The Trump administration has reportedly banned the leading US public health agency from using certain words in a budget proposal due next year.
And what words: vulnerable, entitlement, diversity, transgender, fetus, evidence-based and science-based. The choice reflects the Trump camp鈥檚 well-known dislike of science
But more subtly, it reveals a less-noticed dislike of equality, which research suggests could be deeply rooted in the psychology of Trump supporters. This is a problem, not just because equality is , but because it is integral to public health.
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On Friday that at a meeting the previous day, officials at the US Department of Health and Human Services told finance officers at the Centers for Disease Control and Prevention (CDC) 鈥� the country鈥檚 leading public health agency 鈥� not to use the seven terms in a draft budget for the president鈥檚 2019 budget proposal. This is due to go to Congress in February.
The report sparked outrage in the scientific world, prompting the head of the CDC, Brenda Fitzgerald, to 鈥渢here are no banned words at CDC鈥�. But the proposal came from the Department of Health, which runs the CDC, and it hasn鈥檛 fully denied the Post report. Spokesperson Matt Lloyd merely said it was a 鈥溾��.
He hasn鈥檛 offered a better characterisation. But suggest that rather than a ban on words, the discussion was an effort, in the face of major proposed cuts in federal health funding, to get the CDC budget past members of Congress who see those words as ideological red flags.
Beyond the budget
This goes well beyond the budget, however. Trump鈥檚 officials have previously made efforts to censor science. The US Department of Agriculture has been told to say 鈥�weather extremes鈥� instead of climate change, while the State Department has been told to聽call sex education 鈥溾��, a buzzword for 鈥渁bstinence only鈥� birth control.
The risk, say , is that this could lead to self-censorship in other statements. Besides hobbling science, this could threaten public health.
鈥淭he specific words that were 鈥榝orbidden鈥� by this administration reflect a clear agenda to limit the core purpose of public health 鈥� focussing on vulnerable populations and health disparities,鈥� leading US public health experts Elizabeth Sommers and Sandro Galea.
Disparities are the key issue here. Disease threatens everyone, so public health aims to give equal access to vaccination or treatment to everybody, including those whose poverty or ethnicity impedes access.
The targeted words reveal a profound dislike of recognising, and rectifying, inequalities. CDC employees have been told on other occasions not to even say 鈥渉ealth equity鈥� in public. It is hard otherwise to understand why the CDC shouldn鈥檛 say vulnerable.
Another targeted word, entitlement, implies a right to equal access to health care. US Social Security and Medicare, which pay medical bills for the poor, are called 鈥渆ntitlement programmes鈥� 鈥� and are by Republicans.
Abortion rights
There could be a deeper reason than politics for this. Research has shown that narcissists tend to believe that inequality is part of the natural order. They see themselves on top, and thus oppose efforts to rectify this.
Trump himself is . Moreover, research has shown that with similar characteristics.
Targeting 鈥渇etus鈥� continues administration efforts to control language around 鈥� or maybe a fear of discovering more damage to US fetuses by Zika virus. Meanwhile, 鈥渄iversity鈥� and 鈥渢ransgender鈥� signal the dislike of out-groups typical of the prominent among Trump supporters.
This year questions about gender identity were removed from public health surveys and the . If the word transgender is discouraged as well, the CDC won鈥檛 only lack data, it will have trouble even talking about people often in need of support.
But of all the terms, discouraging the use of 鈥渟cience-based鈥� and 鈥渆vidence-based鈥� is likely to cause the most harm. CDC officials have reportedly been told to instead say: 鈥淐DC bases its recommendations on science in consideration with community standards and wishes.鈥�
So some other, non-scientific, community has to approve the science first. As Sommers and Galea point out, such consensus thinking has previously meant believing the Earth is flat, and is anathema to real science.
Words matter. Whether these seven are banned or not, they suggest Trump鈥檚 camp has possibly innate psychological problems with evidence, diversity and, especially, equality. Given the problems facing the US, from disease to racism to climate, this is deeply troubling.
