President Trump’s assault on diversity, equity and inclusion efforts is provoking heated debate within his administration — and the public health field more broadly — over whether words like “race,” “equity” and “disparity” are too politically toxic to use.
The latest battle erupted on Monday, inside the domain of Health Secretary Robert F. Kennedy Jr., when employees of the Atlanta-based Centers for Disease Control and Prevention received an email instructing them to avoid using more than a dozen “key words” when writing annual goals for performance evaluations. The disfavored terms, according to copies of the email reviewed by The New York Times, included “health equity,” “race,” “bias,” “disparity,” “culturally appropriate” and “stereotype.”
In Washington, the C.D.C.’s parent agency, the Health and Human Services Department, insisted that there was no “official or unofficial CDC list of banned words,” and accused C.D.C. officials of trying to undermine Mr. Kennedy and Mr. Trump by “intentionally falsifying and misrepresenting guidance they receive.”
The C.D.C. issued a clarifying email saying that the words were still permissible after The Times inquired. But the dispute exposes much deeper tensions, both internal and external, over Mr. Trump’s work to reshape the federal government by rooting out what his allies call “woke ideology.”
Throughout the agency, career scientists and civil servants have been on high alert since Mr. Trump issued a directive for departments to crack down on diversity, equity and inclusion efforts. A big chunk of the C.D.C.’s work is promoting “health equity” by narrowing disparities between different groups.
That work does not necessarily involve reducing disparities between white people and other racial groups; there are all kinds of health disparities, including between rich and poor, or rural and urban, that are driven by factors like income, education and access to good housing.
But in a nation where life expectancy is, on average, nearly five years shorter for Black people than for white people, discussions of race in public health are difficult to ignore. The American Public Health Association has declared that racism is a public health crisis.
“In our country, race is a social construct which drives every aspect of our lives,” said Dr. Georges Benjamin, executive director of the association, which represents more than 25,000 public health professionals. “So when we don’t use words that have such an enormous impact, its difficult for people to understand what you’re talking about.”
But Dr. Sandro Galea, dean of the School of Public Health at Washington University in St. Louis, said it is perhaps time for the C.D.C. and public health officials to rethink terms like race and health equity.
Public health, he said, is concerned with the health of populations, not individuals. The ultimate goal, he said, is “to improve health for all populations” — no matter what you call it.
“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?’” Dr. Galea said.
When “particular expressions are so charged that it is closing people’s minds,” he added, “the way around that is not through endless repetition in a moment when people are not willing to hear.”
Monday’s email, according to two people familiar with it, was intended to comply with Mr. Trump’s series of executive orders aimed at gutting diversity, equity and inclusion programs, which the president views as discriminatory and wasteful. The people spoke on condition of anonymity to avoid reprisal.
Mr. Trump’s policy is a sharp departure from that of his predecessor, President Joseph R. Biden Jr., who took office at the height of the coronavirus pandemic, which took a devastating toll on people of color. Declaring that racial equity would be at the core of his coronavirus response, Mr. Biden installed a health equity officer in the White House.
Civil rights organizations have sued the Trump administration, arguing that the president’s orders are discriminatory and illegal and that they threaten funding for groups that provide critical services to historically underserved groups. Last week, a federal judge in Maryland temporarily blocked the enforcement of some of the initiatives.
In Atlanta, the C.D.C. is clearly wrestling with how far to go in discussing matters like race and equity now that Mr. Trump is president.
The agency’s five-year strategic plan, adopted in 2022, calls for decreasing “health disparities” by 2024. The goal, it says, is to “narrow racial disparities in blood pressure control, focusing initially on Black adults with hypertension, by improving blood pressure control rates in Black adults by 5%.”
But the C.D.C. also has an Office of Health Equity, which defines health equity as “the state in which everyone has a fair and just opportunity to attain their highest level of health.”
The office’s website appears to have been scrubbed of most mentions of race. Its page on National Minority Health Month includes three mentions of Latinos, but no mention of Black or white people.
The omissions are “astounding,” said David Rosner, a medical historian who co-directs the Center for the History of Ethics and Public Health at Columbia University.
“It’s impossible for a public health person to act responsibly without recognizing that African Americans have suffered,” he said, adding, “Every public health student recognizes in the first year of school that race is a determinative factor of health status. 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.”
Apoorva Mandavilli contributed reporting.
