Racial health disparities could widen as states grapple with Trump cuts, experts warn – ictnews.org

Report on the Impact of U.S. Federal Funding Reductions on Health Equity and Sustainable Development Goals

Introduction: Setbacks for SDG 3 and SDG 10

Recent federal funding cuts and policy shifts in the United States are poised to widen racial health disparities, presenting a significant challenge to the achievement of key Sustainable Development Goals (SDGs). The termination of grants and the restructuring of programs aimed at health equity directly undermine progress on SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities). Public health experts warn that these actions threaten to reverse gains made in addressing systemic inequities in healthcare access and outcomes for minority and vulnerable communities.

Threats to SDG 3: Good Health and Well-being

Exacerbation of Existing Health Disparities

The reduction in funding for programs targeting health equity directly impacts the goal of ensuring healthy lives and promoting well-being for all. The COVID-19 pandemic highlighted pre-existing vulnerabilities, and the current policy changes risk magnifying these disparities. Key areas of concern include:

• Disproportionate Disease Burden: Communities of color experience higher rates of chronic illnesses, cancer deaths, and diabetes-related amputations due to inadequate access to care. Black women face a nearly 40 percent higher risk of death from breast cancer than white women.
• Infectious Disease Control: The nation has seen a rise in congenital syphilis cases, which disproportionately affect Black and Indigenous families. Reduced public health capacity could allow for the wider spread of outbreaks.
• Access to Care: Projected cuts to Medicaid spending, estimated at $911 billion over the next decade, are expected to remove individuals from health coverage. As Black and Hispanic people are disproportionately represented on Medicaid rolls, this will severely impact their access to essential health services, contrary to the principles of SDG 3.

Undermining SDG 10: Reduced Inequalities

Systematic Dismantling of Equity-Focused Initiatives

The administration’s actions represent a direct challenge to SDG 10, which calls for reducing inequality within and among countries. By targeting programs specifically designed to address racial and social inequities, these policies risk entrenching and worsening disparities.

Key Administrative Actions and Their Impact

1. Termination of Federal Grants: Hundreds of grants from the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and the Department of Health and Human Services (HHS) have been terminated. These grants funded state, local, and nonprofit initiatives addressing health equity in rural, low-income, and minority communities.
2. Closure of Minority Health Offices: Federal offices dedicated to fighting health disparities, such as the Offices of Minority Health under the Centers for Medicare & Medicaid Services, have been gutted. This trend extends to the state level, with the Arkansas Department of Health shutting down its minority health-focused office due to a lack of federal grant funding.
3. Reclassification of Equity Efforts: The Department of Justice has issued guidance suggesting that Diversity, Equity, and Inclusion (DEI) initiatives that receive federal funding may be “discriminatory.” This policy shift discourages and delegitimizes targeted efforts to reduce inequality.

Impact on Institutional Frameworks and Partnerships (SDG 16 & SDG 17)

Erosion of Data Collection and Institutional Capacity

The policy changes weaken the institutional mechanisms required to monitor and address health inequities, affecting SDG 16 (Peace, Justice and Strong Institutions). Furthermore, the cancellation of grants dismantles vital collaborations, hindering progress on SDG 17 (Partnerships for the Goals).

• Data Suppression: Health agencies report that federal officials are no longer requiring the collection and reporting of race and ethnicity data. This impedes the ability to identify disparities, measure outcomes, and design effective interventions, which is fundamental to building accountable institutions.
• Reduced Local Capacity: State and local health departments are experiencing layoffs and reduced resources. The Santa Clara County Public Health Department in California had its $5.7 million grant to address COVID-19 disparities canceled, money that was being used to prepare vulnerable communities for future health crises.
• Disruption of Partnerships: The terminated grants sever partnerships between federal, state, and local governments, as well as universities and community organizations, which are essential for creating tailored, community-based health solutions.

Conclusion: A Regression in Sustainable Development

Expert Assessment of Long-Term Consequences

Health policy experts, clinicians, and researchers express grave concern that the cumulative effect of these funding cuts and policy changes will lead to a significant regression on national health goals and the SDGs. The consensus is that these actions will not only harm the most vulnerable but will also undermine the health system for everyone by allowing for more late-stage disease, which is costlier for both patients and health systems. The combination of declining public health capacity and increasing need creates a formula for widening health disparities, moving the nation further away from the universal goals of good health, well-being, and equality.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The article’s central theme is health, focusing on racial health disparities, access to healthcare, and the impact of funding cuts on public health programs. It discusses higher mortality rates from COVID-19 and breast cancer among racial minorities, the prevalence of chronic illnesses like diabetes, and the spread of communicable diseases such as HIV, congenital syphilis, and measles.
• SDG 10: Reduced Inequalities: The article directly addresses inequality by highlighting how federal policy changes are expected to widen racial health disparities. It details the termination of grants and the shuttering of offices specifically designed to address “worse health care access and outcomes for racial minorities,” thereby exacerbating inequalities between different racial groups.
• SDG 1: No Poverty: The article connects health disparities to poverty and economic vulnerability. It mentions that cuts to Medicaid will disproportionately affect Black and Hispanic people, who are overrepresented on the rolls. It also points to hidden poverty and food insecurity in wealthy areas like Silicon Valley, where “more than 27,000 children suffer food insecurity,” linking economic status to health vulnerability.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.3: End the epidemics of AIDS… and other communicable diseases. The article mentions the termination of research grants for illnesses like “HIV and AIDS, which disproportionately affect Black and Hispanic people.” It also refers to a “spike in congenital syphilis cases” and the uncontrolled spread of “measles,” indicating a setback in combating communicable diseases.
• Target 3.4: Reduce by one-third premature mortality from non-communicable diseases. The article discusses higher rates of chronic illnesses and cancer deaths in communities of color. Specifically, it states that “Black women have an almost 40 percent higher risk of death from breast cancer than white women” and that communities of color have “more diabetes-related amputations,” which are outcomes of non-communicable diseases.
• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services… for all. The article highlights threats to universal health coverage by discussing cuts to Medicaid, which is projected to “push people off the rolls.” The core issue of “less access to health care” for communities of color is a direct challenge to achieving this target.
• Target 10.2: Empower and promote the social… inclusion of all, irrespective of… race, ethnicity… or other status. The article details the rollback of programs aimed at health equity. The shuttering of federal offices and termination of grants for Diversity, Equity, and Inclusion (DEI) programs directly undermines efforts to promote the inclusion of racial minorities in the health system.
• Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory… policies and practices. The article discusses the federal administration’s crackdown on DEI programs, which were established to combat systemic disparities and reduce inequalities of outcome. The termination of these programs and the potential widening of health gaps represent a failure to ensure equal opportunity in health.
• Target 1.3: Implement nationally appropriate social protection systems and measures for all… and achieve substantial coverage of the poor and the vulnerable. The article points to the erosion of a key social protection system by describing projected cuts to federal Medicaid spending. It notes that these changes will disproportionately impact Black and Hispanic people, who are a significant portion of Medicaid enrollees, thereby reducing coverage for the vulnerable.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Mortality and Morbidity Rates Disaggregated by Race: The article provides specific data points that serve as indicators of health inequality. These include:
  • Higher death rates for “Black, Hispanic and Indigenous people” from COVID-19 compared to white people.
  • The “almost 40 percent higher risk of death from breast cancer” for Black women compared to white women.
  • The disproportionate occurrence of “congenital syphilis cases” among Black and Indigenous families.
  • Higher rates of “diabetes-related amputations” in communities of color.
• Funding and Existence of Health Equity Programs: The article implies that the number and funding levels of programs dedicated to health equity are key indicators. It explicitly mentions the termination of “hundreds of grants for state, local and territorial health departments,” the cancellation of “more than 5,400 NIH research grants,” and the gutting of “federal offices dedicated to fighting disparities,” all of which can be tracked.
• Health Insurance Coverage Rates: The projected impact of Medicaid cuts serves as an indicator for access to care and social protection. The article notes that the new law is “projected to cut federal Medicaid spending by an estimated $911 billion over the next decade,” which will lead to people being “pushed off the rolls,” directly impacting coverage rates, especially for minority groups.
• Collection of Disaggregated Health Data: The article indicates that data collection practices are a crucial measure of commitment to addressing disparities. It states that “federal officials are informing health agencies that race and ethnicity data are no longer required to be reported.” Whether this data is collected or not is a direct indicator of the ability to monitor and address health inequalities.

4. Table of SDGs, Targets, and Indicators

Source: ictnews.org