Trump-led attacks on equity are setting the stage for our next public health crisis
The Trump administration is advancing an anti-equity agenda that will make people in the U.S. sicker and less economically secure. In his first 100 days, Trump rescinded dozens of Biden-era executive orders designed to advance racial equity and directed federal agencies to end all diversity, equity, inclusion, and accessibility offices and programs. His “Restoring Equality of Opportunity and Meritocracy” EO takes direct aim at the pursuit of racial equity as a policy goal by attacking Titles VI and VII of the Civil Rights Act of 1964, which prohibit discrimination on the basis of race, color, or national origin (and religion and sex as well in the case of title VII) in programs that receive federal funding and employment, respectively.
Trump’s order for government agencies to remove all content and materials related to equity from government websites—leading to the disappearance of words like “diversity,” “historically,” and “female” from government documents—clearly shows that his administration does not value the perspectives, lived experiences, and struggles of those who are not white, male, heterosexual, and cisgender. Trump’s anti-equity actions will stunt efforts to understand, measure, document, and address health and economic disparities. For all the attempts made by the Biden administration to treat equity as a federal policy goal, Trump’s objective is to reverse that progress.
Why is this happening?This newly created barrier to assessing and addressing disparities is not accidental; it serves a concrete purpose. By obscuring racial and other types of disparities and making them harder to address, this administration seeks to keep the benefits of production for its favored groups (i.e., employers, the wealthy, men, white people, cisgender people, and citizens), and to push the harmful parts of production onto vulnerable groups (workers, the poor, women, Black people, transgender people, and immigrants).
Trump and his allies’ motivation to remove protections for vulnerable populations in ways that benefit employers is no secret. The “Restoring Equality of Opportunity and Meritocracy” EO describes “disparate-impact liability”—i.e., the consideration of the impact of ostensibly neutral actions by employers and of policy on outcomes across groups—as having “hindered businesses from making hiring and other employment decisions based on merit and skill, their needs, or the needs of their customers because of the specter that such a process might lead to disparate outcomes, and thus disparate-impact lawsuits.” Trump is explicitly removing ways employers (and his administration) can be held legally and materially accountable for their harm to vulnerable groups. This helps employers avoid costly lawsuits, while workers and communities who lack the means to resist are exposed to discrimination and bias without recourse.
To be very clear: These anti-equity actions are one of the administration’s vanguard efforts toward advancing authoritarian governance that is rooted in white male supremacy. In restricting our ability to measure disparities where they emerge, removing government responsibility for addressing economic or social inequities, and further removing means of holding the government or employers accountable for the harm done to vulnerable populations, Trump has set the stage for a new regime of oppression which will make us all more vulnerable to the next public health crisis.
Why does this matter for public health?The Trump administration’s anti-equity agenda poses long-term and widespread threats to the nation’s health. Among these is the loss of capacity to research, report on, and prevent the disproportionate burden of sickness, injury, and premature death borne by racial and ethnic minorities. This loss of capacity is already in motion with Trump’s gutting of public health institutions, particularly in divisions focusing on health equity, and also extends to nonprofits and academic institutions who rely on federal funding to carry out their advocacy and research.
Public health equity demands that we allocate resources toward addressing structural barriers in ways that improve health for the disadvantaged. By abandoning equity as a policy goal, the Trump administration shirks this responsibility, choosing instead to leave communities under-resourced and structural barriers intact, and impeding progress on improving health for vulnerable communities.
Leaving health disparities and the structural barriers that maintain them unaddressed is dangerous for the entire population, however, not just the most vulnerable. The COVID-19 pandemic gave the nation a stark lesson in social epidemiology: An infectious disease may hurt vulnerable groups more severely for a time, but the pain will eventually spill over to privileged groups as well. The entire economy suffers when essential workers—often people from disadvantaged and vulnerable communities—are debilitated by disease. Moreover, we share public spaces. Epidemics and pandemics do not stay localized to minorities, immigrants, or the poor; it is in the interest of the entire country to take health crises seriously, and that requires taking health equity seriously.
Why does this matter for racial health disparities?To close racial health disparities through policy, we need to be able to study them and understand how they emerge. The Biden-era government agency Equity Action Plans sought to measure disparities across groups, account for the ways government policy has underserved and harmed people of color and other vulnerable populations, and investigate how each agency could break down structural barriers to thriving and fully participating in American life. On his first day in office, Trump directed all government agencies to terminate all equity action plans, along with any grants, programs, initiatives, or contracts related to equity. If we can’t say the word “equity” or ensure government agencies are operating equitably and funding is taken away from those who measure disparities, we will be unable to address health inequities.
Losing our ability to assess racial disparities and pursue racial equity limits our ability to hold corporations accountable for the harm they inflict on people of color. The use of menthol cigarettes is growing among Black and Hispanic adults due to aggressive, targeted advertising by tobacco companies toward those communities. We know this because of government programs like the Centers for Disease Control and Prevention’s investigation of health disparities related to commercial tobacco and advancing health equity and academic efforts like Standford’s Research into the Impact of Tobacco Advertising collection. Cigarette smoking is the leading cause of preventable death in the United States, and menthol in cigarettes are associated with greater nicotine addiction and dependence. Understanding how corporations are responsible for rising menthol cigarette use in Black and Hispanic communities despite smoking rates generally falling nationwide is essential to combatting racial health disparities. When the Trump administration eliminates offices, positions, and grant mechanisms related to equity from the Department of Health and Human Services, it becomes more difficult to identify the root causes of racial health disparities and develop policy that will close gaps.
What will it mean economically for workers and their families?Racial and ethnic health inequity is a drain on the nation’s economic well-being—and the steep cost of that inequity to the U.S. economy shows just how much Trump is sacrificing by shirking the responsibility to address disparities. A landmark study by the Tulane University Institute for Innovation and Health Equity (commissioned by the National Institute on Minority Health and Health Disparities, whose director has now been placed on administrative leave by the Trump administration) estimated the total cost of lost labor market productivity, excess medical care due to excess morbidity, and premature death due to health inequities, by racial and ethnic group and for the nation as a whole. They estimated that in 2018, the economic burden of falling short of health equity was $421.1 billion for racial and ethnic minorities, two-thirds of which was due to premature death and most of which were attributable to losses faced by the Black population. The total cost to the nation of not achieving health equity goals was estimated to be $1.03 trillion. Stepping away from equity is not just a moral failing by the Trump administration, it is an economic policy failure.
The costs and racial and ethnic health inequities to the US economy are substantial and more than justify the societal investment in developing policies and programs to eliminate health inequities and larger data sets for smaller racial and ethnic subpopulations. Even a modest reduction in health inequalities can save the nation billions of dollars in medical spending and lost labor market productivity annually.
—Institute for Innovation and Health Equity, Tulane University
Economic and social inequity is costly for workers, their families, and the economy. The Trump administration is shortsightedly sacrificing the potential for new engines of economic growth by neglecting disparities across groups and preventing efforts to pursue equity.
What should we do about it?As the Trump administration continues to wage war on equity at the federal level, it becomes increasingly important to call out the racism, sexism, and xenophobia at the root of his actions, and to make full-throated commitments to the pursuit of equity through policy where possible. That means shoring up economic and health equity programs at the state and local levels, as well as continuing to resist the dismantling of our federal institutions through office closings and staff reductions.
Unions are an effective means of instituting equity in pay and working conditions where government standards may be lacking. Supporting organized labor is therefore important for maintaining both economic and health equity. But beyond their impact on workplaces, unions also increase political participation. The sooner we can empower workers and their families to use their voices to hold corporations and our government accountable, the sooner we can renew our commitments to pursuing equity through policy and the sooner we can secure ourselves against future economic and public health crises.
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