In December 2017, the Trump administration, by way of the U.S. Department of Health and Human Services (HHS), reportedly banned the use of several terms at the Centers for Disease Control and Prevention (CDC), including “fetus,” “evidence-based,” “science-based” and “transgender.”
In subsequent reporting, major news outlets clarified CDC employees were never formally barred from using the terms. Rather, officials had recommended that CDC employees use more “muted” and “neutral” language in budget proposal documents, with HHS officials claiming this was merely a strategy to boost the Trump administration’s approval of the CDC’s forthcoming budget.
The CDC incident, however, warranted concern three years ago and still deserves attention today. As executive director of the American Public Health Association Dr. Georges Benjamin later expressed to CNN, “It is important to note that in their artful response, HHS and the CDC never denied that these seven specific words (vulnerable, evidence-based, etc.) were singled out.” Undoubtedly, the banned words were part of a broader pattern of the Trump administration’s sidelining science, a troubling record that has grown immensely over the course of the administration — and even in its waning days of power has yet to stop. Taking away the words of scientists diminishes power, leaving a dangerous void that erodes human rights and science at the federal all the way down to the local level.
A Troubling Pattern
While there may not have been an all-out word ban, and refining word choice in policies to appeal to decision makers is common practice, the reported events at the CDC are deeply troubling. Words matter, and words in policies have deep human impact. Make no mistake, this rhetorical tiptoeing is a troubling symptom of a larger disease that emerged from the Trump administration. From 2016 to the present, the strategic manipulation of scientific and human rights language, whether by official action or covert budgetary recommendation, follows a more subtle but widespread pattern.
The Trump administration’s agenda is marred by actions and other moves that are anti-reproductive rights, anti-human rights, anti-science and detrimental to the LGBTQ and BIPOC communities. The repeated news of strategic censorship of employees within federal agencies is alarming but not surprising, given the administration’s egregious track record against evidence-based science.
The Harmful Language of HHS Under the Trump Administration
A prime example of the Trump administration’s strategic opposition to scientific and human rights language, language that cannot be replaced by other terms without losing meaning, is evident in the removal of protections based on “sex” from the Final Rule on Section 1557 of the Affordable Care Act (ACA). Section 1557 of the ACA had a non-discrimination clause interpreting discrimination on the basis of sex to include protections for the LGBTQ community. However, under the Trump administration, the language of discrimination “on the basis of sex” maliciously narrowed in June 2020. Under this rule, Section 1557 no longer protects from discrimination based on sexual orientation, gender identity, sex stereotyping, perceived gender identity and abortion. Just days after the final rule was released, the Bostock v. Clayton County decision from the United States Supreme Court upheld workplace protections against discrimination for LGBTQ people, putting the final rule on Section 1557 at odds with the court’s definition of discrimination based on sexual orientation and gender identity. In September 2020, a federal court blocked the appalling final rule on Section 1557.
While litigation continues, the Trump administration’s rule on Section 1557 is yet another assault against human rights language. This assault on inclusive language attacks peoples’ rights to be seen, heard and cared for with dignity and respect when seeking healthcare.
Climate Change Heats Up Within HHS
Continuing a harmful pattern of manipulating human rights and scientific language, instances of erasing the term “climate change” have mounted within HHS under Trump and HHS Secretary Alex Azar. In 2016, “climate change” was removed from the National Institute for Occupational Safety and Health, which is housed under the CDC. The Environmental Data & Governance Initiative reports that agency changes included altering “climate change” to more ambiguous, less transparent terms such as “climate variation,” “variation” or “climate” or removing the phrase “climate change” completely.
Other well-documented cases of strategic censorship of scientific information within HHS by the Trump administration include removing information explaining the relationship between health and climate change. Data from a joint initiative between the Sabin Center for Climate Change Law at Columbia University Law School and the Climate Science Legal Defense Fund reveal that HHS attempted to prohibit scientific research, publication or public discourse of climate change information on at least 40 other well-documented occasions.
Beyond HHS, “climate change” was strategically wiped from other federal agencies’ public-facing documents and platforms, such as the U.S. Environmental Protection Agency’s and the U.S. Department of Transportation’s, among numerous other federal agencies’ materials. Erasing climate change from the public’s view erases fact, leaving dangerous room for harmful, inaccurate interpretations to fill the void.
The Trickle-Down Effect
What does the manipulation of, opposition to and outright erasure of human rights and scientific language mean? Manipulation of scientific and human rights language by a presidential administration and, subsequently, federal agencies has a trickle-down effect to people at regional, state and local levels. In FY2019, the CDC provided $7.7 billion in grant funding to states’ health initiatives. From personal experience in public health with state and local health entities, I am concerned knowing federal agencies’ top scientists are muzzled from speaking truth, prevented from sharing evidence with the public and subtly told to control meaning. These actions at the federal level create a form of self-censorship.
After the reported CDC word ban confusion in 2017, I remember cautious conversations among colleagues at the state health initiative where I worked about replacing the word “fetus,” which has medical merit and meaning, especially when trying to communicate and share information with others in the field of maternal health. In reality, self-censorship among federal agency employees trickles down to state and local health initiatives that rely on federally funded grants. In my experience, many local health employees are left to wonder if they should delete inclusive language, not because they believe the deletion is justified but because they are pressured to comply with the Trump administration’s tactics within federal agencies. This trickle-down effect mattered in 2017, and it matters just as much, if not even more, today.
As I said before and will state again, this is yet another symptom of a larger disease. Manipulation of evidence-based, scientific, inclusive and correct human rights language by federal leadership has caused confusion, wariness and chaos among the people who implement health programs on the ground. Even more importantly, the people using federally funded programs are harmed as local and state public health entities shy away from inclusive and accurate evidence-based language. These are public programs using public dollars. These programs are meant to serve communities — all communities — with inherent respect and dignity, no matter who holds the highest office in the nation.
Moving Forward
Not only does the accurate use of scientific and human rights terminology at the federal level ensure transparency to the public, using inclusive language also demonstrates respect for identity. Deliberately erasing or altering important information and language has the power to erase the rights and identities of individuals, families and communities.
While manipulation of evidence-based and inclusive language under the Trump administration has played out in often quiet, covert ways since 2016, the Trump administration’s harms against human rights need to continue to be voiced out loud. That’s why in 2021, with the Biden-Harris administration taking office, the research team at Equity Forward remains committed to tracking Cabinet members’ and federal agency leaders’ personal records and policies regarding abortion, reproductive health and justice and policies impacting LGBTQ and BIPOC communities.
Rachel Wormer is a research intern at Equity Forward. Rachel brings experience within various state agencies and community research initiatives improving maternal and sexual health outcomes in rural areas. She is an advocate for reproductive healthcare access and equitable public health practice. Rachel is pursuing a master’s degree in public health policy from the City University of New York’s Graduate School of Public Health.