Executive Summary

This report analyzes the increasing integration of social justice frameworks into the medical profession, examining its impact on clinical practice, research, and institutional policy. The analysis is framed through the lens of the United Nations Sustainable Development Goals (SDGs), with a particular focus on SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), SDG 10 (Reduced Inequalities), and SDG 16 (Peace, Justice and Strong Institutions). The report assesses case studies in public health responses to racial inequality and the evolving standards of care in gender medicine, highlighting a tension between advancing social equity and upholding evidence-based medical principles. The findings suggest that while the intent to address inequalities aligns with the SDGs, certain applications may challenge the integrity of healthcare institutions and the delivery of care, potentially undermining the primary objective of SDG 3.

The Influence of Social Equity Agendas on Public Health and Clinical Practice

Recent years have seen a significant push to embed principles of social justice, particularly racial equity, into healthcare policy and practice. This movement seeks to address systemic disparities, a core target of SDG 10 (Reduced Inequalities). However, the implementation of these principles has generated debate regarding their alignment with established clinical ethics and the overarching goal of SDG 3 (Good Health and Well-being).

Case Studies in Equity-Focused Health Policy

Several instances illustrate the complex application of equity frameworks in public health and clinical decision-making:

• Public Health Guidance: Following the death of George Floyd, public health professionals advocated for mass protests, arguing the public health benefits of combating systemic racism outweighed the risks of COVID-19 transmission. This approach prioritized social justice objectives over conventional epidemiological risk assessment.
• Resource Allocation: Proposals emerged to use race as a primary factor in rationing scarce resources, such as ventilators and COVID-19 vaccines. The CDC’s Advisory Committee on Immunization Practices initially suggested prioritizing non-white populations over older age groups for vaccination to counteract historical inequities. This was ultimately rejected by the CDC on the grounds that an age-based strategy was more effective at preventing mortality, thereby better serving SDG 3 for all populations, including minority seniors.
• Institutional Mandates: Leading medical bodies, including the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC), have promoted mandatory anti-racism training to dismantle structural oppression.

These initiatives highlight a critical challenge: balancing the imperative to reduce inequalities (SDG 10) with the need for transparent, scientifically grounded, and trusted health institutions (SDG 16) that deliver optimal health outcomes for individuals (SDG 3).

Gender Medicine: A Focal Point for Debates on Evidence, Ethics, and SDGs

The field of gender medicine, particularly concerning youth, has become a prominent area where differing approaches to healthcare clash. The debate centers on the appropriate clinical pathways for gender dysphoria and involves complex considerations related to SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 16 (Peace, Justice and Strong Institutions).

Analysis of Institutional Guidance and Research Practices

The American Psychiatric Association’s (APA) 2023 textbook, Gender-Affirming Psychiatric Care, advocates for an affirming model but has faced criticism for its lack of balanced analysis. This raises concerns about the role of professional organizations in upholding the principles of SDG 16, which calls for effective and accountable institutions.

1. Omission of Clinical Complexities: The textbook reportedly fails to adequately address co-occurring mental health conditions, the phenomenon of desistance (where gender dysphoria resolves), or the debate surrounding Rapid-Onset Gender Dysphoria (ROGD). A comprehensive approach to SDG 3 requires thorough assessment and treatment of all contributing health factors.
2. Lack of International Context: The publication did not include the vigorous international debate and policy shifts occurring in several European nations, thereby failing to incorporate global evidence-sharing crucial for SDG 17 (Partnerships for the Goals).
3. Suppression of Unfavorable Data: Reports have emerged of researchers withholding data that did not show significant mental health benefits from puberty blockers, citing concerns that the findings could be used to restrict access to care. This practice directly undermines the scientific integrity necessary to build the accountable institutions envisioned in SDG 16 and to ensure all health interventions under SDG 3 are safe and effective.

International Evidence and Policy Divergence (SDG 17)

In contrast to the “full-speed-ahead” approach critiqued in the report, several European countries have adopted more cautious policies based on systematic evidence reviews, demonstrating the importance of international collaboration (SDG 17) in shaping best practices.

• The Cass Review (UK): The 2024 independent review commissioned by the UK’s National Health Service concluded that the evidence base for medical transition interventions for youth is “remarkably weak.” It recommended that puberty blockers and hormones be used with “extreme caution” outside of a research protocol, prioritizing the long-term well-being central to SDG 3.
• Other European Nations: Sweden, Norway, and France have also revised their guidelines to reflect the uncertainty of benefits and potential for harm, classifying such treatments as experimental and advising clinical restraint.

Conclusion and Recommendations for Aligning with Sustainable Development Goals

The integration of social justice objectives into medicine presents both opportunities and challenges for achieving the Sustainable Development Goals. While addressing health disparities is fundamental to SDG 10 and ensuring the rights and well-being of all individuals is key to SDG 5, the methods employed must not compromise the foundations of medical science and ethics that underpin SDG 3. The erosion of public trust in medical institutions due to perceived politicization poses a direct threat to the vision of SDG 16.

To move forward, the following actions are recommended:

1. Reinforce Evidence-Based Practice: Healthcare institutions must recommit to evidence-based medicine as the primary standard for clinical guidelines, ensuring that all recommendations are based on high-quality, transparent research to support SDG 3.
2. Promote Institutional Accountability: Professional medical organizations must foster open debate and present balanced analyses of controversial topics, incorporating global evidence and diverse clinical perspectives to strengthen their role as accountable institutions under SDG 16.
3. Enhance Research Integrity: A culture of scientific integrity must be upheld, where all research findings, regardless of their political implications, are published to inform clinical practice and public policy.
4. Foster International Collaboration: Greater emphasis should be placed on international partnerships (SDG 17) to share data, evidence reviews, and long-term outcomes to develop global best practices for complex health issues.

Ultimately, achieving sustainable health outcomes requires a balanced approach that reduces inequality (SDG 10) and promotes well-being (SDG 3) through strong, trustworthy, and scientifically rigorous institutions (SDG 16).

Analysis of Sustainable Development Goals in the Article

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

• SDG 3: Good Health and Well-being

  This is the central SDG addressed in the article. The entire text is a critique of current trends in medicine and public health. It discusses clinical care for gender dysphoria, mental health comorbidities (depression, anxiety, PTSD), public health responses to the COVID-19 pandemic (vaccine allocation, risk communication), and the fundamental mission of medicine to improve health.

• SDG 5: Gender Equality

  The article extensively discusses “gender medicine,” focusing on the treatment of transgender, non-binary, and gender-expansive (TNG) individuals, particularly youth. It delves into the controversies surrounding gender-affirming care, puberty blockers, and surgery. The mention that rapid-onset gender dysphoria “seems to overwhelmingly affect girls” also connects the issue directly to this goal.

• SDG 10: Reduced Inequalities

  The article directly addresses policies aimed at reducing racial inequalities in healthcare. It cites examples from the post-George Floyd era, such as proposals to prioritize Black patients for ventilators and COVID-19 vaccines as a form of “reparations” or to counteract demographic imbalances. The American Medical Association’s strategic plan to “confront inequities and dismantle white supremacy, racism” is also a key example.

• SDG 16: Peace, Justice and Strong Institutions

  The author critiques the integrity and accountability of major medical and scientific institutions. The article questions the actions and publications of the American Psychiatric Association (APA), the American Medical Association (AMA), the Centers for Disease Control and Prevention (CDC), and medical schools. It highlights a perceived loss of objectivity, “censorship” in research, the withholding of unfavorable study results, and a subsequent erosion of “public trust in the medical system,” all of which relate to the strength and transparency of institutions.

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

• SDG 3: Good Health and Well-being

  • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
    
    Explanation: The article’s focus on treating gender dysphoria and its “frequent co-occurring issues, such as depression, anxiety, and posttraumatic stress disorder” directly relates to promoting mental health and well-being. The author questions whether current approaches, like those in the APA textbook, are effective or evidence-based, thus engaging with the “treatment” aspect of this target.
  • Target 3.8: Achieve universal health coverage, including… access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
    
    Explanation: The debate over access to and the quality of gender-affirming care (puberty blockers, hormones, surgery) is a central theme. The article also discusses the allocation of COVID-19 vaccines, questioning a proposal to prioritize based on race over age, which touches upon equitable access to essential medicines. The author’s core argument is a critique of the “quality” and “effectiveness” of these services when influenced by ideology.
  • Target 3.d: Strengthen the capacity of all countries… for early warning, risk reduction and management of national and global health risks.
    
    Explanation: The article critiques the public health response during the COVID-19 pandemic. It cites an epidemiologist who, in the author’s view, blurred her professional role by advising on moral prerogatives rather than providing objective risk metrics. It also discusses the CDC’s decision-making process on vaccine allocation, which is a core function of managing national health risks.

• SDG 5: Gender Equality

  • Target 5.1: End all forms of discrimination against all women and girls everywhere.
    
    Explanation: The article discusses gender-affirming care, which is intended to support individuals facing discrimination based on gender identity. The author’s specific mention that the phenomenon of “rapid-onset gender dysphoria” seems to “overwhelmingly affect girls” links the debate directly to the health and well-being of girls.

• SDG 10: Reduced Inequalities

  • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory… policies and practices…
    
    Explanation: The article directly discusses policies proposed to reduce inequalities of outcome for racial groups. It describes a bioethicist’s argument to “prioritize black patients” for ventilators and the CDC committee’s recommendation that “race should supersede age as a prioritization category” for vaccines. The author critiques these specific policies as a means to achieve the goal.

• SDG 16: Peace, Justice and Strong Institutions

  • Target 16.6: Develop effective, accountable and transparent institutions at all levels.
    
    Explanation: The author’s primary argument is a critique of medical institutions. The article accuses the APA of publishing a biased textbook that “omits essential facts,” and it highlights a researcher who “withheld data on the impact of puberty blockers” because the results were not favorable to her position. These actions are presented as failures of accountability and transparency.
  • Target 16.7: Ensure responsive, inclusive, participatory and representative decision-making at all levels.
    
    Explanation: The article criticizes the decision-making processes within professional organizations. It argues the APA textbook is not representative of the “vigorous international scientific debate” and that the CDC advisory committee’s initial advice on vaccines was not based on objective risk metrics, suggesting a failure in responsive and representative decision-making.

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

• For SDG 3 (Good Health and Well-being)

  • Mental health outcomes for youth receiving puberty blockers: The article explicitly mentions a study that measured “improvement in depression and suicidal ideation” in adolescents using puberty blockers. The withholding of this data implies its existence as a key indicator of treatment effectiveness.
  • COVID-19 mortality rates based on vaccine allocation strategies: The article cites a CDC official’s estimate that a “race-based vaccine allocation plan would result in up to 6.5 percent more COVID-related deaths.” This is a quantifiable indicator used to evaluate public health policy.
  • Prevalence of psychiatric comorbidities: The article notes the importance of treating “frequent co-occurring issues, such as depression, anxiety, and posttraumatic stress disorder” in gender-dysphoric youth, implying that tracking the prevalence and treatment of these conditions is a key clinical indicator.
  • Rates of desistance and detransition: The article mentions the phenomenon of “desistance—the phenomenon wherein gender dysphoria diminishes before transition” and the need for high-quality studies to track it, suggesting this rate is a critical indicator for understanding outcomes.

• For SDG 10 (Reduced Inequalities)

  • Use of group identity in clinical triage: The article discusses proposals to use race as a primary factor for rationing scarce resources like ventilators and vaccines. Whether or not such policies are implemented is a direct indicator of how institutions are attempting to address inequality.

• For SDG 16 (Peace, Justice and Strong Institutions)

  • Publication of comprehensive and evidence-based clinical guidelines: The article’s critique of the APA’s textbook implies that an indicator of institutional integrity is the quality and impartiality of its official publications. The failure to mention the Cass Review or international debates is cited as a negative indicator.
  • Public trust in the medical system: The author explicitly states that certain policies “deal a serious blow to public trust in the medical system.” While not quantified, public trust is presented as a key indicator of institutional health.
  • Transparency in research reporting: The article provides a specific example of a researcher who “withheld data” from a multimillion-dollar study. The rate of publication of all study results, regardless of outcome, serves as an indicator of institutional transparency and accountability.

SDGs, Targets, and Indicators Table

Source: aei.org