The federal government has for decades invested vigorously in research aimed at narrowing the health gaps between racial and socioeconomic groups, pouring billions of dollars into understanding why minority and low-income Americans have shorter lives and suffer higher rates of illnesses like cancer and heart disease.
Spending on so-called health disparities rose even during the Trump administration’s first term. But in its second, much of the funding has come to a sudden halt.
Following a series of executive orders prohibiting diversity, equity and inclusion policies at every level of the federal government, the National Institutes of Health this year began terminating initiatives that officials said smacked of identity politics and offered dubious benefits.
“Spending billions on divisive, politically driven D.E.I. initiatives that don’t deliver results is not just bad health policy — it’s bad government,” said a spokeswoman for the Department of Health and Human Services.
The N.I.H will invest in projects that support “all vulnerable populations,” and expand participation “based on clinical need — not identity,” she added. She declined to be identified.
In letters from the N.I.H., scientists were told that their projects were canceled because they “harm the health of Americans,” “provide a low return on investment,” or “do not enhance health, lengthen life, or reduce illness.”
“The communication is very clear: We do not value health equity, we do not value a focus on underserved and under-treated populations, we do not consider these to be a priority,” said Dr. Kemi Doll, a cancer specialist at the University of Washington School of Medicine, who coaches younger researchers from minority backgrounds.
In interviews, many scientists whose work depends on N.I.H. grants described the terminations as harrowing and bewildering. Many felt their research was not evaluated on its merits, but nixed because words like “race” or “gender” were in the project’s title or description.
According to an analysis of federal data by The New York Times, as of mid-June the N.I.H. had terminated at least 616 projects focused on closing the health divide between Black and white, and rich and poor, Americans.
The N.I.H. had earmarked about $407 million in funding for the projects, nearly 45 percent of the approximately $913 million in total awards terminated by the Trump administration before court rulings ordered that some be reinstated.
About half were aimed at supporting researchers from underrepresented backgrounds. These training and recruitment programs, seen as a form of affirmative action, have long drawn conservative ire.
In July, a federal judge hearing two lawsuits challenging the cancellations described them as acts of discrimination and ordered the N.I.H. to resume funding many awards.
By The Times’s analysis, as of mid-August, 267 of the canceled disparities grants had been reinstated. But the Trump administration has filed an emergency appeal to the Supreme Court, asking the justices to allow many of the cancellations to proceed.
The Times’s analysis includes some awards that were canceled because the lead investigators were affiliated with universities that the Trump administration has accused of antisemitism. Some were reinstated after agreements were reached with federal officials.
But the figures do not include research that the N.I.H. had intended to support and has apparently reneged on funding. Nor does the total include ongoing work that the N.I.H. has simply stopped paying for without formal cancellations.
Dr. Jay Bhattacharya, who leads the N.I.H., has said that the well-being of minority populations remains “a central focus” of the agency, and that President Trump’s executive orders were not intended to halt “fundamental research” that advances the health of minority Americans.
But even critics who have long derided scientists and universities for liberal bias wonder if the cuts have gone too far.
In Project 2025, the Heritage Foundation’s blueprint for the Trump administration, Roger Severino, a former H.H.S. attorney, criticized “woke” policies at H.H.S.
He said in an interview that a scientist’s identity should not be considered in awarding government grants, as was the case with the training programs. But Mr. Severino also acknowledged that research into the health disparities between various populations was a “legitimate area of scientific inquiry.”
“The president’s D.E.I. executive orders are meant to end the bad research — the ideologically loaded, conclusory research,” Mr. Severino said.
Officials should not “throw the baby out with the bathwater,” he said, suggesting that some of canceled studies may have sought to answer valid scientific questions.
The rollbacks represent a seismic shift for health scientists, and the hobbling of a long campaign to unravel the causes of poor health in minority communities, low-income and rural areas, and among Americans with disabilities.
The effort to close those gaps took on added urgency during the pandemic. Covid-19 killed Black and Hispanic people, and Native Americans, at higher rates than white people, in part because of a higher prevalence of pre-existing conditions like diabetes, hypertension and obesity, which left them more vulnerable.
Even simple medical devices like pulse oximeters, used to assess the severity of respiratory disease, failed Black patients — the devices were not properly calibrated for darker skin tones.
Scientists stunned by the sudden grant cancellations this year say their research aimed to understand risk factors for high disease rates among racial and ethnic minorities and in low-income and rural communities.
Pregnancy-related mortality rates are almost three times as high among Black women than among white women, for example, a disparity driven by underlying chronic conditions and limited access to high-quality care, among other reasons.
Many of the deaths occur after delivery, so researchers at Columbia University wanted to train birthing coaches, or doulas, to support new mothers during the postpartum period. Their trial was open to all low-income women on Medicaid.
“If we could improve it with this cost-effective intervention, women will have better health and you’ll have healthier children,” said Dr. Uma Reddy, a professor of obstetrics and gynecology at Columbia University Irving Medical Center and one of the study’s principal investigators.
The N.I.H. canceled that study, then reinstated it as part of a deal with Columbia University to settle allegations of antisemitism.
Another initial casualty was a project training health providers to support pregnant women and mothers who are assaulted by their partners and at risk of being killed. Homicide is a leading cause of death during pregnancy and the postpartum period, particularly among Black women under 30, studies have shown.
The study may have been targeted because it had the word “equity” in its title, said Sarah Peitzmeier, an assistant professor of behavioral and community health at the University of Maryland, one of the study’s principal investigators.
But it was aimed at a broad spectrum of communities, while focusing on those where the problem was most severe, she said. A recent court order forced the N.I.H. to reinstate her grant.
Sunghee Lee, an associate research professor at University of Michigan’s Institute for Social Research, lost N.I.H. funding to develop more detailed data about dementia in demographic subgroups.
Dr. Lee was told that her research could lead to discrimination. Her grant has not been reinstated.
One of the important insights gleaned from disparities research so far: Life circumstances — including social and economic factors, access to healthy food and stable housing, even neighborhood and ZIP code — play a role in health outcomes.
One defunded study intended to explore how these exposures may alter the expression of genes to affect health outcomes.
Researchers created a unique bank of blood samples taken at two different time periods in a woman’s life to track how the environment might cause these epigenetic changes over the course of a lifetime.
“We were going to look at biological aging, a very specific biological process that could explain why Black women have a higher risk of adverse birth outcomes,” said Dr. Jaime Slaughter-Acey, an epidemiologist at the University of North Carolina at Chapel Hill who led the project. “No other study in the U.S. has the ability to do that.”
Despite high maternal mortality rates among Black women, her grant “no longer effectuates agency priorities” and does “not enhance health, lengthen life or reduce illness,” according to the termination letter she received.
“It’s like they erased the problem,” Dr. Slaughter-Acey said. She is now seeking donations in order to complete the data collection for the 600 mothers and babies in the study, she said: “We don’t want their voices silenced.”
Critics of the administration’s pullback argue that this research has led to initiatives that improve the quality of care for all Americans, not just the minority groups who may have been the original focus.
For example, one study found that when hospitals brought in birthing doulas for high-risk women, C-section deliveries for all women were reduced by half.
When new mothers were sent home with blood pressure cuffs and could text the readings to their health providers — a program originally tested among Black mothers — patients of all races became more scrupulous about monitoring their blood pressure. None had to be readmitted to the hospital after delivery.
When there is a health gap between different demographic groups, and programs target the general population, those who are already doing well may do slightly better, experts say.
But those doing poorly often fall even further behind, increasing the health gap between Black and white, rich and poor, urban and rural.
Dr. Georges Benjamin, executive director of the American Public Health Association, said: “Disparity programs ask the question: Who are we missing, and why, and what do we need to do to optimize their health?”
Methodology
The Times’s analysis relied on a list of terminated grant awards published by the Department of Health and Human Services and on records from RePORT, the National Institutes of Health’s registry of grants and projects.
An N.I.H. research grant is typically disbursed in a series of annual awards. The count of terminated grants as of mid-June is based on the June 13 version of H.H.S.’s list. (The list includes multiple awards for some grants. The analysis counts each grant only once.) The count of reinstatements is based on a comparison of the June 13 list with the Aug. 8 list.
To calculate the amount that had been earmarked for the terminated research, The Times totaled the figures listed as obligated in RePORT for each terminated award. These figures are different from those that appear in H.H.S.’s list of terminations. The latter are inconsistent, at times showing the amount of the award and other times showing the amount across several years of the award’s parent grant.
Roni Caryn Rabin is a Times health reporter focused on maternal and child health, racial and economic disparities in health care, and the influence of money on medicine.
Irena Hwang is a data reporter at The Times, using computational tools to uncover hidden stories and illuminate the news.
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