By Nancy Kass,


C. Everett Koop, Surgeon General under President Reagan—and known publicly to oppose abortion, homosexuality, and premarital sex–insisted in the mid-1980s that the brochure “Understanding AIDS” be sent to every American household. It began, “Some of the issues included in this brochure may not be things you are used to discussing openly. I can easily understand that.”  But it emphasized, in fighting AIDS, the need for accurate information.  The brochure provided education, not only that condoms can prevent infection, but also precisely how and what type of condoms to use.  When the Reagan administration wanted Dr. Koop to issue a report describing the psychological harm of abortion, he refused, stating that, despite his own wish to curtail the practice, data did not support the claim.


The Centers for Disease Control and Prevention is our nation’s public health agency, and, consistent with history, it can do its work successfully only when driven by accurate, transparent science rather than by politics.  And yet new restrictions imposed on the CDC this week forbid the agency from using the words diversity, transgender, vulnerable, fetus, entitlement, evidence-based, or science-based in certain communications.  While clever professionals can find ways to frame their same ideas differently, what is pernicious is the message being sent that science or evidence is not the way to design, fund, or communicate our national public health strategies, and that vulnerable populations- including transgender persons specifically, or diverse populations generally—should be made to disappear or have their interests literally silenced.


Public health, like other professions, is guided by ethical codes and frameworks.  These frameworks emphasize that public health should provide benefit through preventing or minimizing illness and death; that public health strategies cannot be imposed by government on the people without strong evidence that supports their effectiveness; that harms of any interventions must be minimized, including through transparency and truthfulness; and that public health must be bound by assurances of fairness to all people.


Public health is a responsibility of government in all 50 states as well as within our federal government.  It helps, for example, to ensure that we have safe water and food, and it requires vaccination and bicycle helmets, saving hundreds of thousands of children from preventable death.  That public health is responsible for the health of all persons in a community means two things.  First, it means public health cannot ignore the health needs of particular subgroups of a population—both because of commitments to fairness, that undergird the field, and also because public health discovered long ago that health risks facing any particular group often ultimately threatens the health and well-being of others.  Second, a responsibility for all means public health must collect data on how and why the health of particular subgroups may differ, and on which responses work best for which populations.  So yes, understanding the particular health risks transgender people face is a responsibility of public health, as is understanding the risks faced by adolescents, people in rural communities, pregnant persons, or any other population.  And then using information collected to communicate to transgender people and/or their clinicians areas of health to particularly discuss, symptoms to watch out for, and respectful ways of interacting, lowers the chance that yet another vulnerable population will have lives cut short unnecessarily.


Ethics and public health are intertwined.  They both stand for truth, science, fairness, and prevention of harm to others.  Public health can improve the public’s health only when it doggedly defends its ability to – like doctors, nurses, or teachers—serve all without judgment.  Silencing the interests of some populations, and compromising evidence-based policy through the tainted lens of promoting community values, has been shown for decades to backfire.  If morality within government means avoiding the truth, or avoiding those in need, it is a frame of morality that may need to be silenced.



Image: Natalie Hope McDonald

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Nancy Kass

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