Legal and Ethical Implications of HHS Investigation of DEI in Healthcare

Graphic by Alej Gonzalez-Acosta

Diversity, Equity, and Inclusion (DEI) have become central to the conversation of improving medical education and healthcare. Medical schools and healthcare institutions have adopted DEI initiatives to address racial and socioeconomic disparities, aiming to create a more representative workforce. However, these programs have sparked many controversies and the current presidential administration has taken a hard stance against these policies, arguing that they prioritize identity over merit and lead to discrimination. This tension embodies a core question: Is DEI an essential tool for equitable healthcare, or does it amount to unfair discrimination?

On March 7, 2025, the U.S. Department of Health and Human Services (HHS) announced that its Office for Civil Rights (OCR) had initiated four investigations into medical schools and hospitals over allegations that their “medical education, training, or scholarship programs for current or prospective workforce members discriminate on the basis of race, color, national origin, or sex”. [1]  This comes as a response to President Trump’s Executive Order “Ending Illegal Discrimination and Restoring Merit-Based Opportunity”, which aims to end illegal preferences and discrimination, ordering agencies to “enforce our longstanding civil-rights laws and to combat illegal private-sector DEI preferences, mandates, policies, programs, and activities”. [2] 

Proponents for DEI initiatives in healthcare believe it is vital to “address the long-standing and well-documented inequities in our healthcare system”. [3] Diversity in healthcare workers can target the vast racial disparities in health outcomes in the U.S., particularly for Black people. According to a 2023 study published by the JAMA Network, a higher proportion of Black primary care doctors is associated with longer life expectancy and lower mortality rates among Black people. [4] DEI initiatives can help combat implicit biases in healthcare by ensuring that medical students receive training on the unique health challenges faced by different communities. Supporters of DEI argue that these policies do not constitute discrimination but rather correct historical inequities. Therefore, DEI aligns with the medical ethics principles of justice and beneficence, requiring that all individuals have equal opportunities to access and succeed in medical education and work in the best interest of diverse patient populations effectively. Without DEI, medical institutions risk perpetuating a cycle of inequality that leaves underserved communities at a disadvantage.

Critics of DEI in medical education raise ethical concerns about fairness. They argue that DEI policies may lead to reverse discrimination, where qualified candidates from non-minority backgrounds are disadvantaged in admissions and hiring. As evidenced by the recent HHS investigation, critics argue that DEI policies violate the Civil Rights Act, which prohibits racial discrimination in federally funded institutions. Jay Greene, a senior research fellow at the Heritage Foundation, claims that seeing physicians of the same race or increasing the number of doctors from any particular racial group does not improve health outcomes. [5] There are also concerns that DEI efforts could unintentionally lower academic and professional standards. Some worry that medical schools might accept students with lower qualifications, potentially impacting the quality of medical training and patient care, thereby violating the medical ethical principles of justice and beneficence by promoting unqualified students and workers. 

The ethical debate over DEI in healthcare is unlikely to be resolved soon, especially as legal and political battles continue. While DEI advocates see it as a moral imperative to correct systemic inequalities, critics warn against policies that could create new forms of discrimination. The challenge lies in finding a balance between promoting diversity and maintaining fairness in medical education and healthcare.

Reviewed by Anna Chen

Resources

 [1] Department of Health and Human Services. (2025, March 7). HHS’ Civil Rights Office Investigates Alleged Discrimination in Health Care Workforce and Training to Restore Merit-Based Opportunity. HHS.gov. https://www.hhs.gov/about/news/2025/03/07/hhs-civil-rights-office-investigates-alleged-discrimination-health-care-workforce-training-restore-merit-based-opportunity.html 

[2] The White House. (2025, January 21). Ending Illegal Discrimination And Restoring Merit-Based Opportunity – The White House. The White House. https://www.whitehouse.gov/presidential-actions/2025/01/ending-illegal-discrimination-and-restoring-merit-based-opportunity/ 

[3] American Medication Association. (2024, March 26). Statement on improving health through DEI. American Medical Association. https://www.ama-assn.org/press-center/press-releases/statement-improving-health-through-dei  

[4] Snyder, J. E., Upton, R. D., Hassett, T. C., Lee, H., Nouri, Z., & Dill, M. (2023). Black Representation in the Primary Care Physician Workforce and Its Association With Population Life Expectancy and Mortality Rates in the US. JAMA Network Open, 6(4), e236687. https://doi.org/10.1001/jamanetworkopen.2023.6687 

[5] Greene, J., & Kingsbury, I. (2023, December 20). Racial Concordance in Medicine: The Return of Segregation . Do No Harm. https://donoharmmedicine.org/research/2023/racial-concordance-in-medicine-the-return-of-segregation/ 

Public Health Initiatives: How Policy Can Drive Preventative Care

Graphic by Shameema Imam

Public health programs are critical in creating healthcare systems because they prioritize prevention over treatment, resulting in more sustainable and cost-effective healthcare solutions. As healthcare systems throughout the world confront increased pressure from aging populations, chronic disease, and limited access to resources, preventative measures have emerged as a viable policy tool for lowering long-term healthcare costs, improving population health, and addressing inequities. This shift to preventative medicine delivers a multifaceted strategy that includes legislative reforms combined with public health initiatives and active engagement from government agencies to provide aid to healthcare professionals and the necessary communities. Preventive health policies can play a significant role in reducing health disparities. Marginalized communities such as low-income individuals, minorities, and rural populations often face barriers to healthcare access and experience higher rates of chronic diseases. Through preventative care programs, governments can help reduce these inequities by ensuring that all individuals have equal access to common services like vaccinations and regular checkups.

One of the biggest drivers of preventive care is its ability to reduce healthcare costs. Studies have shown that implementing preventive health measures can save billions of dollars in healthcare spending by reducing the burden of treating costly chronic diseases through expense cutting. This conclusion is supported by a study by the Trust for America’s Health where they estimated that the implementation of evidence-based community prevention programs could save the U.S. healthcare system more than $16 billion annually in healthcare costs (1). These programs include efforts to promote physical activity, healthy eating, smoking cessation, and mental health services, which are known to lower the risk of chronic diseases. The Affordable Care Act (ACA) in the U.S. supplemented the importance of preventive care by expanding access to preventive services without cost-sharing, thus ensuring that more people have access to preventative measures that can detect health issues before they become more serious and costly (3).

Investing in public health education and advertising is critical for effectively driving public health efforts that promote preventative care. These campaigns can help change behaviors that lead to chronic diseases, such as poor dietary and addictive habits as well as physical inactivity. For example, the CDC’s “Tips From Former Smokers” campaign has had a measurable impact on smoking rates in the U.S. as it raises awareness about the dangers associated with tobacco use while also providing resources to help individuals quit (2). Other public health campaigns have focused on the leading causes for declining health in America. Their main focuses lie in successfully helping reduce obesity rates by encouraging healthier eating habits and increasing physical activity. Still, these programs are only effective when supported by substantial policies that make healthy options more accessible to the general population. They aim to encourage physical activity and ensure that nutritious foods are available in communities.

The role of healthcare providers also cannot be understated in promoting preventive care. Healthcare professionals are on the front lines of public health, offering guidance and support for preventive measures. However, they as well as their patients require appropriate policy backing to be able to effectively engage in these activities. For example, policies that reimburse providers for preventive care services like vaccinations and screenings encourage healthcare professionals to prioritize these services. Policies during the COVID era such as the American Rescue Plan Act (ARPA), passed in 2021, included provisions aimed at expanding access to health care, including preventive services. ARPA temporarily increased federal funding for Medicaid, which covers preventive health services like routine screenings and vaccinations for low-income individuals (4).  When preventive care is integrated into routine medical practice and supported by the healthcare system, it creates an environment where prevention becomes a standard part of patient care rather than an afterthought.

In conclusion, preventive care through public health initiatives is not just an ethical must but also a cost-effective strategy that can improve population health and reduce overall healthcare costs.  Through legislation, governments can shift from a system that reacts to diseases to one that actively works to prevent them, resulting in a healthier and more equitable society. A successful initiative depends on cooperation between policymakers and the healthcare system to ultimately drive public health initiatives which will shape a healthier future for communities around the world.

Reviewed by Matthew Ahlers

References

1. Trust for America's Health. (2009). Prevention for a healthier America: Investing in the health of our communities. Retrieved from https://www.tfah.org/report-details/prevention-for-a-healthier-america/

2. Centers for Disease Control and Prevention (CDC). (2018). Tips from former smokers: Impact of campaign efforts. Retrieved from https://www.cdc.gov/tobacco/campaign/tips/

3. Robert Wood Johnson Foundation. (n.d.). The Affordable Care Act: A collection of insights. Retrieved from https://www.rwjf.org/en/insights/collections/affordable-care-act.html

Congress.gov. (2021). H.R.1319 - American Rescue Plan Act of 2021. Retrieved from https://www.congress.gov/bill/117th-congress/house-bill/1319

Justice Behind Bars: The Ethics of Medical Care in Prisons

Graphic by Ariha Mehta

We often think of justice in terms of courts, verdicts, and prison sentences. But what happens when someone enters the prison system and becomes, in many ways, invisible? One of the most overlooked aspects of incarceration in the U.S. is healthcare. Not just access to it, but the quality, the ethics, and the enormous disparities between policy and practice.

“The U.S. incarcerates more of its population than any other nation, including nations that have similar rates of crime” [1]. And yet, the healthcare system inside those prisons is wildly under-examined by voters, by policymakers, and often by the medical community itself. Over 51% of incarcerated individuals in state prisons report having a chronic health condition—diabetes, heart disease, asthma, you name it—along with 43% in federal prisons [2]. But even more staggering is the number of people struggling with untreated mental illness. About two in five people who are incarcerated have a history of mental illness (37% in state and federal prisons and 44% held in local jails). This is about twice the amount of people in the U.S. who are impacted by mental illness [3]. Prisons weren’t designed to be hospitals. Yet somehow, they’ve become one of the largest providers of mental healthcare in the country. Perhaps this is not a design flaw, but more of a policy failure.

There’s a big dilemma within this discussion: What does it mean to provide “adequate” care to people society has deemed punishable? On paper, the Eighth Amendment prohibits cruel and unusual punishment, and courts have interpreted medical neglect as falling under that umbrella. But in practice? It’s a gray zone. Some prisons outsource medical services to private companies that get paid more when they spend less [4].

In prison, There are real horror stories. People with cancer are denied biopsies, inmates are forced to give birth in solitary, and psychiatric patients can be locked in isolation for months. But the everyday realities are just as disturbing: delayed diagnoses, skipped medications, and untreated infections. Persistent staff vacancies—nurse positions alone have a 37% vacancy rate—make it significantly harder for prisons to meet even basic healthcare needs, often resulting in delays that stretch far beyond what would be acceptable in any other setting [5]. In some cases, incarcerated people report waiting extended periods for care that would be considered urgent outside prison walls [5]. 

Of course, there are arguments on the other side. Resources are limited. Some say prisoners shouldn’t get “free” healthcare while working-class Americans struggle to afford insulin. However, there’s also a public health perspective people forget. Prisons aren’t closed systems. People cycle in and out. If diseases spread inside—think tuberculosis, hepatitis C, or even COVID—they don’t stay there. In fact, during the early waves of the pandemic, prison outbreaks were directly tied to spikes in surrounding communities [6, 8]. Neglecting prison healthcare could be short-sighted as it leads to widespread consequences—both at the individual and community level.

And what about re-entry? If someone leaves prison without treatment for their addiction, their bipolar disorder, or their chronic pain, they’re at higher risk for recidivism. Or worse. Studies have shown that the first two weeks post-release are some of the most dangerous for overdose and suicide [7, 9]. If we care about rehabilitation—and not just retribution—then medical care must be part of the conversation.

So what do we do with all of this? This is a tough question that should be addressed in policy within the coming years. The way we treat people in prisons reflects who we are outside of them. Are we okay with a two-tiered system that draws its ethical line at the prison gates? Or can we imagine a version of justice that embodies compassion, even behind bars?

Healthcare in prisons is messy, underfunded, and often invisible. But that doesn’t mean it should stay that way. The goal shouldn’t be perfection, it should be dignity. And maybe we start by acknowledging that everyone deserves a fighting chance at health, no matter what side of the bars they’re on.

Reviewed by Matthew Sun

References

[1] Widra, E., & Herring, T. (2021, September). States of incarceration: The global context 2021. Prison Policy Initiative. https://www.prisonpolicy.org/global/2021.html?gad_source=1&gclid=CjwKCAjwnPS-BhBxEiwAZjMF0ucBeW1XMbZgWuPVOY-Jybvpqf5e7ZKTm9MRGqUOOZBLTG1cOS-COxoCUAgQAvD_BwE

[2] Maruschak, L. M., Bronson, J., & Alper, M. (2021, June 2). Medical problems reported by prisoners: Survey of prison inmates, 2016. Bureau of Justice Statistics. https://bjs.ojp.gov/library/publications/medical-problems-reported-prisoners-survey-prison-inmates-2016#:~:text=About%2051%25%20of%20state%20and,currently%20having%20a%20chronic%20condition.[3] Mental health treatment while incarcerated. National Alliance on Mental Illness. (n.d.). https://www.nami.org/advocacy/policy-priorities/improving-health/mental-health-treatment-while-incarcerated/

[4] Szep, J., Parker, N., So, L., Eisler, P., & Smith, G. (2020, October 26). Special report: U.S. jails are outsourcing medical care — and the death toll is rising. Reuters. https://www.reuters.com/article/usa-jails-privatization-special-report-idINKBN27B1D7/

[5] Crumpler, R. (2025, March 11). NC prisons struggle to meet health care demands amid rising costs, staff shortages. North Carolina Health News. https://www.northcarolinahealthnews.org/2025/03/11/nc-prisons-face-growing-health-care-costs/ 

[6] Rubin, A. (2020, April 27). Prisons were once designed to prevent disease outbreaks. Honolulu Civil Beat. https://www.civilbeat.org/2020/04/prisons-were-once-designed-to-prevent-disease-outbreaks/

[7] Crumpler, R. (2024, March 21). Formerly incarcerated at higher risk of suicide - even years after prison release, study finds. North Carolina Health News. https://www.northcarolinahealthnews.org/2024/03/21/formerly-incarcerated-at-higher-risk-of-suicide-even-years-after-prison-release-study-finds/?utm_ 

[8] Shoot, B. (2024, December 16). How prisons become “corridors of contagion” during a pandemic. Prism. https://prismreports.org/2024/12/16/how-prisons-become-corridors-of-contagion-during-a-pandemic/ 

[9] Merrall, E. L., Kariminia, A., Binswanger, I. A., Hobbs, M. S., Farrell, M., Marsden, J., Hutchinson, S. J., & Bird, S. M. (2010). Meta-analysis of drug-related deaths soon after release from prison. Addiction (Abingdon, England), 105(9), 1545–1554. https://doi.org/10.1111/j.1360-0443.2010.02990.x