Behind the Assault on Diversity, Equity, and Inclusion

Upon taking office, President Trump terminated diversity, equity, and inclusion (DEI) programs throughout the government. Federal agencies, including the Department of Health and Human Services (HHS), closed DEI offices and scrubbed websites to remove equity-related content. Although a federal judge blocked some of these actions, the hold was temporary, and state agencies, universities, and many of the nation’s largest companies are following suit and terminating their DEI programs.

The most charitable explanation for this phenomenon is that many politicians, employers, and voters have come to resent the way DEI has been implemented, especially at workplaces and schools. They believe that DEI and its efforts to curb discrimination based on gender, race, ethnicity, sexual identity, and disability have gone too far and sometimes discriminate against male, White, or straight candidates. This concern deserves constructive debate. DEI programs can be recalibrated to broaden opportunity for everyone, leaving no talent on the sidelines.

However, the anti-DEI movement has cast a much wider net, eliminating funding for research on racial disparities, banning equity-oriented language, impeding enrollment of minorities in clinical trials, ending collection of racial data for Medicare and Medicaid, and cutting services for marginalized populations. This is occurring with an ideological fervor not seen since the McCarthy era of the 1950s. Federal staff have been ordered to report colleagues who are disguising DEI efforts. HHS staff have been doxed for writing about equity or racism. Researchers who study health disparities are operating in fear, lowering their profile, and abstaining from public comments to avoid losing their funding, jobs, or personal safety.

What is this really about?

The assault on DEI goes well beyond its impacts on health and health policy, and is rooted in our past.  This moment bears eerie similarities to past episodes in American history when people in power sought to silence conversations about race and block efforts to expand opportunity across racial lines. Consider, for example, the attacks on abolitionists in the early 19^th century or the backlash to Reconstruction that occurred following the Civil War. From Jamestown onward, White elites sought to protect their power and wealth by preventing Black people from assembling, voting, or competing for property, profits, and elected office. They also resorted to acts of terror, from tribal massacres to lynchings.

All this was rationalized by their belief in a hierarchy of human value based on skin color, in which dark-skinned people were deemed inferior to those with White complexions. This social construct was a creation of northern Europeans; writings before the 17^th century said little about Whiteness or classifying people by skin color, but these notions became useful to European colonizers in justifying the lucrative slave industry and displacing indigenous populations. For centuries, American settlers believed that people of color were less civilized, less intelligent, and less deserving than White people. The discredited field of eugenics sought to establish racial inferiority as a scientific fact.

Emancipation brought an end to slavery in the United States but not to racial bias. The distaste for people of color became the fuel source for Jim Crow laws, segregation, and other efforts to keep “non-Caucasians” out of White neighborhoods, workplaces, and schools. Although such practices are unconstitutional, racial bias remains a daily fact of life. People of color are disproportionately rejected for loans, jobs, and promotions. They receive inferior health care and are more likely to be prosecuted and incarcerated for crimes. The current frenzy to deport immigrants stems from beliefs that dark-skinned foreigners threaten public safety.

Polite society uses code words for these biases. For example, the new Defense Secretary, Pete Hegseth, a White major who replaced a Black four-star general, advocates a “merit-based” system for the Department of Defense, one that is “color-blind” and focused on qualifications. Meritocracy, a popular talking point these days, sounds reasonable on its face, but it often serves as an excuse for ignoring history. For example, many observers take issue with the poverty and social needs they observe today in communities of color without considering the policies of the past that put those conditions in place.

For example, when US soldiers returned from World War II, the benefits of the GI Bill were offered preferentially to White veterans, helping them to attend college, buy homes, and transfer wealth to their children. Most Black veterans were denied benefits, losing the opportunity to pursue an education, compete for high-earning jobs, and acquire property. Their children, who attended segregated schools in underfunded school districts often received an inferior education. In a knowledge economy, they were at a competitive disadvantage with their White counterparts. Saddled with lower-paying jobs and fewer assets, Black households could not easily climb the economic ladder. Redlining practices and restrictive covenants prohibited them from purchasing homes, leaving many with little wealth or social position to pass to their children. The cycle has repeated with each successive generation.

A similar story occurred with other minoritized groups, as when resources for tribal communities on Indian reservations were restricted for generations, and when discriminatory practices barred opportunities for Hispanic/Latino and immigrant families. Repeating this cycle over multiple generations has a compounding effect, perpetuating not only multigenerational poverty but also gaps in qualifications that prevent people of color from getting ahead. Each generation is further traumatized by discrimination and the allostatic load it places on physical and mental health. Epigenetic research indicates that this trauma also damages the chromosomes inherited by descendants.

To be “color-blind” is to put on blinders. Asking everyone to pass the same test while turning a blind eye to the obstacles they face is to pretend the past did not occur. It’s an old playbook. A century ago, Black people were denied an education and then given literacy tests to prevent them from voting. Today as well, systems that ignore the disadvantages produced by generations of racism remain rigged against people of color. The equal opportunity movement of the civil rights era and the more recent social justice movement that spawned DEI sought to restore balance by making an extra effort to help populations that had been systematically deprived. It is a perversion, but also a clever pivot, for critics of DEI efforts to label these efforts to combat racism as racist.

This is not to minimize the disappointment of people who lose opportunities, seemingly unfairly, to other candidates. However, the frustration of individuals struggling to get ahead does not explain the hostility directed at DEI by the nation’s leading policymakers, most of whom sit on top of the economic ladder, hold vast wealth and power, and have not been left behind by programs for minorities. Their opposition comes from a different place. Many dispute the premise that minorities are owed more opportunities. They see disparities in capacity and outcomes—including health inequities—as inevitable, not an ill that society must correct, certainly not at the expense of White families and taxpayers. Adherents to these views are alarmed by projections that minorities will soon outnumber White Americans and are fearful of being “replaced.” They are reluctant to see more minorities in corporate boardrooms, the professions, and elected office. They want to reverse the current trajectory.

The systematic dismantling of DEI efforts

One way to reverse the trajectory is to take control of the government and use its power to engineer a sweeping culture change—a process that is now unfolding. This is the strategy being used by the Trump administration and was planned and detailed in Project 2025. In January 2025, President Trump and like-minded ideologues, Elon Musk included, with ties to domestic and overseas right-wing extremists, took control of the federal government. Under the guise of ending DEI, the administration methodically began to dismantle programs that promote opportunities for people of color.

First, the Trump administration removed access to data and research on racial disparities, thereby erasing evidence that a problem exists. Using artificial intelligence to search websites for approximately 20 keywords such as “diverse” and “historically,” HHS staff removed content on equity or racism, race-specific data, and reports on health disparities. Institutions across the country—including universities, think tanks, professional societies, and state agencies—removed DEI content from their websites and renamed programs and conferences. The National Institutes of Health announced cuts in research funding. Investigators who study racial-ethnic health disparities deleted inclusive language from grant proposals and publications or withheld submission.

Second, the administration banned DEI policies, effectively restoring the preferential treatment of White people. The culture shift was swift, fueled by messaging from conservatives who blamed DEI for all manner of problems, even the mid-air collision of a commercial jet and Army helicopter over Washington, DC. Trump laid off federal DEI officers and revoked a 1965 order protecting equal employment opportunities. Schools were ordered to end “discriminatory” DEI policies, the government began investigating DEI practices at companies, and universities and much of the private sector acquiesced by ending their DEI programs.

Third, the federal government cut services for low-income Americans, disproportionately impacting minorities. Trump froze federal loans and grants to investigate “Marxist” equity policies, forcing clinics for low-income populations to close. To finance tax cuts—another attempt at preserving wealth for the wealthy—the House of Representatives proposed cutting $2 trillion from programs for the poor, notably Medicaid but potentially also Affordable Care Act premium assistance, food stamps, school lunch programs, Head Start, and loans for low-income college students. The administration terminated environmental justice and civil rights investigations, increasing the exposure of minority neighborhoods to environmental toxins and other threats, including police misconduct. Citing “gender ideology extremism,” the administration rescinded protections for sexual minorities, especially transgender individuals. Hospitals discontinued gender-affirming care. The harm resulting from these cutbacks will be difficult to measure because agencies were ordered to stop collecting relevant data.

Fourth, the administration targeted education to alter what students learn about history and racism, thereby suppressing awareness of the issue for future generations. The White House announced plans to dismantle the Department of Education, mandate “patriotic education,” and cut federal funding for K-12 schools engaged in “discriminatory equity ideology.” Many states and localities took similar action and, rallied by parents’ groups, pressured school districts to revise curriculum and testing policies and remove library books that discuss racism.

Fifth, the administration is using branding to solidify public support. Catchphrases for popular causes on the right—such as eliminating DEI, “wokeness,” and waste—have served as political cover for firing thousands of knowledgeable career staff, replacing them with Trump loyalists, and feeding humanitarian agencies to the “wood chipper.” People of color recruited for high positions by the Biden administration, such as the chairman of the Joint Chiefs of Staff, were also fired. West Point disbanded clubs for cadets of color and the Pentagon stopped recognizing Black History Month and Martin Luther King, Jr. Day (a federal holiday).

Why this matters to population health

Americans have shorter life expectancies and poorer health outcomes than people in other high-income countries, and the Trump administration’s multipronged assault on DEI will only deepen the crisis. Racial and ethnic inequities are already responsible for an enormous death toll in the United States. Between 1999 and 2020, the mortality gap between non-Hispanic Black and White Americans claimed an estimated 1.63 million lives, equivalent to 81.9 million years of potential life lost. According to one study, racial and ethnic health inequities cost the country between $421 billion and $451 billion—in one year alone (2018).

The anti-DEI movement is targeting initiatives aimed at reducing these inequities, including federal funding for research on the causes of health inequities and promising solutions. Patients do better when their clinician looks like them, and minorities are underrepresented in the health professions. People of color are more likely to live in health professional shortage areas or lack health insurance. For years, the government has sponsored sensible policy solutions, such as attracting underrepresented young people to the health professions, bringing health care to underserved areas, and expanding Medicaid coverage and other insurance products for low-income families. These programs, now castigated as DEI and “bloat,” are on Elon Musk’s chopping block, but their elimination endangers the health of all disadvantaged Americans, including White families struggling to make ends meet.

Population health is greatly affected by the social determinants of health, such as food security, stable housing, education, livable wages, transportation, and more. Americans will find these predictors of life expectancy increasingly inaccessible as the administration and Congress enact economic, tax, and tariff policies that inflate the cost of basic necessities and as efforts to downsize government eliminate agencies, programs, and personnel that could help those in need. They are rolling back environmental regulations, canceling projects to remove toxins from communities, promoting fossil fuel production, and reducing disaster relief that could help victims of severe weather produced by climate change. All this will harm population health, particularly in minority and low-income communities, where exposure to pollutants and devastation from natural disasters are often greatest.

What then should be done?

America faces a choice. Either it supports efforts to widen opportunities for all Americans or it does not. When the murder of George Floyd in 2020 sparked a nationwide movement to adopt more inclusive policies, was that response genuine—reflecting core American values—or a superficial exercise to be politically correct? If it was genuine, then the actions of the Trump administration to extinguish those efforts and restore power to White people are unacceptable and must be opposed. However, if past actions were a superficial exercise and not what Americans truly believe, then the quick moves by businesses, universities, and other sectors to roll back those policies and follow the lead of the Trump administration make perfect sense.

World observers—including ascendant right-wing parties and autocrats in other countries—are watching closely to see whether the US population welcomes or rejects the racial policy agenda of the Trump administration. Time is running out to decide. The Trump administration’s methodical seizure of government and its sweeping information blackout to reduce public awareness of racial disparities are moving at breathtaking speed and may soon become impossible to reverse, leaving an indelible mark on history.

The decision also will have enormous population health consequences. The systematic assault on DEI and on efforts to provide all Americans with the opportunity for good health is likely to deepen health inequities, increase morbidity and mortality rates, and further widen the gap in life expectancy between the United States and the developed world. Members of the medical and public health communities also face a choice. Those who are unconcerned can stand down, but those who oppose this outcome should rise to the occasion and act on their principles. As organizations and individuals, they should speak out and take concrete action in legislatures, courtrooms, and the ballot box to protect the health of marginalized populations. History will record the actions taken by the Trump administration—and how Americans chose to respond.

Acknowledgment: The author thanks Brian D. Smedley, PhD, Anthony Iton, MD, JD, MPH, and Zinzi D. Bailey, ScD, MSPH for their helpful comments on an earlier draft of this article.

About the Author