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An emergency room nurse tends to a patient at Houston Methodist The Woodlands Hospital in Texas. States, counties and nonprofits are striving to continue their work to close racial health disparity gaps but are struggling amid a loss of federal dollars (Brandon Bell\/Getty Images).<\/p>\n
Racial health disparities may widen as states, universities and nonprofits grapple with federal funding cuts to programs that were aimed at filling gaps in care, public health experts say.<\/p>\n
As part of its federal restructuring and crackdown on diversity, equity and inclusion (DEI) programs, the Trump administration has been shuttering federal offices and rescinding grants dedicated to addressing worse health care access and outcomes for racial minorities.<\/p>\n
The shake-up has caused some state agencies and nonprofits to pause programs and some groups and universities to apply for foundation grants instead.<\/p>\n
Hundreds of grants have been terminated for state, local and territorial health departments as well as nonprofits and universities, many of which addressed health equity across rural, low-income and communities of color.<\/p>\n
The nation\u2019s racial health disparities were laid bare during the COVID-19 pandemic, when the virus killed Black, Hispanic and Indigenous people at higher rates than white people. The police murder of George Floyd in May 2020 also fueled a racial reckoning across the nation, prompting efforts by states, universities, health systems and the federal government to address racial health disparities.<\/p>\n
Those approaches ranged from targeted vaccine campaigns and efforts to enroll more people of color in clinical trials to corrections<\/a> of diagnostic tests that relied on inaccurate<\/a> information<\/a> about race and biology.<\/p>\n COVID revealed the impact of health disparities to individual health \u2014 as well as how not addressing these disparities undermines the health system for everyone.<\/p>\n<\/div>\n \u2013 Dr. Georges Benjamin, executive director of the American Public Health Association<\/b><\/p>\n<\/div>\n<\/div>\n Communities of color have long had less access to health care, increased exposure to environmental pollutants and higher rates of certain chronic illnesses and cancer deaths. They also have more diabetes-related amputations because of a lack of access to care. And specific genetic diseases, such as sickle cell disease, disproportionately affect Black people.<\/p>\n \u201cCOVID revealed the impact of health disparities to individual health \u2014 as well as how not addressing these disparities undermines the health system for everyone,\u201d said Dr. Georges Benjamin, executive director of the American Public Health Association.<\/p>\n Now, many of the programs trying to address health disparities are being rolled back.<\/p>\n As a result, health policy experts, clinicians and researchers fear those disparities will widen as states, universities and nonprofits grapple with lost federal dollars while the administration continues to limit federal funding for DEI programs. In July, the U.S. Department of Justice released guidance saying<\/a> such initiatives should not receive federal funding, alleging they are \u201cdiscriminatory.\u201d<\/p>\n Entities that receive federal funds \u201cmust ensure that their programs and activities comply with federal law and do not discriminate on the basis of race, color, national origin, sex, religion, or other protected characteristics\u2014no matter the program\u2019s labels, objectives, or intentions,\u201d the news release said.<\/p>\n Several state and local health officials were reluctant to speak with Stateline on the record about how the federal administration\u2019s DEI crackdown has left them in a bind, fearing retaliation or targeting by the federal government. The White House did not respond to Stateline\u2019s request for comment.<\/p>\n \u201cMy concern about what the administration is doing is that they are, in effect, making these disparities worse,\u201d Benjamin said. \u201cEverybody\u2019s health is not the same. \u2026 It\u2019s important to know that the disparities are really profound.\u201d<\/p>\n Benjamin added that the cumulative effect of disparities means more late-stage disease \u2014 costing both patients and health systems more.<\/p>\n \u201cThere\u2019s a trope or misunderstanding out there that DEI is a \u2018woke\u2019-related agenda. DEI is not a \u2018woke\u2019 agenda. DEI is an American agenda, because it\u2019s really one that is the same thing as \u2018rising tides lift all boats,\u2019\u201d said Brandon Wilson, senior director of Health Innovation and Public Health at Community Catalyst, a health equity advocacy organization. \u201cWhen you cut [resources] off, you\u2019re actually disproportionately impacting those who are already impacted.\u201d<\/p>\n The administration canceled billions of dollars in grants from the National Institutes of Health (NIH), the Centers for Disease Control and Prevention, the Environmental Protection Agency and the Department of Health and Human Services.<\/p>\n Many of the grants helped recipients create solutions tailored to their communities\u2019 needs and strengths.<\/p>\n At least three dozen<\/a> state, local and territorial health departments have had pandemic-era grants that addressed health equity terminated. While originally focused on COVID-19, agencies have since used that grant money for other public health efforts: testing and contact tracing for a wide range of diseases, better data reporting, and community partnerships that address social and environmental effects on health.<\/p>\n The money was part of a $2.2 billion national health equity initiative that aimed to address vulnerabilities and protect those communities ahead of the next outbreak.<\/p>\n The Department of Health and Human Services told media<\/a> such cancellations were due to the pandemic emergency ending in 2023.<\/p>\n At NIH, the administration terminated more than 5,400 NIH research grants<\/a>, although about 2,800 were reinstated. Canceled grants included research toward illnesses like HIV and AIDS, which disproportionately affect Black and Hispanic people as well as gay and transgender people.<\/p>\n The Trump administration has also gutted federal offices dedicated to fighting disparities, including the Offices of Minority Health under the Centers for Medicare & Medicaid Services and the Department of Health and Human Services.<\/p>\n At the state level, the Arkansas Department of Health recently shut down its own minority health-focused office<\/a>. Ashley Whitlow, a spokesperson for the department, said in a statement that it \u201crelies on federal grant funding to support a variety of public health programs.\u201d<\/p>\n \u201cThe recent reduction in program staff reflects the Arkansas Department of Health\u2019s ongoing efforts to operate more efficiently with the resources available. Despite these changes, ADH remains fully committed to serving communities across the state,\u201d the statement said.<\/p>\n Meanwhile, Maryland\u2019s Department of Health said its minority health office is funded through state general funds and not directly impacted by the federal cuts.<\/p>\n The nation has seen a spike in congenital syphilis cases, which disproportionately occur among Black and Indigenous families.<\/p>\n \u201cRegardless of whether you\u2019re at the highest risk, any outbreak that\u2019s not controlled can spread widely and broadly, and you can see that that\u2019s what\u2019s happening with measles,\u201d said Dr. Julie Morita, former executive vice president of the Robert Wood Johnson Foundation and former health commissioner Chicago Department of Public Health.<\/p>\n But states likely can\u2019t replace all the lost federal dollars.<\/p>\n \u201cYou\u2019ve got declining capacity, and increasing need \u2014 which is a formula for problems,\u201d said Richard Frank, director of the Brookings Institution Center on Health Policy.<\/p>\n \u201cIt\u2019s impossible to make all that up with state and local dollars,\u201d he continued. \u201cYou\u2019re going to see programs that serve real people getting pulled back.\u201d<\/p>\n Frank and Wilson also expressed concern about the Medicaid changes included in the broad tax and spending law President Donald Trump signed in July. The law is projected to cut federal Medicaid spending by an estimated $911 billion<\/a> over the next decade, largely because new work requirements will push people off the rolls. Data shows the majority of Medicaid enrollees already work, and experts say many will be kicked off the rolls due to difficulties in states\u2019 reporting processes. Black and Hispanic people are disproportionately represented<\/a> on the Medicaid rolls.<\/p>\n OB-GYN Dr. Versha Pleasant, a clinical assistant professor at the University of Michigan, directs the Cancer Genetics and Breast Health Clinic at Von Voigtlander Women\u2019s Hospital. She treats patients at high risk for breast and ovarian cancers. Black women have an almost 40% higher risk of death from breast cancer than white women.<\/p>\n \u201cThat, to me, is unacceptable,\u201d she said, adding that such disparities speak to the need for ongoing programs to \u201cprovide everyone with a fair chance at leading a long and healthy life.\u201d<\/p>\n \u201cIf we don\u2019t make a special effort to save the most vulnerable lives \u2026 where does that leave us?\u201d she continued. \u201cThe changes that we\u2019re seeing are only going to magnify preexisting challenges.\u201d<\/p>\n Dr. Sarah Rudman, acting public health officer at the Santa Clara County Public Health Department in California, and others have told Stateline that federal officials are informing health agencies that race and ethnicity data are no longer required to be reported.<\/p>\n \u201cWe are being asked to change the way we collect our own data here and report it,\u201d Rudman said, adding that her county is going to continue collecting data to \u201cunderstand who is here, who\u2019s experiencing what health outcome and what they need.\u201d<\/p>\n Many families, in the shadow of the county\u2019s Silicon Valley, still struggle<\/a> with poverty \u2014 more than 27,000 children suffer food insecurity, United Way Bay Area says.<\/p>\n \u201cIt is sometimes surprising and striking to people to understand how much poverty and other types of vulnerability are hidden among the more visible wealth of Silicon Valley, and that\u2019s where we\u2019ve dedicated our resources,\u201d Rudman said.<\/p>\n \u201cIt\u2019s hard to even imagine what my colleagues in smaller areas of California or in other parts of the country are experiencing,\u201d she added about lower-income counties. \u201cWe are feeling extremely strained and already in our second round of layoffs, knowing that many more are likely. So I think that the hits are going to be that much more significant in areas who have less resources than we do.\u201d<\/p>\n Federal officials also canceled the county\u2019s $5.7 million grant to address COVID-19-related disparities, used to shore up vulnerable communities ahead of the next disease outbreak, natural disaster or heat wave, Rudman said. The money helped the county conduct basic laboratory testing and vaccine outreach for a wide range of diseases, not just COVID-19.<\/p>\n Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org<\/a>.<\/em><\/p>\n\n<\/div>\n\n\n\u2018Increasing need\u2019<\/h4>\n
Data and dollars<\/h4>\n