Public Health Is About to Get Sicker
A new federal rule seeks to defund public health degrees, even as RFK Jr.’s anti-DEI, pro-“efficiency” crusade erodes care capacity
By Dr. Mariam Rashid and Dr. Perry N. Halikitis
Last month, a deadly hantavirus outbreak spread across a cruise ship whose crew and passengers represented 23 countries, including Americans. Thankfully, the world’s surveillance systems — built on decades of investment in international cooperation, trained epidemiologists, and rapid data-sharing — detected it, tracked it, and contained it. This time. But right now in the U.S., the public health infrastructure that made that response possible is being systematically dismantled in the name of eliminating diversity, equity, and inclusion.
Under a new federal rule taking effect July 1, students in nursing, public health, and social work programs will be locked into a $20,500 annual loan cap and a $100,000 lifetime loan limit — while the federal Grad PLUS program, which previously allowed students to borrow up to the full cost of attendance, is eliminated entirely. Students pursuing law, medicine, dentistry, or theology will qualify as “professional” students, eligible to borrow up to $50,000 per year and $200,000 over a lifetime. For many graduate nursing programs that cost $100,000 in tuition alone, the math simply does not work. This is not a bureaucratic footnote. It is a statement about which Americans this administration believes are worth protecting — and who gets to do the protecting.
We write from two vantage points: one of us as the dean of a major public health school, the other as a race and health equity researcher who tracks what these decisions do to real communities. From both positions, we are watching the same story unfold: the deliberate gutting of the American public health system; a pattern in which the communities bearing the greatest health burdens are the first to lose the protections designed to address them.
At Rutgers School of Public Health, where one coauthor works, 80% of students are women and 55% are people of color. These students overwhelmingly choose careers in rural communities, underserved neighborhoods, and places with acute shortages in primary care options. These are also the communities — disproportionately Black, Latino, and Indigenous — that face the highest rates of chronic disease, maternal mortality, and environmental hazards. As of May, 106 million Americans live in a federally designated primary care shortage area. The administration’s answer to this crisis: make public health degrees harder to afford, pricing out the very students most likely to serve these vulnerable communities.
This new rule affecting professional health and public health degrees doesn’t exist in isolation. Anti-DEI executive orders have produced the most significant rollback of public health capacity since the creation of modern disease surveillance systems. Over 1,700 research grants have been terminated, many of them focused on understanding and reducing racial health disparities. Surveillance teams that tracked maternal mortality for nearly four decades have been disbanded — programs that existed precisely because Black women in America die in childbirth at nearly three times the rate of white women.
When Congresswoman Summer Lee (D-PA) pressed HHS Secretary Robert F. Kennedy Jr. on this at an April congressional hearing, asking how the administration planned to solve the Black maternal mortality crisis while directing agencies to remove the word “Black” from funding applications, he offered no answer. He instead pivoted to talking point about DEI dividing the country. That evasion tells you everything about what this administration considers a public health priority.
These are not wasteful programs, as the administration says they are. They are the early warning systems that determine whether we detect the next outbreak in days or weeks — and whether the people trained to respond are there at all. They are the ways we monitor environmental contamination, which disproportionately exposes communities of color to toxic sites and polluted air and water. They are the means by which we measure where healthcare needs are greatest in this country and seek to address them. Dismantling prevention doesn’t eliminate costs — it defers them and multiplies them.
Health inequities cost the American economy more than $450 billion annually in lost productivity and preventable expenses. Randomized clinical trials showed that community health workers save Medicaid $2,500 per enrollee annually by preventing costly hospitalizations — a fraction of what a single emergency room visit costs. What looks like a spending cut is a cost shift from affordable prevention to expensive crisis response, paid by everyone.
When a government systematically defunds the research that tracks certain communities’ health outcomes, disbands the teams that monitor their environmental conditions, and prices out the students who would have served them, it makes a moral claim. It says racial and economic disparities in health are not problems worth solving. It says some Americans are acceptable losses. That is dehumanizing. And it is dangerous for everyone, because disease does not honor those distinctions.
The hantavirus does not check passports. Contaminated water does not stop at zip code boundaries. An outbreak that begins in an under-resourced community with no surveillance, no community health workers, and no trained response capacity does not stay there. An America that decides some of its people are not worth protecting does not become stronger; it becomes more vulnerable — and pays more for the privilege of that choice.
Congress can still act. The degree reclassification takes effect in 15 days — it can be reversed. Terminated research funding can be restored. The surveillance infrastructure being dismantled can be rebuilt. The question is whether lawmakers are willing to treat this as the public safety emergency it is, or whether they will wait until the next outbreak makes the cost of this ideology even more impossible to ignore.
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 Humanizing Public Health: How Disease-Centered Approaches Have Failed Us, which is cited throughout this publication. The statistics stated in this publication pertaining to Rutgers University were provided by Dean Halikitis.