There was public outrage when The Washington Post reported that the Trump administration informed the Centers for Disease Control and Prevention (CDC) and other divisions within the Department of Health and Human Services to avoid using seven words in documents when submitting their 2019 budgets. The list included:
It’s unlikely that these words were randomly selected, yet officials declined to give a reason for banning them. The absence of an explanation fueled emotional, politically motivated assumptions regarding the administration’s intent, described as “Orwellian,” “ridiculous” and “censorship.” Democrats’ concerns on the impact were highly generalized: “the Trump Administration is yet again prioritizing ideology over science.”
But what is really behind the ban, and how might it affect healthcare?
I analyzed the frequency and context of how these words were used in the 2018 Health and Human Services budgets. Because words are typically aligned with priorities, the elimination of words offers insights to the administration’s priorities and may signal specific changes we will see to services and programs in the 2019.
- These seven words and phrases are used 59 times in the 2018 HHS Budget Overview. Together, “evidence-based” and “science-based” are the most prominent and appear 22 times, 34 percent of the total. According to the Post, the CDC was given guidance to substitute “evidence-” and “science-based” with the following: “CDC bases its recommendations on science in consideration with community standards and wishes.”
Behind the Ban: Even with the substitution, science will undoubtedly continue to guide the activities of the agency. However, the administration’s directive to consider “community standards and wishes” may mean we are entering an era when science is diluted by religious and political preferences and hijacked by the personal perceptions of legislators and regulators.
- “Evidence-” and “science-based” are most often used to refer to describe programs and funding related to prevention-related activities. This includes:
- Infections, with a focus on preventing food poisoning as well as new cases of HIV, tuberculosis, hepatitis C, sexually transmitted infections and Ebola.
- Chronic illnesses, by promoting healthy eating, physical activity, and reducing high-risk behaviors in adults and children.
- Mental illnesses, by finding better ways to support mental health and prevent the mental illness, substance abuse and addiction that affect 43 million Americans.
Behind the Ban: Prevention-focused programs are the essence of public health and critical to the nation’s safety as well as sustainable long-term health reform. If the administration’s directive signals the de-prioritization of public health, we will further cement our nation’s culture of “sick care” since:
- public safety will be reactive rather than proactive;
- people will have a passive dependence on the medical system rather than being actively engaged in their healthcare choices; and
- the absence of adequate mental health resources will increase the number of Americans who experience the despair of mental illness.
- The HHS division that may be most impacted by the elimination of these terms (based on the frequency of word use) is the Administration for Children and Families (ACF). The ACF’s budget uses “vulnerable” and “entitlement” 16 times. “Vulnerable” also appears five times in the CMS budget and specifically in sections describing the Children’s Health Insurance Program (CHIP).
Behind the Ban: The ACF and the CMS promote the well-being of our neediest populations with particular attention on children in low-income families. If the administration’s directive suggests that enabling and empowering self-sufficiency is no longer a core value, then we will see greater widening of the nation’s economic, social and physical disparities resulting in worsening polarization and unrest.
My conclusion? I, too, am outraged — not because of political bias but because of a concern for human health. Eliminating these seven words from the lexicon of the HHS budget will potentially negatively impact the integrity of scientific research, undermine the advances we’ve made in prevention and public health, and abandon support for at-risk populations. Words matter.
Archelle Georgiou, MD, is former chief medical officer of UnitedHealthcare and has made national appearances on FOX Business Network, CNN and Good Morning America. The author of the book “Healthcare Choices: 5 Steps to Getting the Medical Care You Want and Need,” she is industry adviser for the Medical Industry Leadership Institute at the Carlson School of Management at the University of Minnesota. Follow her on Twitter @ArchelleMD