In the summer of 2020, Cleveland City Council declared a distinct public health crisis: racism.
Following the declaration, the city laid out a plan for reducing racial and geographic disparities in health outcomes like heart disease, drug overdoses and infant mortality.
Almost six years later, city staff are still grinding away alongside a community coalition called Racism as a Public Health Crisis. Cleveland’s public health department hopes to publish its first progress report on the key metrics the city is tracking this spring.
The national conversation around race, though, has changed drastically since 2020’s widespread reckoning. On his first day of office in 2025, President Donald Trump reversed former President Joe Biden’s executive order to advance racial equity. Trump then issued his own order that seeks to limit entities that receive federal grants from promoting diversity, equity and inclusion, which it called a guise for “immoral race- and sex-based preferences.”
That’s just one of several new strings attached to federal money Cleveland relies on to support its public health department. Trump signed an executive order meant to “defend women” from transgender people who have transitioned from male to female – which is supposed to ensure federal grant funds don’t promote “gender ideology.” Another order sought to exclude certain immigrants who entered the U.S. illegally from receiving taxpayer benefits.
In response, cities across the country have upended diversity programs in many areas to keep the millions in federal dollars they receive. Dallas and Fort Worth both ended some diversity and inclusion efforts. Portland changed certain equity policies.
In Cleveland, though, the city’s Health Equity and Social Justice division — a 13-member group within the department of public health — says its work will continue. The team was created after racism was declared a public health crisis in 2020. Since then, staff at the division helped craft the plan to reduce health disparities, and it developed another to make city government more diverse, equitable and inclusive.
“In terms of what we’re doing here, the questions that we get a lot are, are you gonna change the name? Can you still say equity? Do you still have a job?” said Lita Wills, the commissioner of the health department’s Health Equity and Social Justice division, speaking at a city council committee meeting Monday. “Yes, we’re still here. We’re still doing this work.”
The health equity and social justice division oversees several programs, including a federal grant to pay rent for people living with HIV or AIDS. It also carries out the MomsFirst program, where community health workers visit expectant mothers at home and educate them on infant well-being. The program is an effort to reduce infant mortality disparities, which are particularly wide between Black and white babies.
“Equity’s still a thing. Diversity is still a thing. You don’t get to do anything in the City of Cleveland without diversity. It’s not a thing,” Wills told the committee. “…This is a diverse city. No matter if you don’t say it — if you whisper it quietly in the dark — it’s still here.”
The Cleveland Department of Public Health heavily relies on federal funding to carry out its work. Signal Cleveland asked whether the city of Cleveland planned to comply with the federal orders on DEI, gender and immigration status.
In a statement, city spokesperson Jorge Ramos Pantoja wrote that the city is reviewing recent federal actions and guidance on the use of federal funds to ensure “continued compliance” with all applicable laws. Signal Cleveland also asked whether the city has had to give up any federal dollars as a result of the new rules. The city did not address this question in its response.
City feel the tangible effects of some Trump orders
Wills said some executive orders have hit harder than others.
Wills called the ban on DEI “kind of toothless” in the committee meeting. The executive order specifically says that grant recipients can’t operate programs promoting DEI that “violate any applicable Federal anti-discrimination laws.”
“The way that it talks about diversity, equity, inclusion is, like – no one’s doing that,” Wills said in an interview.
The order about “gender ideology” has had tangible effects on the MomsFirst program, though.
The city receives about $1 million annually from the federal government to fund its MomsFirst program, according to Spectrum News.
Last September, the city received a new grant agreement from the federal government to receive the rest of the money it was owed for the year, Wills said. While it didn’t mention DEI or immigration, the agreement had new requirements to ensure grant programs don’t promote gender ideology, Wills said.
“The gender ideology question is more difficult because it’s like, are you guilty, as far as the president is concerned, if you have a gender-neutral bathroom?” asked Dr. David Margolius, the director of public health for the city.
The law department is still trying to determine whether Cleveland can accept the money without violating the federal mandates or the city’s rules barring discrimination, Wills said.
That means agencies on the ground, whose staff are visiting moms, dads and babies through the MomsFirst program, are short the amount of federal money they need. They’re still operating because MomsFirst has other funding sources, including the county, city and First Year Cleveland, Wills said.
But, Wills said, agencies are getting “close to a point” where they won’t be able to bill the health department for their work.
Immigration requirements not showing up in grant agreements
Some local governments have said in lawsuits that federal grants are coming with stipulations that they must verify a resident’s U.S. citizenship in order to serve them.
Margolius said that he is not aware of language around serving undocumented immigrants being included in Cleveland’s public health grant agreements yet. Generally, he said his team is not trained to screen clients for their citizenship status.
“From the beginning, we’ve been clear that it’s not our job or training to check for immigration documents for our team,” Margolius said.
Wills said her office is seeing fear grow among immigrant clients, in light of ICE raids nationally and anti-immigrant sentiments from the federal government. The MomsFirst program visits residents at home, which is drawing a lot of concerns.
“For our immigrant population that utilizes this service, many do not want a government worker coming to their house, right?” Wills told the council committee. “… So we’ve had to get very creative.”
