10/11/2024
Racism was called a health threat. Then came the DEI backlash.
A growing number of institutes exploring the nexus between racism and health — and their researchers — are under attack.
David R. Williams and Rachel Hardeman are population health researchers at different universities with one thing in common: Both have been added to a right-wing “watch list” for teaching about and researching the ways racism affects health.
At the American Academy of Dermatology, some members proposed “sunsetting all diversity, equity and inclusion programs,” arguing DEI has evolved into a political movement filled with perceived antisemitism that labels people as oppressed or oppressor — a proposal that failed at the annual meeting in March.
And grant-making organizations that awarded millions of dollars to investigate racism as a threat to public health are now asking some researchers to stop using the word “racism.”
A growing number of U.S. institutes created to explore the nexus between racism and health — and the researchers who preside over them — are finding themselves under attack, their missions and funding in peril barely four years after the nation had what many called its “racial reckoning.”
Other efforts to address systemic racism and inequality — in education and corporate America — have encountered resistance, but the stakes are especially stark with health care because centuries of inequities yield life-or-death consequences.
“It’s very taxing. This anti-DEI movement creates a climate of fear,” said Chandra L. Ford, a professor at Emory University and founding director of the Center for the Study of Racism, Social Justice & Health.
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In spring 2020, George Floyd was murdered by Minnesota police officers as a crowd watched, begging the police to stop. Lives in Black, Hispanic and Native American communities were being cut short at grossly disproportionate rates by the coronavirus. And anti-Asian hate was on the rise.
Corporations declared Black lives matter and promised billions of dollars to address health, education and economic inequality. Hospitals created chief diversity officers. Anti-racism research centers and programs received an influx of money. Federal health agencies — and hundreds of cities and states — declared racism a threat to public health and vowed to end it.
The backlash was swift, as a mostly conservative countermovement began to argue that DEI doesn’t mean fairness, justice and representation but discrimination, exclusion and indoctrination.
It reflects a broader movement. According to the Chronicle of Higher Education’s DEI Legislation Tracker, state lawmakers have introduced at least 85 anti-DEI bills since 2023. More than a dozen Republican attorneys general sent a letter urging Fortune 100 companies to reexamine their DEI strategies after the Supreme Court banned race-conscious college admissions policies. And the conservative activist who led the campaign to oust Claudine Gay, Harvard University’s first Black president who resigned amid plagiarism allegations in January, said on X that it was “the beginning of the end for DEI in America’s institutions.”
Among the arguments against diversity, equity and inclusion initiatives: that they deepen racial inequality by lowering standards to make space for unqualified people of color, resulting in reverse discrimination because skin color — not merit — becomes a deciding factor in hiring and school acceptance.
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Miller’s group, along with other conservative lawmakers, activists and organizations, is using the threat of litigation and the courts — once the venue used to help secure civil rights progress — to invalidate race-conscious programs dedicated to addressing the harm caused by centuries of legalized racial injustice.
Conservative lawmakers have threatened the funding of medical schools that have a DEI office or lessons on structural racism.
The Medical Board of California has been sued for requiring continuing medical education courses to include implicit-bias training. The suit is backed by the Pacific Legal Foundation, a Sacramento law firm that says it “fights for limited government, property rights and individual rights.” The firm represents two California doctors and Do No Harm, a nonprofit whose website says it was founded to “counteract divisive trends in medicine, such as ‘Diversity, Equity and Inclusion’” and gender expansive care. The legal and advocacy group has suits pending in Louisiana, Montana and Tennessee, too.
And in August, Do No Harm and a Wisconsin law firm filed a complaint against the Cleveland Clinic with the Department of Health and Human Services’ Office for Civil Rights, saying two efforts — the Minority Stroke Program and Minority Men’s Health Center — illegally discriminate on the basis of race. In a statement, the hospital system said its mission is to “care for life, research for health and educate those we serve … regardless of race, ethnicity, or other characteristics,” adding that the stroke program is “open to all patients” but the men’s health center “has not be in place for several years.”
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“A lot of people are under the assumption that we live in a meritocracy, but what they don’t realize is how life chances are dictated by so many other factors,” said Linda Sprague Martinez, a professor at the University of Connecticut School of Medicine and director of the Health Disparities Institute at UConn Health, adding that she, too, has had grant-funders recently challenge her use of the word racism in her work. “DEI initiatives don’t even fully level the playing fields. But if we’re not paying attention to the inequities and addressing them, they’re just going to persist.”
Ford said the debate about merit and inequities is ensnared in an assumption that people from historically underrepresented communities lack the expertise or credentials to hold positions in predominantly White workplaces and academic settings. Research shows Black college students are often asked if they’re on a sports scholarship, and Black doctors are mistaken for food service workers or janitors.
Six states prohibit lessons on meritocracy’s limitations, defining such critiques as “divisive concepts,” according to an April article in the Milbank Quarterly, a population health and health policy journal.
Social scientists say the anti-DEI movement has co-opted and twisted the fight for justice and equal opportunity, which calls for eliminating legal and practical barriers that restrict access to resources and makes climbing the socioeconomic ladder that much harder for people historically pushed to the margins.
Health and Human Services Secretary Xavier Becerra agreed.
Equity remains a key driver of the Biden administration, Becerra said in an interview, despite attacks by the anti-DEI machine. Becerra said he refuses to be intimated by the “McCarthy-type lists” the anti-DEI movement has created that target not just scholars but federal workers.
“We’ve seen this before where people get branded and listed and blackballed,” Becerra said. “In the end, it doesn’t work.”
Becerra urged researchers and “people of good will” who find themselves in the crosshairs to not get distracted or water down their efforts. “Some people can try to deny history. Some people can try to rewrite history. The facts and science prevail,” he said.
Health equity researchers say the hostile response to DEI is happening as the field and academia develop a critical mass of scholars of color.
“There’s always a backlash when we made progress,” said Thomas LaVeist, dean of Tulane University School of Public Health and Tropical Medicine.
“Just like we had a moment during the civil rights movement that was kind of taken down when Nixon came in with his war on drugs,” said LaVeist, who has received hate-filled emails and phone calls because of his research into the economic implications of health disparities.
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Williams and other experts said the nation has made much less progress eliminating patterns of division and disparity than most people think. Residential segregation — which affects school boundaries, longevity, green space, grocery store access, policing, taxes, air and water quality — is worse today than a generation ago, research shows. And the wealth gap remains stubbornly persistent.
According to a 2023 Federal Reserve report, for every dollar of wealth the typical White household had in 2013, Black households had 9 cents and Latino households had 10 cents. By 2022, the gap had improved only marginally: Black families had 16 cents and Latino families had 22 cents for every dollar of wealth held by White families.
And physicians and health equity researchers point out that the dearth of doctors of color, who are more likely to be primary care providers and work in medically underserved areas, hasn’t changed much in more than a century.
A 2021 study from UCLA found that the proportion of Black physicians increased only marginally during the past 120 years, going from 1.3 percent in 1900 to 5.4 percent in 2018. Today, the number remains largely the same at about 5 percent, according to the Association of American Medical Colleges.
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One of the unrecognized aspects of the anti-DEI movement is that it stalls productivity and scientific inquiry, said Hardeman, a professor and reproductive health equity researcher.
Racism was called a health threat. Then came the DEI backlash.
A growing number of institutes exploring the nexus between racism and health — and their researchers — are under attack.