George Carlin’s “seven dirty words” got people clutching pearls over broadcast TV. The CDC’s version got people clutching
spreadsheets over federal budget season. Different decade, different vibes, same underlying theme: language is powerand
whoever controls the words can quietly control what gets discussed, what gets funded, and what gets ignored.
In late 2017, reports surfaced that CDC staff were advised to avoid seven specific words or phrases in documents used to
justify budget requests. The list wasn’t profanity. It was public health vocabularyterms that show up when you’re describing
who needs help, what works, and why funding matters. Critics called it censorship; officials called it a misunderstanding.
Either way, the episode became a masterclass in how politics can creep into “just paperwork.”
Quick context: what a CDC budget request really is (and why it’s so wordy)
When the President submits a federal budget, agencies like the CDC also submit a detailed companion document often called a
Congressional Justification (you’ll also see “CJ”). Think of it as the CDC’s “show your work” packet: it explains
what the agency does, what it plans to do next fiscal year, and how requested dollars connect to outcomes. In theory, it’s
boring. In practice, it’s where priorities get translated into line itemsand where word choice becomes strategy.
Here’s the tricky part: a CJ isn’t just a scientific report. It’s also a persuasion document written for multiple audiences:
appropriations staff, lawmakers, oversight bodies, andindirectlyeveryone who cares whether public health programs live,
shrink, or disappear. That means the writing style can drift from “pure science” to “please don’t make my program a
political piñata.”
The “seven dirty words”: what they were
The now-famous list included the following terms, reportedly flagged for avoidance in budget-related materials:
- Vulnerable
- Diversity
- Entitlement
- Transgender
- Fetus
- Evidence-based
- Science-based
On their own, these words are normaland often essentialin public health communication. Together, they form a political
Rorschach test: some people see neutral technical language; others see culture-war landmines. And when budgets are on the
line, landmines make everybody nervous.
Word-by-word: why each term matters in public health funding
1) “Vulnerable”: the word that keeps programs honest
Public health isn’t one-size-fits-all. Risk isn’t evenly distributed across geography, income, age, disability status, or
access to care. “Vulnerable populations” is a shorthand that signals the CDC is targeting resources where harm is more
likelyor where the consequences are more severe. Strip the word, and you don’t magically eliminate vulnerability. You just
make it harder to name.
Budget implication: If you can’t clearly describe who is at greater risk, it becomes easier to fund generic messaging while
underfunding targeted interventions (the unglamorous work of outreach, testing, surveillance, and follow-up).
2) “Diversity”: not a buzzword, a data requirement
“Diversity” can be used as a workplace slogan, sure. But in public health budgets, it often points to something much more
concrete: the reality that communities differ in exposure, prevalence, outcomes, and barriers to care. Collecting and
analyzing data across diverse groups helps identify disparities and prevents “average” results from masking hotspots.
If your data set doesn’t reflect diverse populationsor you’re discouraged from even using the wordyour program risks
sounding like it’s designed for a mythical “standard American.” Spoiler: that person does not exist, and Congress has a way
of funding myths when the truth is awkward.
3) “Entitlement”: the budget word that makes appropriators flinch
This one confuses people because the CDC doesn’t run big “entitlement programs” in the way Social Security or Medicare does.
So why is “entitlement” on the list?
Because in Washington, “entitlement” is often used as a political shorthand for mandatory spendingmoney that flows by law
rather than annual appropriations. It’s a loaded term. In budget negotiations, it can trigger debates about “dependency,”
“waste,” or “big government,” even when the underlying issue is simply ensuring people get preventive services or essential
support.
Translation: “entitlement” isn’t a scientific word so much as a budget dialect word. Avoiding it may be less about science
and more about dodging an ideological food fight.
4) “Transgender”: precision matters when health risks aren’t evenly shared
If you work in public health, you learn quickly that naming a population is not “politics,” it’s accuracy. The health system
impacts transgender people in specific waysthrough barriers to care, stigma, mental health strain, and, in some contexts,
elevated risk for certain infections due to structural factors (like access to prevention and affirming services).
Replacing “transgender” with vague euphemisms doesn’t make the topic disappear. It makes program goals blurry, data
collection messier, and outcomes harder to evaluate. It also signals, loudly, that a group can be politically inconvenient
enough to be linguistically erasedwhich is a terrible look for an agency whose credibility depends on plain speaking.
5) “Fetus”: the clinical term that became a political tripwire
In medicine and epidemiology, “fetus” is standard. You need it when describing congenital conditions, pregnancy outcomes,
exposures during gestation, and infectious disease impacts. During the Zika outbreak era, for example, fetal development and
birth outcomes were central to risk communication. If you can’t use the correct biological term, you end up writing around
itand that’s how clarity dies.
The irony is that avoiding “fetus” doesn’t de-politicize anything. It politicizes the writing process itself, turning a
clinical term into a taboo. And once that happens, everyone wastes time debating vocabulary instead of preventing harm.
6) “Evidence-based”: the phrase that signals accountability
“Evidence-based” is not a vibe. It’s a claim: we have data, evaluation, and results. In budget language, it’s also a signal
to Congress that programs aren’t just well-intentionedthey’re tested, measured, and improved. That should be a funding
slam dunk. Yet the phrase can become controversial when “evidence” conflicts with political priorities or when it implies
certain policy directions (even if the CDC isn’t proposing policy at all).
There’s also a subtler reason it matters: if you discourage “evidence-based,” you can drift toward “tradition-based,”
“talking-point-based,” or “please-don’t-yell-at-us-based.” None of those belong in public health.
7) “Science-based”: the cousin of evidence-based, and a lightning rod anyway
“Science-based” overlaps with “evidence-based,” but it carries its own rhetorical punch. It’s a flag planted on the hill of
expertise: methods, peer review, replication, and the scientific process. In normal times, calling something science-based
is as uncontroversial as saying water is wet. In polarized times, it can be interpreted as a jabespecially when “science”
is framed as elitist or partisan.
Here’s the uncomfortable truth: “science-based” shouldn’t be brave. And yet, in moments like this, it starts to feel like a
statement of values rather than a description of process. That’s exactly why critics worried about the implications.
Were the words actually “banned”?
This is where the story gets complicatedand, frankly, very government. The original reports described a list of words to
avoid in budget-related documents, with suggested alternative phrasing for at least some items. Soon after, CDC leadership
publicly pushed back, emphasizing that there were “no banned words” and reaffirming the agency’s commitment to science and
evidence. The Department of Health and Human Services also described the situation as a mischaracterization of budget
discussions.
So what happened? In plain English: it may not have been a formal “ban” stamped in red ink. It looked more like a warning
from budget-world veterans: “If you use these words, your draft may come back with edits, or your request may face extra
resistance.” That’s not the same as censorshipuntil it functions like censorship.
In bureaucracies, there’s a special category of pressure that isn’t written down but still shapes behavior. Call it
“incentivized self-censorship.” If staff believe certain terms will sink funding, they’ll avoid them. The result can be the
same: important topics become harder to describe, and programs become harder to defend.
Why language in budget requests matters more than you think
Budgets are policy, with decimals
You can say “we care about prevention” in a speech, but a budget tells you what prevention you actually paid for. Budget
language frames the story: which risks are urgent, which communities are visible, and which interventions are considered
legitimate.
If you can’t name it, it’s easier to underfund it
Programs serving marginalized groups often rely on precise descriptions of need. When those descriptions get blurred, it
becomes easier for decision-makers to pretend the need is also blurry. That doesn’t just affect messaging. It affects
staffing, surveillance, research priorities, andeventuallyhealth outcomes.
Public trust is fragile (and the CDC spends it every time it speaks)
The CDC’s authority isn’t built on enforcement power. It’s built on credibility. If the public suspects that scientific
communication is being filtered through political optics, trust erodes. And when trust erodes, compliance dropswhether
that’s vaccination uptake, emergency guidance, or outbreak response coordination.
But aren’t these just words? A reality check from the budget trenches
A useful way to think about this controversy is to separate two questions:
- Can the CDC do science without these words? Technically, yes. Science can be described many ways.
- Can the CDC defend funding priorities without these words? That’s tougherbecause budgets are arguments.
One analysis at the time noted that some of the flagged terms appeared rarely in historical budget documents anyway, while
others (like “evidence-based”) were more common. That detail matters because it suggests the “word list” may have been as
symbolic as it was practical. But symbolism is not harmless in a science agency. It tells staff what kind of honesty is
rewardedand what kind is risky.
How agencies talk around sensitive words (without losing the plot)
If you’ve ever edited a sentence to avoid a political tripwire, you already know the technique. The danger is that the
workaround becomes so careful it stops communicating. Still, there are ways to preserve clarity:
Use precise descriptions, not euphemisms
If “transgender” is avoided, the replacement should still accurately define the population and the health contextwithout
reducing people to stereotypes or awkward phrasing that undermines dignity.
Anchor claims in measurable outcomes
When “evidence-based” is politically touchy, describing the evaluation design, performance measures, and documented results
can be harder to dismiss.
Keep scientific terminology scientific
Terms like “fetus” exist for a reason: they carry specific clinical meaning. Substituting vague language may create medical
ambiguity, which is a terrible trade for political comfort.
What the episode teaches us (even if you never write a budget request)
First, it reminds us that public health funding is not just a math problem. It’s a storytelling problem. Whoever frames the
narrativewho is at risk, what works, and what “counts”has an advantage.
Second, it shows how pressure can operate without formal rules. You don’t need a printed list titled “BANNED WORDS” to
change behavior. You just need enough staff to believe certain words will cost them time, approvals, or dollars.
Third, it points to a recurring pattern in U.S. health policy: the tug-of-war between scientific institutions and political
incentives. Sometimes it’s about vocabulary. Sometimes it’s about what research gets funded. Sometimes it’s about what data
gets emphasized. The mechanism changes, but the stakes don’t: public health outcomes depend on clear information and
consistent investment.
FAQ
What are CDC “Congressional Justifications”?
They’re detailed budget documents that explain and support an agency’s requested funding levels, outlining goals, planned
activities, and comparative budget data across years.
Did the CDC stop doing science because of the word list?
There’s no credible indication that CDC scientific work ended because of the controversy. The concern was about how public
health priorities get described and defended in official funding documentsand the precedent that sets.
Why did people compare it to censorship?
Because discouraging specific termsespecially terms tied to vulnerable populations and scientific standardscan function as
a form of message control, even if it’s framed as “budget strategy.”
Conclusion
The “seven dirty words” episode wasn’t really about whether the CDC can physically type a word into a document. It was about
whether a public health agency can speak plainlyabout science, evidence, and the people most affected by diseasewhen money
flows through political channels.
If you care about public health funding, don’t just watch the final budget numbers. Watch the language that justifies them.
When we make certain communities harder to name, we make them easier to ignore. And when “science-based” becomes a risky
phrase, we’ve got a bigger problem than a copy edit.
Experiences: life in the land of “please don’t say that in a budget memo”
Let’s talk about the human side of thisbecause budget requests aren’t written by faceless printers. They’re written by
people who care about programs, outcomes, and, occasionally, keeping their blood pressure under 140/90. What follows is a
composite of common experiences reported by grant writers, policy analysts, and program staff who live in the space where
science meets appropriations.
Experience #1: The “red-pen translation” meeting. You walk into a conference room (or a video call that should’ve been an
email) with a draft that’s clear, honest, and medically accurate. You walk out with “notes” that read like a thesaurus got
into a fight with a political consultant. “Vulnerable populations” becomes “priority communities.” “Transgender” becomes a
vague phrase that’s technically inclusive but sounds like it was assembled by a committee of frightened robots. Nobody says
the word “ban.” They just say “tone,” “sensitivity,” and the all-purpose budget incantation: “This will play better.”
Experience #2: Writing around a word feels like writing around reality. If you work on maternal and infant health, you
quickly learn that biology doesn’t care about anyone’s talking points. You still need to describe prenatal exposures, fetal
development, and health outcomes with precision. When you’re nudged away from the correct term, you spend extra time
crafting sentences that are longer, less direct, andworst of allless useful for decision-makers trying to understand why
a program matters.
Experience #3: The “evidence” paradox. People in public health love evaluationat least in theory. In practice, the moment
you say “evidence-based,” someone somewhere hears “and therefore we should fund it,” and then someone else hears “and
therefore my favorite narrative loses.” The result is a weird dance: staff pack proposals with data, outcomes, and
peer-reviewed results… but soften the label that signals “this works.” It’s like bringing a fire extinguisher to a kitchen
blaze but being told not to call it “fire safety” because it might upset someone who sells matches.
Experience #4: The credibility tax. Even when leadership insists “there are no banned words,” staff still absorb the lesson:
certain terms create friction. Over time, that friction becomes a cost people quietly avoid. The cost isn’t only time. It’s
morale. It’s the feeling that scientific clarity is negotiable. And it can become self-reinforcing: the less directly
documents name specific communities, the easier it is for critics to claim those communities were never a priority.
Experience #5: The audience is always plural. Budget writers aren’t writing for one reader. They’re writing for an
appropriations staffer scanning for “hot buttons,” a lawmaker looking for waste, a program partner looking for reassurance,
and a future auditor looking for consistency. That’s why these controversies flare: a phrase like “science-based” is
unremarkable to researchers but can be interpreted as “political posture” to someone else. Navigating that split is a daily
skill, and it’s exhausting when the goalposts move.
The takeaway from these experiences is simple: you can survive without certain words, but you’ll pay for itin clarity,
efficiency, and trust. And in public health, those are expensive things to lose.
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