Last week, the Trump Administration reportedly asked the United States’ top public health agency to avoid using seven words and phrases: “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based” in its annual budget request. In effect, the Centers for Disease Control and Prevention (CDC), which is tasked with addressing critical health crises and entrenched challenges and works in more than 60 countries—has been told to speak about its programs only in ways this Administration finds politically expedient.
Since taking office, the Trump Administration has made every effort to undermine science and fact. Under the banner of “fake news,” US President Donald Trump constantly suggests that truth is in the eye of the beholder. Banning language is indicative of the Administration’s broader, alarming effort to subvert evidence-based policy making to conservative religious ideology.
After a year of policy backtracking, consistent attacks on sexual and reproductive health and rights, and jettisoning of facts and evidence in favor of conservative, religious ideology, this list should come as little surprise. After all, in October, the CDC’s parent agency—the Department of Health and Human Services—issued a draft strategic plan that flew in the face of established evidence to perpetuate the claim, popular among anti-abortion activists, that life begins at conception.
However, this language is particularly striking at the CDC, the federal public health agency responsible for preventing and responding to outbreaks of disease, both in the United States and around the world. The CDC’s own factsheets tout that the agency “has more than 70 years of public health excellence, a record of trail blazing science, and evidence-based decision making.”
Rhetorical shifts are generally indicative of more than politicized wording, and may have global repercussions. The CDC manages the US government’s response to the Zika virus, including research on affected fetuses as well as monitoring pregnant women who have been exposed to the virus. On a practical level, how is the agency going to do its job and discuss this research while avoiding the word “fetus?” Beyond the word choice, the political ideology underpinning the removal of the word fetus— namely, the extreme anti-choice policies that have been a hallmark of this Administration—will likely have policy implications for the CDC’s work with pregnant women affected by the disease.
The CDC is also a key implementing agency in the President’s Emergency Plan for AIDS Relief (PEPFAR), the US government’s flagship, global HIV/AIDS care, treatment, and prevention program. Per the agency’s own website, the “CDC uses its technical expertise in public health science” to work with ministries of health to combat the epidemic through building sustainable public health systems. The CDC’s HIV programs include technical assistance and training of local workforces, and, through PEPFAR, the agency works in over 60 countries. The shift in rhetoric begs the question of what exactly the CDC will be promoting overseas in the name of preventing and responding to disease, if not “evidence-based’ and “science-based” approaches.
In addition, changing the wording cannot change the reality, and refusing to use the word “transgender” will not change the fact that transgender people are disproportionately affected by HIV, and, like other marginalized groups, often face additional barriers in accessing services and treatment. It does, however, have serious implications for US policy, which has made immense strides in recent years toward focusing resources on the key populations—like transgender persons—that are most at risk for contracting HIV. If the CDC cannot bring itself to even say the word “transgender,” how can the agency be expected to carry out effective programs around the world to meet the needs of this community?
The CDC is not the only place where shifts in rhetoric have indicated deeper shifts in policy and programming. Elsewhere, the State Department has begun using the term “sexual risk avoidance” in lieu of talking about sex education—a critical distinction because the US Congress has defined “sexual risk avoidance” as abstinence-only education. The science and evidence are clear: abstinence-only programming doesn’t work. The CDC’s own task force recommended “comprehensive risk reduction” education, and was unable to prove that abstinence education was effective in preventing early pregnancy, HIV, and other sexually transmitted infections. Other studies have shown that abstinence-only education doesn’t work, and doesn’t equip young people to effectively make decisions in the real world. Yet despite these established facts, the State Department’s language choice suggests a reversion to abstinence-only education—and girls around the world will pay the price.
Words have consequences. Even in the absence of clear, immediate policy change, the choice in new rhetoric sends a disturbing message around the globe: that the CDC is increasingly concerned with ideology and politics, at the expense of science and fact. A CDC budget request that removes language recognizing the vulnerability and marginalization of certain groups and veers away from science and evidence lays the groundwork for policies and programs that leave these same groups behind, and prioritize conservative ideology over people. Based on this Administration’s track record, we have every reason to assume that these changes are indicative of ongoing policy shifts with devastating consequences to women, girls, and marginalized groups globally.
Photo: Molly Adams