Student Submission: The Education and Health Impact of Restricting Diversity, Education, and Inclusion Programming in Alabama

April 12, 2024
Raimi Liebel | UAB Graduate Student, Magic City Acceptance Center Intern

LHC is proud to feature student work on relevant policy issues such as this one. If you are a UAB student interested in contributing to Policy Watch publications, please email lhc@uab.edu.

The concept of DEI (diversity, equity, and inclusion) has become a political hot-button in recent years. DEI in higher education refers to programs, training, events, organizations, and spaces that are centered around historically marginalized identities. Higher education institutions have been incorporating DEI measures since the 1960s following the civil rights movement. DEI is not a new concept and has been integrated into universities and colleges across the country. Historic legislation such as Title IX, the Americans with Disabilities Act (ADA), and Deferred Action for Childhood Arrivals (DACA) have contributed to the increase in DEI offices, services, and organizations at higher education institutions across the US over the past 60 years.

Since 2022, more than 40 anti-DEI bills have been proposed in the US. Texas, Florida, North Dakota, South Dakota, Texas, Utah, and now Alabama have all signed bills into law limiting or banning DEI offices at higher education institutions. Representative Will Barefoot introduced SB 129 to the Alabama Senate on February 20th, which restricts state-funds from being used for DEI offices and sponsored DEI programming, potentially including student organizations such as USGA and SJAC. The University of Alabama at Birmingham alone has 12 DEI offices and more than 150 student organizations that could face state funding loss. SB 129 moved from its first reading to being passed in the Senate within three legislative days before was signed into law by Governor Kay Ivey on March 19th.

According to a 2023 mixed methods analysis, “Students of color thrive and achieve more at higher educational institutions where there are deliberate efforts made to provide diversity, equity, and inclusion activities.” The link between student success, belonging, and graduation rates and DEI programming has been demonstrated in several studies. Academic communities fear that legislation of this kind may prevent students from enrolling in higher education institutions where DEI restrictions are present. Reduced staff and student enrollment or retention can result in economic effects on institutions across the state, especially those that use diversity as an incentive to drive recruitment. DEI efforts at higher education institutions help facilitate students’ learning from a variety of thoughts and perspectives, which has proven to increase cognitive development and cross-cultural empathy.

DEI has been attributed to improved student enrollment, retention, and graduation rates. A 2023 mixed methods study identified significant positive correlations between perceived campus climate, diversity in staff/faculty, curricular diversity, and interactional diversity and college student re-enrollment. Also, explicit DEI policies in workplaces led to more diversity in employment, accounting for 46% of the variance reported in the study. Higher education institutions and workplaces benefit from recruiting and retaining diverse staff.

Attainment of a college degree is positively correlated with improved health outcomes and behaviors. Those who attain a bachelor’s degree or higher earn $1.2 million more than their high school-educated peers over their lifetime, and college degree holders are almost twice as likely to have employer-sponsored health insurance (ESI). ESI covers approximately 60.4% of the US population and is often the most affordable and comprehensive option for workers.

Degree attainment and long-term health are correlated, and historical trends showcase certain populations have lower enrollment and retention rates. The U.S. Department of Education notes that the “participation of underrepresented students of color remains a problem at multiple points across the higher education pipeline including at application, admission, enrollment, persistence, and completion.” DEI bans compounded with lower college enrollment could lead to increased health disparities for marginalized communities. Decreasing diversity in classrooms, workplaces, and communities decreases collaboration, cultural exposure, and productivity.

Other facts of note:

Click here to view this brief in PDF format.

Policy Watch: Creating a Voluntary Do-Not-Sell List in the National Instant Criminal Background Check System for Firearm Purchases

Background 

Currently, in the state of Alabama, the ability to buy a firearm is available to most adults over the age of 18, with certain weapons restricted to citizens over the age of 21. Individuals who have been convicted of certain violent or alcohol-related crimes are not able to legally purchase a firearm. Alabama follows federal regulations regarding background checks, where licensed gun dealers must process a potential buyer’s information through the National Instant Criminal Background Check System database, facilitated by the Federal Bureau of Investigation. 

Alabama is one of the most lenient states in the country regarding gun laws. No additional background checks, evaluations, waiting periods, or training are required to purchase a firearm. In 2022, the state enacted a permitless concealed carry law allowing anyone over the age of 18 to carry a handgun without a permit, background check, or mandated safety training.

Voluntary Do-Not-Sell lists have been proposed in several states since 2019. Sometimes called “Donna’s Law,” the legislation was first initiated after Donna Nathan admitted herself to a psychiatric facility and later took her own life by firearm upon release. 

Legislation 

Voluntary Do-Not-Sell legislation was first submitted in 2022, by by Reps. Rafferty (D-Birmingham) and Farley (R-McCalla) as a bipartisan bill calling for the establishment of a database operated by the Alabama Department of Mental Health for individuals to volunteer their own names onto a Do-Not-Sell list. HB37, sponsored by Rep. Ensler, builds upon that legislation to be in compliance with constitutional requirements, and increases opportunities and access for individuals to utilize the service. 

HB37 would restrict an individual’s ability to purchase or possess a firearm once their name was added to the list and creates criminal penalties for violations. The bill also provides a pathway for individuals to remove their name once it has been added. The purpose of this list is to restrict access to firearms to individuals when there is a fear that he or she may become a risk to himself or herself or others.

With a start date of June 1, 2025, the ADMH is tasked with developing the searchable database, along with creating and distributing a registration form for applicants. Individuals wishing to add their names to their name to the Do-Not-Sell List may do so in the following ways: 

  1. Submitted in person at a circuit clerk’s office with government-issued photo identification. A county clerk shall immediately transmit any received registration form to the department.
  2. Mailed to the department with a copy of the registering individual’s government-issued photo identification.
  3. In person at a healthcare provider’s office with a government-issued photo identification. The healthcare provider should immediately transmit the forms to the department for processing. 
  4. Submitted electronically to the department by short message service or multimedia messaging service along with a copy of government-issued photo identification and a photographic portrait of the individual that contains exchangeable image file format data proving that the photographic portrait was taken within one hour before transmission to the department.

Individuals who request to be added to the Do-Not-Sell List must wait 21 days before requesting their names to be removed. Their application for removal will be administered by the district court, where the individual must provide evidence stating that they are not a harm to themselves or others. 

Impact 

Self-harm is the 10th leading cause of death in adults in the United States, and access to a firearm triples the risk of suicide. Recently, several states such as Virginia and Washington have enacted legislation establishing voluntary Do-Not-Sell Lists for firearms to restrict access to individuals experiencing a mental health crisis. According to the Centers for Disease Control and Prevention, half of all suicides are caused by a firearm and are, by far, the deadliest method with the highest chance of mortality per attempt. Delaying firearm purchases has been found to reduce the number of suicides without increasing the number of suicides by other means, showing that suicide attempts by different methods “is unlikely to undermine the lifesaving potential of these laws.”

There is empirical data to support the creation of a Do-Not-Sell list. A survey conducted in Alabama distributed to 200 patients receiving psychiatric care found that 46% of responses indicated they would register for such a database. Broader internet surveys found up to ⅓ of all participants would add their name to a Do-Not-Sell List. According to the New England Journal of Medicine, the vast majority of individuals experiencing suicidal ideation or thoughts will see a clinician within a year of their death, putting medical practitioners in a position to screen their patients for suicidal tendencies: 

“​​Clinicians routinely assess their patients’ risk of suicide, yet they are limited in terms of the practical interventions they can use for patients who are not actively suicidal but who fear they may become so. … [Voluntary Do-Not-Sell Lists] reduce suicide risk consensually and indefinitely in advance of a crisis. The majority of people who die by suicide see a primary care provider in the year before their death.” 

As a part of standard medical practice, clinicians can regularly encourage the use of advance directives such as determining a medical proxy, so this form of legislation offers patients an opportunity to create such a directive in reference to firearm-related decisions. Unlike other mental health interventions, voluntary registries develop opportunities to enhance patient autonomy and preserve their role in their healthcare decision-making processes. 

Next Steps 

HB37 is pending action in the Public Safety and Homeland Security Committee. If you want to make your voice heard on this or future legislation, click here to identify your elected officials

Don’t know what to say? Check out this guide from the American Civil Liberties Union on drafting a letter to your government officials. 

Learn More 

Want to know more about firearm legislation and how gun violence impacts mental health? Take a look at these resources: 

Gifford Law Center to Prevent Gun Violence 

APHA Gun Violence Fact Sheet 

EFSGV Public Health Approach to Gun Violence 

Policy Watch: US House of Representatives Proposes Significant Spending Cuts to CDC, Public Health Funding

Kimberly Randall | August 15, 2023

ATLANTA, GA – Exterior of the Center for Disease Control (CDC) headquarters

Background 

Each year, the House of Representatives and Senate pass a series of legislation that determine the funding for the federal agencies operating in the US government. Funding is broken down into two categories – mandatory (63%) and discretionary (30%) – determined by whether the funding is tied to specific laws. The remaining budget is dedicated to interest repayment on federal loans.

The budget discussions traditionally begin with the President’s Budget Request (PBR), a formalized plan from the executive branch outlining the President’s suggested funding and taxes for the following fiscal year. Then, respective House and Senate committees produce budget bills that will be discussed, reconciled, and voted on in committee before being sent to the chamber floor. According to the Congressional Budget Act of 1974, the budget is to be voted on by April 15th for the following fiscal year, which begins on October 1st. However, many times this process takes longer. 

For the fiscal year 2024 (FY24), President Biden officially requested $144 billion in discretionary spending, an 11.5% ($14.8 billion) increase from FY23, for Health and Human Services, through which the majority of public health funding is funneled. The official budget statement claims that the budget increase is expected to expand healthcare access, lower medical costs, increase funding for cancer research, increase access to behavioral health programs, support rural health programs, and improve nutrition and food safety. 

Proposed Legislation 

As Congress begins budget discussions for FY24, the House Appropriations Committee released the Fiscal Year 2024 bill for the Labor, Health and Human Services, Education, and Related Agencies Subcommittee. In the draft, several federal agencies are suggested to see a decrease in funding. The bill, named the Fiscal Year 2024 Labor, Health and Human Services, Education and Related Agencies Appropriations Bill, contains significant spending cuts to programs related to public health infrastructure and eliminates federal funding for family planning, HIV prevention, and gun violence research. 

According to the Appropriations Chair, Kay Granger (TX), the proposed budget legislation is intended to “restore fiscal responsibility and reduce the scope of social spending by $60.3 billion from the FY23 enacted level, eliminating 61 (support) programs” in addition to funding biomedical research on cancer, Althzeimers, opioid use, and other chronic and rare diseases. The legislation also looks to increase funding in rural health by way of telehealth programs, healthcare workforce recruitment programs, and specialized education funding. 

FY23 Enacted Budget (millions) FY24 Presidential Request (millions) FY24 Proposed Budget (millions)
Immunization and Respiratory Diseases $919 $1,256 $326
HIV/AIDS, Viral Hepatitis, STI, TB $1,391 $1,545 $1,171
Emerging and Zoonotic Infections Disease $751 $846 $708
Chronic Disease Prevention and Health Promotion  $1,430 $1,814 $797
Birth Defects, Developmental Disabilities, Disability and Health  $206 $223 $205
Environmental Health $247 $421 $130
Injury Prevention Control $761 $1,352 $730
Public Health Scientific Services $754 $962 $654
Occupational Safety and Health  $363 $363 $247
Global Health  $693 $765 $370
Public Health Preparedness Response $905 $943 $735
Crosscutting Activities and Program Support $724 $1,039 $231
Buildings and Facilities $40 $55 $40

Impact 

In the United States, most public health activities are carried out by state and local government agencies, and a large portion of the CDC’s annual budget is distributed via grants and cooperative agreements to these departments. In FY19, over 55% of the CDC’s annual budget was granted to state and local public health agencies and has significant influence on state and local budgets. 

In 2022, the Alabama Department of Public Health received $129,863,407 from CDC grants, with millions more going to The University of Alabama, The University of Alabama at Birmingham, Auburn University, and Tuskegee University for research in various areas. Reductions in the federal CDC budget will trickle down to impact local programs, including child vaccinations, staffing, and research. The table below represents a hypothetical look at the budget differences between funded programs in 2022 and a proportional budget in line with the FY24 proposed House budget. 

FY23 Grants Awarded (Alabama) Proportional Budget Estimate
Immunization and Respiratory Diseases $4,500,225 $1,597,580 

(-64.5%)

HIV/AIDS, Viral Hepatitis, STI, TB $13,988,137 $11,776,613 

(-15.81%)

Emerging and Zoonotic Infections Disease $2,248,081 $2,096,864

(-5.72%)

Chronic Disease Prevention and Health Promotion  $13,587,018 $7,573,404

(-44.26%)

Birth Defects, Developmental Disabilities, Disability and Health  $6,557,429 $6,524,642

(-0.5%)

Environmental Health $404,616 $212,990

(-47.36%)

Injury Prevention Control $7,174,096 $6,882,110

(-4.07%)

Public Health Scientific Services $727,445 $630,986

(-13.26%)

Occupational Safety and Health  $1,949,377 $1,326,356

(-31.96%)

Public Health Preparedness Response $9,437,092 $7,664,806

(-18.78)

Crosscutting Activities and Program Support $5,528,735 $1,764,219

(-68.09%)

The potential budget cuts come on the tails of a significant loss of funding following the Fiscal Responsibility Act of 2023, where an estimated $1.7 billion in secured funding was recessed. The CDC released a statement that multi-year funded projects would not receive the remainder of their grants: “We can confirm that the last two years of funding is no longer available to CDC for jurisdiction awards. Funds previously awarded are not impacted.” 

Next Steps 

The House of Representatives Appropriations Committee will continue to debate the contents of the bill, amending as necessary. Once the committee agrees on the House bill, party leaders will meet to reconcile it with the Senate bill. 

The Senate Appropriations Committee has already passed an appropriations bill for FY24 in a 26-2 vote, providing $117 billion in funding for the Department of Health and Human Services. The Senate released an official statement in late July regarding the sister legislation in the House: 

It is unclear how this legislation will proceed through the legislative process, given vastly different topline funding levels under consideration in the Senate and House, which has yet to advance its version of this legislation through the full House Appropriations Committee.

A full list of House Appropriations Committee members can be found here, two of which represent Alabama. 

Stay Informed 

Want to learn more about public health policy, funding, and advocacy? Check out the Advocacy Portal on the American Public Health Association’s website. 

Official updates from Congress can be found on the House of Representatives Appropriations Committee website