discussing race in public health, particularly given significant health disparities affecting marginalized groups. Some public health leaders argue that avoiding these terms hampers dialogue, while others suggest reevaluating how such issues are addressed without charged language.
President Trump’s attack on diversity, equity, and inclusion initiatives is stirring intense discussions both within his administration and the wider public health community regarding the appropriateness of terms like “race,” “equity,” and “disparity.”
The latest controversy surfaced on Monday, within the purview of Health Secretary Robert F. Kennedy Jr., when employees at the Atlanta-based Centers for Disease Control and Prevention received an email advising them to refrain from using over a dozen “key words” while drafting annual performance goals. The prohibited terms included “health equity,” “race,” “bias,” “disparity,” “culturally appropriate,” and “stereotype,” as per copies of the email obtained by The New York Times.
In Washington, the C.D.C.’s parent agency, the Health and Human Services Department, claimed that there was no “official or unofficial CDC list of banned words,” and accused C.D.C. officials of attempting to undermine Mr. Kennedy and Mr. Trump by “intentionally falsifying and misrepresenting guidance they receive.”
The C.D.C. later sent a clarifying email stating that the listed words were still allowed following an inquiry from The Times. However, this disagreement highlights more profound tensions, both internally and externally, concerning Mr. Trump’s efforts to transform the federal government by eliminating what his supporters label “woke ideology.”
Throughout the agency, career scientists and civil servants remain vigilant since Mr. Trump mandated a crackdown on diversity, equity, and inclusion efforts. A significant portion of the C.D.C.’s responsibilities revolves around advancing “health equity” by reducing disparities among various population groups.
This mission does not solely focus on diminishing disparities between white individuals and other racial groups; health disparities exist across numerous dimensions, including economic status and geographical location, influenced by factors such as income, education, and access to quality housing.
However, in a country where the average life expectancy for Black individuals is nearly five years shorter than that for white individuals, issues of race in public health cannot be easily overlooked. The American Public Health Association has stated that racism constitutes a public health crisis.
“In our nation, race is a social construct that influences every aspect of our lives,” remarked Dr. Georges Benjamin, executive director of the association, representing over 25,000 public health professionals. “Therefore, when we refrain from using words that profoundly impact our discussions, it hinders comprehension for others.”
Conversely, Dr. Sandro Galea, dean of the School of Public Health at Washington University in St. Louis, suggested that it may be appropriate for the C.D.C. and public health officials to reevaluate the terms like race and health equity.
Public health, he asserted, focuses on population health rather than individual health. The ultimate aim is “to enhance health for all populations,” regardless of terminology.
“We need to exercise caution against becoming overly fixated on terms that have become controversial and to step back and ask, ‘What are our objectives?’” Dr. Galea commented.
When “certain terms become so charged that they inhibit open-mindedness,” he added, “the solution is not to repeat them endlessly during a time when audiences are resistant.”
Monday’s email, as noted by two sources familiar with the situation, aimed to adhere to Mr. Trump’s executive orders intended to dismantle diversity, equity, and inclusion programs, which the president regards as both discriminatory and wasteful. The sources requested anonymity to avoid repercussions.
Mr. Trump’s stance marks a stark contrast to that of his predecessor, President Joseph R. Biden Jr., who assumed office amid the significant impacts of the coronavirus pandemic on people of color. Declaring a commitment to racial equity at the heart of his pandemic response, Mr. Biden appointed a health equity officer in the White House.
Civil rights organizations have filed lawsuits against the Trump administration, asserting that the president’s directives are discriminatory and illegal, jeopardizing funding for essential services to historically underserved populations. Recently, a federal judge in Maryland temporarily halted the enforcement of some of these initiatives.
In Atlanta, the C.D.C. is clearly grappling with the extent to which it can address issues like race and equity under Mr. Trump’s leadership.
The agency’s five-year strategic plan, established in 2022, sets a target to decrease “health disparities” by 2024. It aims to “reduce racial disparities in blood pressure management, initially focusing on Black adults with hypertension, by improving blood pressure control rates in this demographic by 5%.”
Yet, the C.D.C. also maintains an Office of Health Equity, which defines health equity as “the state in which everyone has a fair and just opportunity to achieve their highest level of health.”
Notably, the office’s website seems to have been stripped of most references to race. Its dedicated page for National Minority Health Month includes three mentions of Latino populations but excludes any reference to Black or white individuals.
These omissions are “astonishing,” remarked David Rosner, a medical historian and co-director of the Center for the History of Ethics and Public Health at Columbia University.
“It’s impossible for a public health professional to operate responsibly without acknowledging the suffering of African Americans,” he stated, adding, “Every public health student learns in their first year that race is a critical determinant of health status. Experiencing poverty is challenging, but being Black and poor is far worse — that’s a fundamental lesson. Effective public health practice requires an awareness of these realities.”
Apoorva Mandavilli contributed reporting.