The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
The Fund identifies and shares policy ideas and analysis to advance state health leadership, strong primary care, healthy aging, and sustainable health care costs.
Keep up with news and updates from the Milbank Memorial Fund. And read the latest blogs from our thought leaders, including Fund President Christopher F. Koller.
The Fund publishes The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to health policy leaders.
The Milbank Memorial Fund is is a foundation that works to improve population health and health equity.
Nov 27, 2023
Oct 26, 2023
Oct 11, 2023
Back to The Milbank Quarterly
The Trump administration is considering narrowly defining gender as a biological, immutable condition determined by genitalia at birth, the most drastic move yet in a governmentwide effort to roll back recognition and protections of transgender people under federal civil rights law.
New York Times, October 21, 2018
In 1946 George Orwell wrote his damning essay “Politics and the English Language.” In it he argued that the “political and economic” interests of the moment had led to language’s general debasement. Language and its misuse had become a tool to cover up, confuse, and mislead the population. Orwell argued that imprecise, empty, and confusing language had been used “largely [in] the defense of the indefensible.” His examples included “British rule in India, the Russian purges and deportations, the dropping of the atom bombs on Japan.” “Defenseless villages are bombarded from the air, the inhabitants driven out into the countryside, the cattle machine-gunned. . . . This is called pacification,”1 he sardonically observed.
Certainly, Orwell would have seen some similarities in the use of language in the “defense of the indefensible” in today’s political culture. But the battle over words has taken another ominous turn for the world of science and public health policy. In recent years, a barrage of euphemisms, vague parodies of complex social and scientific issues, and deceptive presentations of evidence have clouded serious discussions about reproductive rights, pollution, and “clean coal,” among other topics. Now efforts to undermine words not just by misuse but by their actual elimination are threatening both the nation’s political culture and the world’s survival. “Climate change,” once known as “global warming,” is but one example. Another is the Trump administration’s current attempt to redefine gender as being fixed at birth without regard to an individual’s self-identity.
Orwell was focused on the growing vacuity of English as it was mauled by the political currents of the Cold War. But the present war on words at federal public health and environmental agencies is more direct: now we see an effort to literally ban their use—at least some of them. We recently learned that the policymakers at the Centers for Disease Control and Prevention (CDC) were instructed by the Trump administration to not use terms like “evidence-based,” “science-based,” “vulnerable,” “entitlement,” “diversity,” and “fetus” in materials that might be circulated to Congress and the administration for fear that they could impact the agency’s budget appropriations. Those at a meeting where this was announced were provided alternatives for certain unavoidable concepts. “Instead of ‘science-based’ or ‘evidence-based,’’’ the Washington Post reported, “the suggested phrase is ‘CDC bases its recommendations on science in consideration with community standards and wishes.’”2
While public health advocates at the CDC, the Department of Housing and Urban Development (HUD), and elsewhere are undoubtedly trying to work around the most outrageous of the Trump pronouncements, now we learn of another new wrinkle that promises to derail efforts to reach out to vulnerable populations. While the Obama administration “loosened the legal concept of gender,” reports the New York Times, the Trump administration is considering guidelines that “define transgender out of existence.” The Department of Health and Human Services (HHS) “is spearheading an effort to establish a legal definition of sex” that would make one’s gender “unchangeable and determined by the genitals that a person is born with.”3 Orwellian indeed.
The very webpages describing the CDC’s wide-ranging and creative set of programs would have to be revised, for virtually all of these words are used multiple times to describe the research and outreach programs it supports. Just look at a few examples: in addition to providing support for “HIV testing to gay and bisexual men of color and transgender youth of color,” the site explains, the CDC is developing a “compendium of evidence-based interventions,” supports “pre-exposure prophylaxis,” and conducts a “national HIV behavioral surveillance” program to “encourage condom distribution.”
Of course, much of the rhetorical attacks on the transgender community are being ignored by responsible officials. There is still a webpage for “HIV Among Transgender People,” which describes the CDC’s wide-ranging campaigns, many of which are aimed at providing information to that community through programs such as “Act Against AIDS,” an effort that encourages trust and better communication between health professionals and their communities. Another program is “HIV Treatment Works,” which encourages people living with HIV to stay in care and features transgender women’s stories of staying healthy while living with HIV. Another program advises the transgender community to “Start Talking [to] Stop HIV.” This program “helps gay and bisexual, cisgender and transgender people to communicate about safer sex, testing, and other HIV prevention issues.” Certainly, if the very words that define the community at risk or the activities necessary to control the epidemic couldn’t be used, the trust essential to gather survey information, and therefore, run these programs would be threatened.
But while there is resistance in some agencies, other government agencies are censoring themselves by no longer even gathering information. HHS has stopped asking questions about sexual orientation and gender identity in surveys of the elderly, thereby limiting its ability to establish meaningful support programs. And the Departments of Justice, Education, and HUD no longer collect information on the LBGTQ community.4 This slow debasement of our language and the data that we collect will ultimately undermine policy and important public health projects. And our agencies are being torn between their efforts to control health threats and follow orders from above.
We as a nation are undergoing attacks on some of our most cherished principles and institutions. For the most part, we have watched in horror as attacks on research, ideals, ideas, and individuals have become so commonplace that we hardly take notice. Now, the pathology that is corrupting our political culture is infecting science and population health as well. The administration’s stated goal to eliminate transgender people from the social fabric of our society threatens our ability to ensure this group’s health and safety. As I complete this essay, the New York Times reports that protesters met President Trump’s visit to Pittsburgh following the shooting at the Tree of Life synagogue with signs that read “Words Matter.” Orwell, and those of us concerned with the health of the nation, would certainly agree.5
David Rosner is the Ronald H. Lauterstein Professor of Sociomedical Sciences and professor of history at Columbia University and codirector of the Center for the History of Public Health at Columbia’s Mailman School of Public Health. He is also an elected member of the National Academy of Medicine. In addition to numerous grants, he has been a Guggenheim Fellow, a recipient of a Robert Wood Johnson Investigator Award, a National Endowment for the Humanities Fellow, and a Josiah Macy Fellow. He and Gerald Markowitz are coauthors on ten books, including Deceit and Denial: The Deadly Politics of Industrial Pollution (University of California Press/Milbank, 2002; 2013) and Lead Wars: The Politics of Science and the Fate of America’s Children (University of California Press/Milbank, 2013). He also testifies for plaintiffs in lawsuits on industrial pollution and occupational disease.
Get the Latest from the Milbank Memorial Fund
The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, political, historical, legal, and ethical dimensions of health and health care policy.