Removing diversity, equity, and inclusion infrastructure in medicine, public health, and science: the cost of overcorrection

On 20 January 2025, Donald Trump, President of the United States, issued executive order (EO) 14151, “Ending Radical and Wasteful Government DEI Programs and Preferences.” The executive order directed federal agencies to terminate “equity-related” grants and contracts within 60 days.1 The following day, the Trump Administration issued EO 14173, “Ending Illegal Discrimination and Restoring Merit-Based Opportunity,” requiring federal contractors and grant recipients to certify that they do not operate “illegal” diversity, equity, and inclusion (DEI) programmes and also directing the US Attorney General to submit a “strategic enforcement plan” to deter DEI programmes among private sector enterprises, including publicly traded corporations, large non-profit organisations, foundations, institutions of higher education, and medical associations.2 By stoking fear and confusion, these directives threaten to disrupt essential, data-driven efforts in medicine, public health, and science, and risk serious harm to the communities we serve. A new report by Global Health 50/50, “Rollback and Resistance: How US-Based Global Health Organizations are Responding to the DEI Crackdown,”³ provides the first evidence-based glimpse into the chilling effect of these actions.

Global Health 50/50 (GH5050) is a global non-profit organisation that collects, analyses, and publishes data on gender equality and diversity among enterprises active in health and health policy. Their new report assesses changes to DEI language on the websites of 72 global health organisations with headquarters in the US in the wake of the executive orders described above.3 GH5050 compared data collected in February 2025 with those obtained between September 2024 and January 2025. The analysis revealed a considerable percentage of organisations have removed their public commitments to gender equality (20% reduction) and language about their policies to advance gender equality or women’s leadership in the workplace (23% reduction). The vast majority of organisations making changes receive funding from the US government.

It is worth exploring the drivers of this type of appeasement—observed across industries 45 since Trump’s election in November 2024—and the curious lack of attention being paid to the downstream impact of jettisoning DEI best practices on mission and market competitiveness. An abundance of evidence supports the relationship between workforce diversity and innovation, profitability, and health outcomes.6789101112 We understand that organisational leaders, motivated to protect their people—both those they employ and those they serve—must mitigate the potential risks of funding loss and litigation. Simultaneously, they must also ensure that decisions made during this crisis are intentional, forward-thinking, and robustly informed by the law and scientific evidence so as to avoid actions that unnecessarily jeopardize their future sustainability and raison d’etre.

We are not attorneys. Nevertheless, the legal response to the Trump Administration’s constitutional over-reach has been swift and provides reassurance that organisational attempts to eliminate DEI programming are at best unnecessary and at worst risky unto themselves. In late February, a US court temporarily stopped the federal government from enforcing the executive orders’ termination, certification, and enforcement-threat provisions.13 Additionally, in February, 16 state attorneys general issued a multi-state guidance clarifying the viability and important role of DEI efforts in maintaining legally compliant and thriving workplaces.14 State attorneys general are the chief legal officers for their respective states and are responsible for enforcement of employment discrimination laws. The guidance specifically criticises EO 14173 for being “inaccurate and misleading” by conflating unlawful preferences in hiring and promotion with “sound and lawful best practices for promoting diversity, equity, inclusion, and accessibility in the workforce.” The guidance also confirms that DEI best practices within private organisations, including those that receive federal contracts and grants, are not only compliant with state and federal civil rights laws but also help reduce litigation risk by protecting against discriminatory conduct that violates the law. Concurrently, 38 US university law professors wrote a memo outlining why common DEI initiatives are legally defensible despite the executive orders.15 We strongly encourage all members of the medical, public health, and scientific research communities— especially executive leadership— to read these well written documents and similarly instructive articles carefully.1617

Given the growing outcry among experts that DEI best practices are not illegal and the federal government is without legal authority to issue executive orders that prohibit these types of DEI activities, why are so many leaders lining up to obey? Historically, individuals, institutions, and nations have pre-emptively conceded, sometimes for very good reasons, to placate authoritarian power. (The Munich Agreement of 1938 is a classic example.) The problem with this seemingly pragmatic approach is that authoritarian regimes are insatiable,18 and it is unrealistic to believe that one concession—like shuttering evidence-based, value-driven, mission-aligned DEI practices—will be enough.

Instead of anticipatory obedience, the medical, public health, and scientific communities must do what we do best: follow the data, be methodical, think critically about the cascade of consequences flowing from our decisions, remind our fellow citizens of the many values we share like access to health and opportunity, and shine a light on untruths and injustices. Let’s begin by taking a collective pause in removing our DEI infrastructure, not only because legally we are not compelled to do so, but also to safeguard our future viability. We know that science, patients, and the planet benefit from harnessing the talents of an entire workforce. Our financial sustainability does as well. If we continue to capitulate to unsubstantiated rhetoric, no matter how threatening it is, our institutions and organisations may not recover.