Words, evidence, science and vulnerable populations – they’re all intertwined

Last Friday, The Washington Post reported a disturbing story regarding a list of “seven banned words,” purportedly a new Centers for Disease Control and Prevention (CDC) policy. The list was particularly disturbing because the prohibited words – diversity, entitlement, evidence-based, fetus, science-based, transgender and vulnerable – are ones frequently used in public health.

The story precipitated more outrage than surprise, given recent events in Washington, D.C. After all, climate change already had been expunged from government parlance. When did evidence-based become an evil word – or science-based? Anger erupted from every corner of our community.

I am grateful that my colleagues in leadership at other schools of public health were communicating with various communities and with one another, and that the president of the Association of Schools and Programs of Public Health (ASPPH), Dr. Laura Magaña, had reached out to appropriate organizations with a strong statement that banning those words was unacceptable. Other organizations, such as Research! America, also acted swiftly.

Over the weekend, CDC Director Dr. Brenda Fitzgerald, who will be our guest at the Gillings School in January, issued a series of tweets addressing the Friday report, which read in part:

I want to assure you there are no banned words at CDC. We will continue to talk about all our important public health programs. You may be understandably concerned about recent media reports alleging that CDC is banned from using certain words in budget documents. I want to assure you that CDC remains committed to our public health mission as a science- and evidence-based institution. As part of our commitment to provide for the common defense of the country against health threats, science is and will remain the foundation of our work.

The Department of Health and Human Services, which oversees the CDC, also issued this statement:

The assertion that HHS has ‘banned words’ is a complete mischaracterization of discussions regarding the budget formulation process. HHS will continue to use the best scientific evidence available to improve the health of all Americans. HHS also strongly encourages the use of outcome and evidence data in program evaluations and budget decisions.

Later, we learned that the conversation relayed to The Post was more nuanced than a ban. It was “a conversation about words that might make it hard to get budgets passed/funded by the partisan committees.”

“This was all about providing guidance to those who would be writing those budget proposals,” an unnamed HHS official said. “And it was very much ‘you may wish to do this or say this.’ But there was nothing in the way of ‘forbidden words.’”

It seemed like a lot of backpedaling was going on. Maybe some of the words were trial balloons. Maybe it was miscommunication or even misunderstanding. Maybe it was a tactical discussion about how to get public health done in a difficult climate. Dr. Fitzgerald seemed genuinely committed to distance herself from the notion of banned words, as did the spokesperson from HHS.

For anyone who thinks I am reporting only the liberal side of the picture, here is another perspective.

Despite recent events in D.C., this type of controversy is not new nor is it the province of a single political party. I recall situations in both Democratic and Republican administrations when, while I was a division director at the National Cancer Institute (NCI), we recognized that some words and phrases were lightning rods to be avoided, especially since they might bring unwanted attention to programs we supported.

At one tobacco-related event, I talked to Vice President Al Gore and said we should communicate the harms of both adult and adolescent smoking. He told me, in no uncertain terms, that we should not focus on adult smoking, as too many interest groups would push back against the administration. He wasn’t saying that funding adult smoking-related programs was banned, but that the language would arouse undue attention. The Clinton administration was navigating a difficult political issue. I thought it was disingenuous, and it left a bad taste in my mouth, but they controlled the words. When President Bush came into office, he had his own sets of words.

What we heard Friday was distressing particularly because the supposedly banned words are so central to public health. We cannot do our jobs as researchers, administrators and public health professionals if our language is censored. For example, at the Gillings School of Global Public Health, we are passionate about creating, evaluating and implementing evidence-based and science-based solutions. Those concepts are foundational to everything we do. Science, solutions and evidence are central to who we are and how we work. They are in our DNA.

Carl Sagan once said that science is “a commitment to a systematic way of thinking, an allegiance to a way of building knowledge and explaining the universe through testing and factual observation.” The people of this country and the world deserve sound policies and practices built on the foundation of science and evidence, for all people.

The views expressed in this blog are Barbara Rimer’s alone and do not represent the views and policies of The University of North Carolina or the Gillings School of Global Public Health.

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