A series of executive orders by President Donald Trump aimed at eliminating diversity, equity, and inclusion—or equal representation—programs are systematically dismantling U.S. public health infrastructure.1 These actions threaten the nation’s capacity to detect disease outbreaks, respond effectively to health emergencies, and protect vulnerable communities.
The Trump administration’s war on representation for all, coupled with the Department of Government Efficiency (DOGE) cuts,2 has led to the termination of more than 1,700 research grants3 across National Institutes of Health (NIH) programs and the elimination of millions of dollars in federal grants4 and of health equity positions, including the layoff of an entire Centers for Disease Control and Prevention (CDC) team monitoring maternal mortality. Additionally, new restrictions5 on federal student loans for health professions—including the Department of Education’s reclassification of public health and nursing degrees as nonprofessional—will likely limit access and the pipeline to nursing and public health education,6 resulting in severe economic consequences. Furthermore, the negative effects of these executive orders will be intensified by the Big Beautiful Bill’s (BBB) cuts to health programs, which will cost American taxpayers billions in preventable healthcare expenses7 while making all communities less safe. The scope of these ideologically driven actions is unprecedented, representing the most significant rollback of public health capacity and infrastructure since the creation of modern disease surveillance systems.8
The dismantling of these programs threatens essential government functions that serve all Americans, irrespective of political affiliation. Cuts to diversity, equity, and inclusion initiatives9 are eliminating10 programs across multiple states—including in Texas11 and in Georgia, among others12—while federal research funding is being terminated,13 and the BBB will impose additional cuts to Medicaid and health programs.14 These documented funding losses will disproportionately affect rural communities15—which already overwhelmingly face healthcare worker shortages—as they lose access to cost-effective community health worker programs16 and environmental monitoring. Urban centers will similarly see reduced capacity for disease outbreak detection and emergency response. The economic consequences will compound the more than $320 billion that health disparities already cost annually17—measured in preventable deaths, higher levels of morbidity, decreased life expectancies, increased healthcare costs, and reduced national competitiveness—affecting individual lives and every American community.
Federal policies create a cascade of health security threats
The termination of federal research funding, including health research funding, severely curtails investment in America’s ability to understand and prevent health threats that affect all populations. The NIH’s cancellation of more than 1,700 grants18 deemed related to diversity, equity, and inclusion represents hundreds of millions of dollars in lost research capacity, including for studies on maternal mortality, environmental contamination, and disease prevention strategies. The U.S. Supreme Court’s decision to let stand $783 million in cuts19 by the Trump administration has accelerated this destruction of America’s health research infrastructure.
These funding cuts target precisely the research that protects national health security. Studies examining why certain communities—often those comprised of racial, ethnic, sexual, and gender minorities—face higher rates of disease and the health impacts of environmental contamination, as well as studies that investigate which interventions prevent20 costly health crises, are being eliminated not for scientific reasons but for political ones.21 The public health system is strongest22 when it is grounded23 in freedom, fairness,24 and safety. The current administration,25 which has proposed gutting programs without transparency, is creating a less prepared, less informed public health system that will miss emerging threats—creating the potential for them to become national emergencies.
The elimination of health surveillance systems compounds these risks. The Pregnancy Risk Assessment Monitoring System, which tracked maternal health disparities for 38 years26 and revealed that discrimination most likely contributed to approximately 30 percent27 of pregnancy-related deaths, has been suspended. Environmental justice monitoring programs28 that can provide early warning of contamination threats such as the lead poisoning seen in Flint, Michigan,29 have been defunded. By withdrawing from the World Health Organization30 and shuttering the U.S. Agency for International Development, the Trump administration has crippled essential disease surveillance systems that, among other outcomes, enabled targeted interventions during the COVID-19 pandemic.
Without these early warning systems,31 federal agencies will be operating blind, and many people, already confused by false health information spreading on social media, will be less prepared to make decisions in the best interest of themselves, their families, and their communities. Deprived of the data needed to guide interventions, the next disease outbreak or pandemic will spread for longer before detection; environmental contamination will go unnoticed until children bear the consequences; and maternal mortality will continue rising, particularly in underserved areas. This policy-driven ignorance will cost lives and money.
Economic impact: Prevention costs hundreds, crisis response costs thousands
The economic consequences of dismantling public health infrastructure are measurable and significant. The CDC estimates that health disparities cost America more than $320 billion annually32 in healthcare expenses and lost productivity—precisely the disparities that eliminated programs were designed to address. By cuttingcost-effective prevention programs that return $2.47 for every $1 invested33 in Medicaid within the first year, the Trump administration is changing federal policy and forcing reliance on expensive emergency care and crisis response, guaranteeing higher costs for taxpayers and employers. All of this runs counter to the goals of the Affordable Care Act, which uplifted prevention not only as a common good but as an economic one.34
Community health worker programs, which are being eliminated across multiple states, clearly demonstrate the economic value of prevention.35 Studies show these programs have median intervention costs ranging from $329 to $600 per patient per year for the management of various chronic diseases, including cardiovascular disease and Type 2 diabetes.36 Research on other diseases such as asthma demonstrates return on investment ranging from $2.33 to $7.79 per $1 spent. A major Health Affairs study found that every $1 invested in community health worker interventions would return $2.47 to average Medicaid payers within the fiscal year.37 The elimination of these programs will force individuals and families into expensive emergency care for conditions that could be prevented.
Environmental monitoring can prevent disasters that lead to billions of dollars in cleanup, healthcare, and litigation costs.The Environmental Protection Agency’s environmental justice activities receive approximately $375 million annually across various programs through discretionary appropriations that can be reduced or eliminated,38 while the Inflation Reduction Act provided an additional $3 billion for environmental and climate justice grants39 that must be awarded by September 2026. The Flint, Michigan, water crisis demonstrates40 the type of preventable public health emergency that environmental justice programs are designed to detect early: contamination that went unmonitored until children were poisoned,41 resulting in more than 626.25 million in legal settlements alone42 plus additional costs for infrastructure repair exceeding $90 million43 and ongoing remediation that continues more than a decade later.44
Disruptions in the workforce pipeline are expected to generate additional economic costs due to healthcare worker shortages. America already faces a shortage of nearly 200,000 nursing positions and the Bureau of Labor Statistics projects a deficit of 74,000 social workers per year over45 the next decade. The Trump administration’s immigration threats have also affected practicing American board-certified doctors.46 Furthermore, the Department of Education’s reclassification of health profession degrees—restricting federal loans for nursing, public health, and social work program—is likely to exacerbate shortages. This combination of factors will further weaken an already crippled public health infrastructure and price out students who are most likely47 to serve in underserved areas.
Workforce development crisis: Degree reclassification disrupts critical pipeline
The Department of Education’s reclassification of professional degrees48 represents a direct attack on America’s health workforce pipeline. Under new federal regulations, only 11 fields49 retain professional degree status with higher federal loan limits of $50,000 per year. Public health, nursing, social work, and other health professions have been reclassified as “nonprofessional,” with loan limits reduced to $20,500 per year—insufficient to cover program costs that average $40,000 to $60,000 per year.
The economic impact of reclassifying degrees
The Trump administration’s degree reclassification policy will disproportionately affect students from the communities most in need of culturally competent healthcare and public health services. Eighty percent of public health students are women and 55 percent are people of color,50 and these students disproportionately return to serve in rural areas, low-income neighborhoods, and tribal communities and to aid immigrant populations and other marginalized populations. For example, many of the students at the Rutgers School of Public Health are first-generation students from working-class families, women, and members of racial and ethnic minorities. By making health profession education financially inaccessible to these students, federal policy ensures that the communities with the greatest health needs will lose access to providers who understand their cultures, languages, and specific challenges. The reclassification of degrees will change the demographics of those practicing public health in the future.
Furthermore, the economic impact of the policy change extends beyond individual students to entire healthcare systems. Current nursing students have an average of $52,000 in federal loans even at public universities, where tuition is significantly lower than at private institutions. At Rutgers, even with state tuition rates, recent Master of Public Health and public health doctoral students had, on average, $52,425 and $78,486 in loans, respectively. The policy’s new loan caps will force students to seek private loans with higher interest rates and less favorable terms or abandon health careers entirely. Recent polling shows that 59 percent of potential nursing students51 are “less likely” to pursue graduate degrees due to the new loan policies.
The contrast in federal priorities is stark: Theology degrees retain professional status while nursing degrees lose it. Medical and law degrees maintain higher loan limits while public health and social work face restrictions. This sends a clear message from the current administration about which professions are valued by the federal government and which populations matter when it comes to healthcare.
Threats to emergency preparedness and national security
The dismantling of public health infrastructure directly threatens America’s ability to respond to national health emergencies and security threats. The COVID-19 pandemic demonstrated the effectiveness of community health workers, disease surveillance systems, and culturally competent outreach programs in responding to a national health emergency. The elimination of these capabilities leaves America less prepared52 for the next pandemic.
Community health workers, front-line public health professionals who are trusted members of the communities they serve, proved essential during the COVID-19 pandemic53 for reaching communities with low vaccination rates, providing accurate health information in multiple languages, and building trust with populations skeptical of government health messages. Their elimination forces public health agencies back to top-down communication strategies that fail to reach diverse populations effectively. When the next pandemic emerges, disease transmission will continue longer in communities that the U.S. public health system cannot effectively engage.
Environmental monitoring programs54 serve similar national security functions by providing early warning of contamination threats that could result from industrial accidents, infrastructure failures, or potential bioterrorism attacks. The elimination of environmental justice specialists removes America’s capacity to detect and respond to environmental threats before they become public health emergencies affecting multiple states and requiring federal disaster response.
The loss of health disparities research eliminates America’s understanding of how social and economic factors create vulnerability to health threats. This research provided the foundation for targeted interventions that protected entire populations during health emergencies. Without this knowledge base, federal agencies will be forced to implement generic responses that miss the populations most at risk and allow threats to spread more widely.
Recommendations: Restoring America's health security infrastructure
Federal lawmakers should immediately reverse policies that are dismantling America’s public health infrastructure and implement measures to strengthen the nation’s health security capacity.
Restore federal research funding: Congress should restore funding for the more than 1,70055 terminated research grants and implement safeguards to prevent politically motivated research cancellations. Research on health disparities is a critical national investment in understanding and preventing costly health crises that affect all Americans.
Maintain professional degree status: The Department of Education should reverse its reclassification of health profession degrees and preserve higher federal loan limits for nursing, public health, social work, and other health fields essential to America’s health workforce. The current policy will worsen critical workforce shortages, which in turn will reduce healthcare access and impede the ability of every American community to thrive.
Preserve surveillance systems: Federal agencies should restore and strengthen health surveillance systems that deliver early warning of disease outbreaks, environmental contamination, and other public health threats. These systems serve essential government functions that protect national health security.
Strengthen community health infrastructure: Federal policy should prioritize the expansion of community health worker programs, environmental justice monitoring, and culturally competent health services. These programs offer cost-effective preventive measures that save taxpayers money and protect vulnerable populations.
Protect academic freedom: Federal funding policies should be based on scientific merit rather than political considerations. This approach enables researchers to investigate health threats; community programming and educational and research programs, which seek to improve the health of the most vulnerable populations; and prevention strategies without fear of losing funding due to political motivations.
Conclusion
America faces a choice between implementing evidence-based public health policy and pursuing ideologically motivated actions that undermine health infrastructure. The Trump administration, on its current path of eliminating research, dismantling surveillance systems, and restricting access to health professions education, will make Americans less safe, worsen health outcomes, and increase healthcare costs for families and taxpayers.
The consequences of advancing politically motivated actions over measurable, evidence-based policies will result in longer and more virulent disease outbreaks, higher healthcare costs, greater health disparities, and diminished U.S. competitiveness in health innovation. Eliminating health equity infrastructure does not only harm marginalized communities—it weakens the entirety of the public health system and leaves all Americans more vulnerable to preventable crises. As other nations advance in research and emergency preparedness, the United States risks losing its leadership role in global health by moving away from scientific approaches.
Restoring health security in the United States requires immediate action to rebuild public health capacity and reverse recent rollbacks. The choice is between a nation prepared to protect all its people and one that learns too late the cost of choosing politics over public health.
Acknowledgments
The authors would like to thank Will Roberts and Jill Rosenthal for their insights and contributions to this report. The authors would also like to thank Ben Greenho and Chandler Hall for fact-checking this report.
Authors’ note: Dr. Mariam Rashid is the associate director of Racial Equity and Justice at the Center for American Progress and an adjunct professor at Rutgers University. Dr. Perry N. Halikitis is the dean of the Rutgers School of Public Health and the author of the book Humanizing Public Health: How Disease-Centered Approaches Have Failed Us, which is cited throughout this publication. Additionally, the statistics stated in this publication pertaining to Rutgers University were provided by Dean Halikitis.