The Battle Over Words: Diversity, Equity, and Inclusion in the Trump Administration

The CDC’s email and the Controversy Over Forbidden Words

On a recent Monday, employees of the Atlanta-based Centers for Disease Control and Prevention (CDC) received an email instructing them to avoid using certain terms when writing their annual performance goals. The list of forbidden words included “health equity,” “race,” “bias,” “disparity,” “culturally appropriate,” and “stereotype.” This email, obtained by The New York Times, sparked immediate controversy both within the Trump administration and the broader public health field. The debate centers on whether such words have become politically toxic and too divisive to use in official communications.

The CDC’s parent agency, the Department of Health and Human Services (HHS), quickly denied that there was any official or unofficial list of banned words. HHS accused CDC officials of intentionally misrepresenting the guidance they had received, suggesting that they were trying to undermine President Trump and Health Secretary Robert F. Kennedy Jr. However, after The New York Times inquired about the matter, the CDC issued a clarifying email stating that the words were still permissible. This back-and-forth highlights the deeper tensions within the administration over President Trump’s efforts to root out what his allies refer to as “woke ideology.”

President Trump’s Assault on Diversity and Inclusion Initiatives

The controversy over the CDC’s email is just one example of a broader effort by the Trump administration to reshape the federal government by cracking down on diversity, equity, and inclusion efforts. Career scientists and civil servants across the administration have been on high alert since President Trump issued a directive ordering federal departments to eliminate diversity and inclusion programs. This directive has been particularly challenging for the CDC, as a significant portion of its work is dedicated to promoting “health equity” and reducing disparities between different groups.

The Importance of Race and Health Equity in Public Health

While health disparities can be driven by factors such as income, education, and access to housing, race remains a critical factor in public health discussions. For example, life expectancy in the United States is nearly five years shorter for Black people compared to white people. This stark disparity underscores the need for discussions about race in public health. The American Public Health Association has declared racism a public health crisis, emphasizing that race is a social construct that drives every aspect of life in the United States.

Dr. Georges Benjamin, executive director of the American Public Health Association, which represents more than 25,000 public health professionals, explained that avoiding words like “race” and “health equity” makes it difficult to address these critical issues effectively. He stated, “In our country, race is a social construct which drives every aspect of our lives. So when we don’t use words that have such an enormous impact, it’s difficult for people to understand what you’re talking about.”

Rethinking Terminology in Public Health

Not everyone agrees that the current terminology is the most effective way to address health disparities. Dr. Sandro Galea, dean of the School of Public Health at Washington University in St. Louis, suggested that it might be time for public health officials to rethink their use of terms like “race” and “health equity.” He argued that public health is concerned with the health of populations, not individuals, and that the ultimate goal should be to improve health for all populations, regardless of the terminology used.

Dr. Galea emphasized the importance of being careful not to over-invest in words that have become politically charged, as this can close people’s minds to meaningful conversations. He suggested that when certain expressions become so divisive that they prevent constructive dialogue, it may be necessary to take a step back and refocus on the underlying goals. “I think we have to be careful not to over-invest in words that have become very difficult to have meaningful conversations about, and to take a step back and say, ‘What are we trying to achieve?’” he said.

The Ongoing Struggle for Health Equity in the Trump Era

The email sent to CDC employees was intended to comply with President Trump’s executive orders aimed at gutting diversity, equity, and inclusion programs. These orders represent a sharp departure from the policies of President Joseph R. Biden Jr., who made racial equity a central focus of his coronavirus response. The Trump administration’s efforts have been met with resistance, including lawsuits from civil rights organizations arguing that the policies are discriminatory and illegal, threatening funding for critical services provided to historically underserved groups. A federal judge in Maryland recently blocked the enforcement of some of these initiatives.

In Atlanta, the CDC is grappling with how far to go in discussing race and equity under President Trump. The agency’s five-year strategic plan, adopted in 2022, includes a goal of decreasing “health disparities” by 2024, specifically targeting racial disparities in blood pressure control among Black adults with hypertension. However, the CDC’s Office of Health Equity has faced criticism for removing most mentions of race from its website, including its page on National Minority Health Month. David Rosner, a medical historian at Columbia University, called these omissions “astounding,” emphasizing that it is impossible for public health professionals to address disparities without acknowledging the impact of race. “Every public health student recognizes in the first year of school that race is a determinative factor of health status,” he said. “Being poor isn’t good, but being Black and poor is terrible — that’s what you learn. You can’t address public health without being aware of that.”

Conclusion: The Fight Over Words and the Future of Health Equity

The controversy over the CDC’s email and the broader debate over the use of terms like “race” and “health equity” highlight the deep tensions within the Trump administration and the public health field over diversity, equity, and inclusion efforts. While some argue that certain words have become too politically charged to be useful, others insist that they are essential for addressing the systemic disparities that persist in the United States. The outcome of this debate will have significant implications for the future of public health, as the ability to use these terms may influence the effectiveness of efforts to reduce health disparities and achieve health equity for all.