What Does the End of DEI Mean For SDOH efforts?

The Trump administration’s sweeping elimination of diversity, equity and inclusion (DEI) programs is stirring up lots of questions. One potential consequence may be the weakening of the countless efforts in recent years to address the social determinants of health (SDOH) and related
data collection.

Anteo Pashaj, D.O., MBA

DEI, SDOH and health equity are deeply intertwined, says Anteo Pashaj, D.O., MBA, regional medical director at Strive Health, a value-based kidney care provider. DEI ensures that diversity, equity and inclusion issues are addressed at every level, regardless of patients’ race, color and ethnicity, he says. At the same time, SDOH focus on external systemic and social elements, such as education, housing, transportation and environmental factors that significantly impact individual and population health outcomes. Healthcare equity secures everyone fair access to high-quality care. SDOH can influence that, Pashaj says, making it harder for some to receive care based on their situation.

Shelia Phicil, M.P.H., M.S.

Some of the problems that SDOH attempts to address, such as racism or political determinants of health, may be targets of the “anti-woke” agenda, says Sheila Phicil, M.P.H., M.S., founder and CEO of Phicil-itate Change, which helps healthcare organizations innovate, partly to create equitable solutions. Phicil gave food deserts as an example. They exist in communities that were historically redlined. Putting on blinders to ignore these situations weakens the ability to use resources to address SDOH in certain communities, she says.

Swept up?

Phicil believes the myriad programs and policies created to mitigate the disadvantages created by SDOH will be weakened but not eliminated by anti-DEI efforts. COVID-19 shined a bright light on SDOH’s relevance, she says, as mortality from disease and access to vaccines were uneven across racial groups. “I think it was a jarring wake-up call about why it’s important to focus on these things,” she says, and the example shows why SDOH continue to be a driving force behind high U.S. healthcare costs. “People are living in communities and in conditions that do not permit them to leave to reach their full health potential.”

Hillit Meidar-Alfi, Ph.D.

Hillit Meidar-Alfi, Ph.D., says she hears a lot of chatter that SDOH efforts will not go away because they had bipartisan support throughout the first Trump administration. “Believe it or not, they added in the health equity component,” says Meidar-Alfi, founder and CEO of Spatially Health, which uses advanced analytics to help value-based care organizations improve patient outcomes and reduce costs by addressing complex social care needs.

“This administration is very, very cost sensitive,” Meidar-Alfi says, and anything that will reduce costs while retaining or improving quality and patient outcomes will be welcomed. Grappling with SDOH is important because they can help improve people’s access to healthcare, she says, but they also lead to a reduction in the total cost of care.

Data collection

CMS currently requires hospitals to ask patients questions in five SDOH categories: housing instability, food insecurity, transportation needs, utility difficulty and safety at home. With the new administration, Phicil anticipates that “either we’ll ask all the questions or we won’t. It’s difficult to keep some but not others.” Asking these questions is a “huge administration lift,” says Phicil. For example, staff members in the emergency room already have a great amount of data to collect. Setting up the process of where to collect data and what to do with the responses is time-consuming.

In 2023, the Biden administration added three optional sexual orientation and gender identification (SOGI) questions for those applying for Medicaid and Children’s Health Insurance Program coverage, as well as Affordable Care Act Marketplace plans. CMS used the data to identify disparities in care access and health outcomes. In February 2025, the Trump administration’s CMS removed those questions.

Some healthcare facilities ask SOGI questions as part of their intake process. If the provider stops asking them, they won’t understand a patient’s unique needs for services, Phicil says. This probably has a more significant impact when treating pediatric or adolescent patients, she says. However, she acknowledges that it is a burden for healthcare staff to ask these questions “because patients are not comfortable being asked these questions, so there’s pushback in disclosing.” Also, people don’t have a lot of trust in what happens to that information, she says.

One other important area of data collection is asking patients which languages they speak. In recent years, Phicil has seen improvement in collecting this data. In addition to collecting demographics such as name, race and ethnicity, providers are asking about the languages the patient speaks. The Biden administration had requirements that made language accessibility in healthcare settings a priority, says Phicil, who sees a potential weakening of SDOH and the frameworks around them, as fewer data will be from patients who are not primarily English speakers.

In early March 2025, President Donald Trump signed an executive order designating English as the official language of the U.S. The executive order did not advise agencies to change the languages used in their documents or services. However, it may still affect which services and information are provided to non-English speakers.

Data collection should be to change, impact and influence medicine, says Pashaj. “We know that 35% of patients with kidney failure are African American, while only 13% of the U.S. population is African American,” he says. Without the collection of, and access to, SDOH data, Strive would not be able to deliver a targeted, proactive approach, says Pashaj. The lack of an SDOH-informed, tailored approach could mean increased costs and worse outcomes, he says.

Clinical trials

“We can’t have a cover-all approach and treat everyone the same when statuses are very different,” Pashaj says. The FDA initially removed clinical trial diversity draft guidance from its website in January 2025, following the White House executive order ending DEI programs. The guidance is currently restored on the site, but concerns over research topics and funding cuts are already having an impact.

With the National Institutes of Health funding many clinical trials, some grants and funding around minority health have been paused and potentially won’t be renewed, Phicil says. “People take cues from what the government is doing,” she says. Some medical publications are focused on or use language looking at racial issues or are segmented by sexual orientation. She says that some authors are being asked to retract or rewrite articles without using that lens. “So it’s already having an effect, for sure,” Phicil says. “We already have a healthcare system that is skewed toward bias, and people who have the resources and means to navigate healthcare really fare better than those who don’t.”

Pashaj, though, is less worried about how the administration will impact clinical trial diversity. “When it comes to clinical trials and getting FDA approval for medication, trials have to comprise or mimic the population that we’re treating. This is why I don’t think there’s going to be significant implications on data collection for clinical trials,” says Pashaj. If it did, he would anticipate a decrease in the collection of race, ethnicity and socioeconomic data in these health records. Data collection on health disparities would decline, “making it more difficult for policy makers, researchers, and healthcare providers to identify and, in turn, justify those targeted interventions.”