In 2019, amid a national conversation about climate change as a public health issue, the accrediting body for the nation’s public health schools posted an article on its blog noting that its curriculum standards include many of the issues raised in the debate.
One of these core competencies highlighted in the blog post, titled “When current events collide with CEPH competencies,” asked that students “Discuss the means by which structural bias, social inequities, and racism undermine health and create challenges to achieving health equity at organizational, community, and societal levels.”
Current events are once again colliding with Council on Education for Public Health competencies, which are the set of educational requirements that schools and programs of public health are required to teach their students. But now, it is weighing the removal of language that specifically requires schools to teach about “structural bias, social inequities, and racism.” The potential changes are not finalized, but some public health educators have pushed back on the potential change as anticipatory compliance to the Trump administration, which has attacked and defunded programs it deems related to “DEI.”
“You can’t on the one hand say that you are standing up for racial justice and for fighting against racial inequities, which you yourself call a public health crisis, and then on the other hand just decimate the entire competency so that students in public health aren’t required to learn about it,” said Michael Siegel, a professor of public health at Tufts University, referencing CEPH’s 2020 statement that racism in America represents a public health crisis.
The Trump administration has not directly targeted CEPH, as it has other accrediting bodies, but several public health professors noted that schools of public health in more conservative states may be under pressure from state legislatures to not use certain terms, or not to teach certain topics. The Trump administration also directly threatened some accrediting bodies via an executive order with the potential to terminate their federal Education Department recognition if they engaged in diversity, equity, and inclusion initiatives that amounted to unlawful discrimination.
In an emailed statement, Laura Rasar King, executive director of CEPH, said she would not comment on the competencies because they are still under development, and that the language would be finalized in 2027. In response to a question about the role of political pressure in this process, she wrote, “Our goal is to maintain rigorous standards while ensuring that our criteria are appropriate and workable for accredited schools and programs in the diverse legal and policy environments in which they operate.”
CEPH, which currently accredits 68 schools of public health and 190 programs of public health, plays a driving role in determining what schools prioritize in their curricula. When these programs apply to renew their accreditation, they must show that their students engage with the topics set forth in the competencies.
“The competencies that CEPH puts out are basically the foundation for every program of public health that’s CEPH-accredited in the country, so they are extremely important,” said Lauren Junge-Maughan, president of the National Association for Doctors of Public Health, which publicly expressed concern about the proposed changes.
The current language, adopted in 2024, states that educators must “discuss the means by which structural bias, social inequities, and racism undermine health and create challenges to achieving health equity at organizational, community, and systemic levels.” A year later, after Trump again became president, the organization proposed a revision, rewriting that requirement to say students should be able to “analyze the factors that create disparate health outcomes.” After receiving comments from program heads, the proposed language was changed again, replacing that requirement with: “Examine systemic factors that contribute to challenges in achieving optimal population health for a given community or communities.”
Marc Kiviniemi, a professor of public health at the University of Kentucky — a state with a Republican-controlled legislature that has repeatedly voted for Trump — sees the new language as a reasonable middle ground. “What we want our students to be able to do is to have the skills to understand, analyze, and appreciate how structural issues and social issues, including prejudice and discrimination, shape health outcomes and shape differences in health outcomes across groups. That is an incredibly important educational goal, and I don’t see that as going away in my read of the draft of the new criteria,” he said.
But others see the potential changes removing explicit mentions of racism as backsliding from the concerted effort during the early days of the Covid pandemic, which took a disproportionate toll on racial minorities, to name racism as a driving force and to more strongly encourage public health practitioners to deal with the role it plays in health. Professional societies, federal agencies, local governments, and even Congress moved to refer to racism as a public health crisis.
During the second Trump administration, however, efforts to reckon with structural racism and the field of public health itself have come under attack. The administration has directed its ire at several school accreditors, including the main body that accredits medical schools, over the adoption of what it called “‘DEI’-based standards.” The administration has also attempted to make public health degrees exempt from classification as a “professional degree,” making it more difficult for students in those programs to take out loans.
In July, CEPH withdrew itself from being recognized by the Education Department, telling Inside Higher Ed that the process of being recognized had “become increasingly political” in recent years.
Several professors told STAT that pressure on schools in red states has led to concerns that the language explicitly calling out racism in the competencies could become a liability — and that a rewrite could represent an opportunity to adopt language that resonates with people who might be skeptical of public health officials.
“Their new language, I think, is actually a bigger umbrella, and it more accurately defines what it is we’re interested in in public health. Which is not to say that you can’t then follow that with another sentence that then says this includes factors that are related to racism, ethnicity, class,” said Amy Fairchild, a historian at the University of Minnesota who is researching backlash to public health and previously led a school of public health.
She added that discussions in recent decades have centered race and racism, at times to the exclusion of social class and divides in rural health. Public health workers, she said, need to find ways to reach people that “profoundly disagree with us” and find ways to connect with them, which is “going to require sustained dialogue, and it is going to require finding ways to talk about equity, to talk about the social determinants of health in ways that meet people where they are, and that they’re going to say, ‘Yeah, that’s me too.’”
But Harry Heiman, a professor who directs the doctor of public health program at Georgia State University — in a state with a Republican governor and state legislature — disagreed that changing the standards will help programs in conservative states. “If I’m at a public university in a red state and there is potential scrutiny of our curriculum, to be able to point to our competencies and say we’re actually not doing anything that is woke or radical, we’re actually doing things that are consistent with nationally accepted competencies for training public health students. It actually gives me some cover.”
He and others also noted that CEPH competencies set the floor for what needs to be taught, but that schools can teach topics beyond those standards. “I still feel like the current version is sort of inclusive of the equity content that we think is important, but it’s quite watered down, and I think many schools are just going to decide on our own, including my school, to just still teach this content anyway,” said India Ornelas, a health systems professor at the University of Washington who helped the school adopt a competency to help students understand racism’s impact on health before CEPH did.
Whether CEPH decides to move forward with the proposed changes could represent a moment of reckoning in the field, and in how it chooses to address systemic bias in its work. Ornelas and some of her colleagues have recently created the Health and Power Organizing Project, a coalition of academics and advocates to provide a counterweight to political headwinds.
“Academic public health did not have much power to push back. We didn’t have a counter-narrative to offer about why these things were important,” she said. “We weren’t organized ourselves, and furthermore, we aren’t actually teaching our students how to organize in these moments, either, which is a critical strategy for fighting structural oppression.”