Data Is Care: Defending Visibility, Equity, and Integrity in Health Professions Education

My name is Joshua Barnes. I am an advanced practice nurse and an educator. My days unfold in patient rooms, across academic spaces, within lecture halls, and in the deliberate work of writing that fills the margins of scholarly journals, advancing practice and advocating for those I care most about: my students, the populations we serve, and our shared humanity. In each of these spaces, I have learned that health and illness are shaped not just by biology but by the systems, policies, data, and narratives that determine whose lives matter.

That truth became more visible when a senior public health expert at the Centers for Disease Control and Prevention resigned rather than comply with directives to remove transgender identity from a national health dataset. As both a clinician and an educator, I recognized immediately that this was not a technical dispute. It was a warning. When identity is erased, research is weakened, resources misdirected, and real people are placed at risk.

In my clinical practice, I care for patients whose health trajectories are shaped long before they present to care. Housing insecurity, racism, delayed diagnoses, interrupted treatment, and structural neglect leave marks that no clinical encounter can undo. I have sat with patients who postponed care because they felt invisible. I have listened to students struggle to reconcile what they are taught with what they witness in exam rooms. These moments make it impossible to separate practice from the systems that shape it.

Public health data is the scaffolding of our healthcare system. When identity is stripped away, whole communities disappear from charts and reports. Disease patterns become distorted. Evidence becomes misleading. Resources are misallocated. Weakened science leads to preventable harm.

For transgender communities, the stakes are especially high. Research consistently shows higher rates of HIV infection, mental health crises, substance use, violence, and barriers to care. These outcomes are not intrinsic to identity. They are the predictable result of exclusion and structural inequity. Removing gender identity from datasets hides these patterns from view and makes them easier to dismiss.

Over time, the damage compounds. Longitudinal research loses continuity, emerging threats go unnoticed, and interventions cannot be accurately evaluated. Funding drifts away from the communities with the greatest need. In turn, data erasure creates a ripple effect that moves through clinical spaces, educational environments, organizational systems, government structures, community and public life, and ultimately the knowledge and narrative spaces where meaning itself is shaped.

This is not a new tactic. Data erasure follows historical patterns of exclusion that have shaped medicine and public health for generations. Black, Indigenous, immigrant, disabled, and LGBTQ+ communities have long been misclassified, underrepresented, or omitted from research and policy. These were not neutral oversights. They were structural decisions that reinforced inequity in access, quality of care, and outcomes. Removing transgender identity from national datasets continues this pattern of exclusion.

This is why the Social Mission Alliance’s call for anti-racist and justice-oriented health education is not optional; it is a professional obligation. Health professions education must prepare learners to recognize how power and policy shape health, how silence within institutions perpetuates harm, and how to respond ethically when science is threatened. It must also expand access and advancement by strengthening pathways for historically excluded communities and removing structural barriers.

One of the most consequential lessons I have learned is that the integrity of our data is inseparable from the integrity of our profession. When students enter training, they trust that systems guiding clinical decisions are grounded in evidence and transparency. They assume the data informing guidelines, funding priorities, and public health strategies reflect the real communities they will serve. When identity is erased from those systems, we teach the next generation of professionals to practice inside a distortion.

I see this tension emerge in classrooms when learners ask why certain populations remain invisible in the research they are studying, or why clinical recommendations fail to account for the lived realities of marginalized patients they encounter in practice. These are not abstract concerns. They shape how clinicians assess risk, choose interventions, and allocate attention at the bedside. When the data are incomplete, our care becomes incomplete.

Health professions education must therefore move beyond technical competence alone. It must cultivate moral courage. Students must be equipped not only to interpret evidence, but to question who is missing from it and why. They must understand how data systems can reinforce inequity, and how professionals have both the authority and the obligation to challenge those systems when they cause harm.

This work also requires institutions to center community power. Communities most affected by erasure must help shape research priorities, data practices, and policy decisions. Their knowledge and lived experience are essential to building systems of care that are not only effective, but just.

Institutions that train health professionals are not passive pipelines; they are architects of the healthcare system. The values they normalize, the competencies they assess, and the voices they elevate shape how future clinicians understand their responsibility to patients and communities. Schools of medicine, nursing, public health, and allied health must also acknowledge and materially support the often-uncompensated labor of students, faculty, and staff. They must teach data ethics as a matter of life and death.

Justice-oriented education must prepare professionals to recognize and resist structural harm. This includes equipping learners to evaluate policy, advocate for evidence-based practice, and engage in institutional reform when systems undermine equity and trust. This is a matter of professional responsibility, and accreditation standards, competencies, and institutional policies must reflect this commitment. Health equity, structural analysis, and accountability cannot remain peripheral topics. They must be embedded across curricula, assessment, and training. The clinicians and leaders we prepare today will determine whether future systems reinforce exclusion or dismantle it.

Healthcare is ultimately a moral enterprise built on trust, truth, and the obligation to protect the vulnerable. When public health data is manipulated or erased, that trust fractures. When institutions remain silent, the fracture deepens. Educators must teach that ethical practice extends beyond the bedside into the research questions we ask, the policies we support, and the data that determine whose lives are seen and valued.

Clinicians, researchers, and students hold collective power. We must insist that our data reflect the realities of all communities, challenge policies that erase people, and partner with those most harmed by inequity to build systems rooted in transparency, reciprocity, shared governance, and genuine community oversight.

This is why I continue to practice at the bedside and teach. It is why I write, speak, and publish about these issues. I remain committed to building systems of care and education that do not trade visibility for convenience and honor the lives behind the data.

The social contract between healthcare and society is rewritten through our choices. We can choose erasure, compliance, and convenience. Or we can choose visibility, accountability, and justice. Reclaiming that contract requires repairing institutional harms through transparency, accountability, and community redress.

A healthcare system cannot protect the communities it refuses to see.

And a profession that fails to defend its data fails its people.