At the CDC, as Elsewhere Throughout the Government, Words Have Consequences

, fellow | January 8, 2018, 10:00 am EST
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It does not matter who pulls the semantic shroud over the Centers for Disease Control and Prevention. When it comes to matters of science and health, any level of silence at the CDC is a declaration that saving lives is secondary to politics.

According to a recent Washington Post story, higher-ups banned from budget requests the words: “diversity,” “entitlement,” “fetus,” “transgender,” “vulnerable,” even “evidence-based,” and “science-based.” CDC Director Brenda Fitzgerald claimed that no words were banned, “period.” But at a minimum, multiple sources confirm that meetings were held on how to craft budget requests so as not to trigger opposition from conservatives in Congress.

Evidence-based declines

Whether ordered or voluntary, the evidence of such changes is clear: many of the above words have already been disappearing during President Trump’s first year, according to Science Magazine. Use of the phrases “diversity” and “vulnerable” are down a combined 68 percent compared to President Obama’s last budget. Use of the phrase “evidence-based” is down 70 percent.

That latter fact hardly seems to be a coincidence given a President with a documented casual relationship with the truth who, according to the Washington Post fact-checking department, has made 1,950 false or misleading claims in his first year in the White House.

The declines in the use of this terminology is consistent with other scientific erasures in the first year of Trump. An analysis this fall by National Public Radio found a major drop in the number of grants awarded by the National Science Foundation containing the phrase “climate change.” Only 302 NSF grants contained the phrase last year, compared with the annual average of 630 during the Obama administration—that’s a 52 percent decline.

NPR quoted Katharine Hayhoe, director of the Climate Science Center at Texas Tech University, as saying, “In the scientific community, we’re very cautious people. We tend to be quite averse to notoriety and conflict, so I absolutely have seen self-censorship among my colleagues.”

Real-life consequences

The obvious question of course is whether shying away from diversity and vulnerable populations such as transgender people in budget requests, or shrinking from assuring that studies are evidence-based will result in failures to monitor disparities and effectively protect Americans’ health.

For instance, take the issue of racial health disparities. It would be tragic if the Trump administration allows a reversal of the progress that has come through decades of dedication from the career scientists and medical and public health experts at the CDC and its parent Department of Health and Human Services who have trudged on regardless of which party controls the White House or Congress.

A good example is the case of black men and women between the ages of 45 and 54, one of the most historically vulnerable groups, who have long died from chronic diseases such as heart disease, stroke and cancer at far higher rates than the national average.

In 1980, according to CDC data, the death rate for black men and women in that age group was 1,480 per 100,000 people and 768 per 100,000 people, respectively. Both rates stood more than twice as high as those for their white male and white female counterparts (699 per 100,000 and 373 per 100,000, respectively).

Even during the Reagan years, in an administration frequently hostile to civil rights and friendly with apartheid South Africa, then-HHS Secretary Margaret Heckler saw fit to address these yawning racial gaps head on. In a landmark 1985 task force report on “Black and Minority Health,” she wrote that the disparities were an “affront to both our ideals and to the ongoing genius of American medicine.” She said it was time to “decipher the message inherent in that disparity.”

That report called for a dramatic increase in health studies to help devise effective, evidence-based interventions for specific racial groups. Unlike the murky controversy of the moment, the 1985 report’s language made it clear that “diversity” was a critical word. Under a section titled, “Implications of Diversity,” the report said: “This diversity among populations is reflected in language difficulties, in cultural practices and beliefs with respect to illness and health, in differences in their birth rates, in differences in the afflictions which kill them.”

Years of progress, but more work ahead

The efforts during the Reagan years set the stage for dramatic progress, even though there is plenty more work still to do.

The death rate for black men aged 45 to 54 dropped 15 percent in the 1980s during the Republican administrations of Reagan and George H.W. Bush. It dropped another 19 percent in the 1990s, and 19 percent again in the 2000s, mostly under the two terms of Democrat Bill Clinton and the two terms of Republican George W. Bush. Finally, under the two Democratic terms of Obama, the rate dropped yet another 18 percent.

The result is a current death rate for these black men of 678 per 100,000, less than half the 1980 rate. The death rate for black women in the same age group is down 42 percent from 1980.

The dramatic progress, and the obvious work left to do, is precisely why the Trump administration must not turn its back on these kinds of evidence-based accomplishments—or the forthright use of language that helped achieve them.

Besides, semantic silence has been tried before and has failed.

In one telling episode during George W. Bush’s first term, for example, HHS tried to eliminate the words “inequality” and “disparities” from a national report on health disparities.

A strong early draft had said: “Inequalities in health care that affect some racial, ethnic, socioeconomic, and geographical subpopulations in the United States ultimately affect every American. From a societal perspective, we aspire to equality of opportunities for all our citizens. Persistent disparities in health care are inconsistent with our American values.”

That draft also said, “The personal cost of disparities can lead to significant morbidity, disability, and lost productivity.”

The final report in late 2003 erased the above, replacing it with this far more cheerful message: “The overall health of Americans has improved dramatically over the last century. Just in the last decade, the United States has seen significant reductions in infant mortality, record-high rates of childhood vaccinations, declines in substance abuse, lower death rates from coronary disease, and promising new treatments for cancer.”

The firestorm that erupted over the two versions forced then-HHS Secretary Tommy Thompson to publish the stronger draft online in early 2004. As if to second its importance, a National Academies report that year said “widespread, reliable, and consistent data” by race and ethnicity are “critical to documenting the nature of disparities in health care and developing strategies to eliminate disparities.”

This is no time to stop developing strategies. Remaining disparities are every bit as urgent as when Margaret Heckler’s task force report said that people of color “have not benefitted fully or equitably from the fruits of science or from those systems responsible for translating and using health sciences technology.”

We can see from examples such as these that words can have serious consequences for Americans’ health. After all, you cannot determine what needs to be done without the language to speak about it.

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