Universities in the United States are being asked to make an extraordinary choice. The Trump administration’s Compact for Academic Excellence arrives dressed in the language of fairness and merit, but underneath is a funding-for-obedience deal that ties public money to political alignment. Released on Oct 5, 2025, the compact conditions federal funding on a package of new requirements: prohibiting consideration of race or gender in admissions and hiring, restricting international students, and enforcing strict “institutional neutrality”. It is not only a domestic policy fight but a template other governments could adopt to remake higher education with far-reaching implications for global health.
Commentaries so far have focused on predictable battlegrounds of higher education: admissions, campus speech and diversity initiatives. Yet very little has been said about its consequences for the health professions.
A health workforce under strain
The Compact directly collides with the responsibilities of health-professional education. Medical, dental, nursing and other health-professional schools train a workforce already strained by shortages, maldistribution, and widening inequities. Their teaching clinics provide safety-nets for patients unable to access the private healthcare market. They rely on international faculty and trainees for research, training, and scientific vitality. And their accreditation standards – like CODA for dentistry and ACCM or LCME for medicine – explicitly require attention to diversity, access, and fairness.
A ban on considering race, ethnicity, gender, or their proxies in admissions or hiring might sound like neutrality. In practice, it dismantles the pipelines that allow underrepresented communities to enter the health professions, putting schools in direct conflict with their accreditors who expect credible efforts to build a workforce reflecting the populations served. The result is predictable: fewer clinicians from communities most affected by disease, and a retreat from long-overdue efforts to correct inequities.
The Compact’s restrictions on international students, faculty and foreign funding strike at the heart of global health exchange. About a quarter of practicing health professionals in the U.S. are foreign-born. They fill critical gaps, sustain services, and enrich research. Forcing universities to screen applicants for ideological alignment, or cap enrolment by nationality, undermines academic integrity and the practical functioning of health-professional education. It also risks fracturing the international scientific collaboration that global health relies on.
The myth of institutional neutrality
Perhaps the most far-reaching clause is the requirement that universities remain “institutionally neutral” on policy matters. This narrows what counts as political in ways designed to silence positions that conflict with those in power.
Health-professional schools cannot pretend that health exists in a political vacuum. Food security, insurance coverage, water fluoridation, tobacco control, environmental regulations, migrant access to care, vaccination mandates, rules for corporate lobbying – these are policy questions with direct consequences for health outcomes. The compact reframes neutrality so narrowly that speaking about structural determinants could be cast as political advocacy, discouraging scholars and clinicians from addressing society’s most urgent challenges. That chilling effect would be felt in teaching clinics serving communities at the sharp end of inequality. Policies that delegitimize gender identity or constrain inclusive practice alter the ethical foundations of care.
In short: the Compact does not only reshape the ideas taught in classrooms. It reshapes who works in health, who feels welcome in our clinics, which research questions are safe to explore, and how universities speak about the conditions that produce disease.
Why this matters beyond the U.S.
Most health professional schools will not have the option to sign or reject the Compact; their fate is tied their parent universities. But the implications extend far beyond U.S. borders. American universities remain major hubs for global science and training. Their faculty shape WHO guidance, lead multinational research, and influence health policy worldwide. International students who train in the U.S. often return home to lead programmes and public-health institutions. Narrowing these pathways weakens global health capacity and will ripple through global professional networks.
Other governments are watching. The Compact has consequences that reach far beyond American campuses. It offers a ready template for countries keen on repressing academic freedom for political gains.
Bystanders, upstanders, and the future of academic freedom
In moments like this, institutions sort themselves into two groups: bystanders, who recognise the risks but wait for others to act, and upstanders, who intervene because silence would compromise the values they claim to uphold. The Compact forces this choice.
Health-professional education has always balanced biomedical training with a broader public-health mission. The Compact threatens to sever that balance. If universities capitulate, they do not only limit academic inquiry; they limit the future of the health workforce and, with it, the health of populations.
Whether the Compact succeeds or fails, it exposes something essential: academic freedom in the health professions is not a luxury. It is a precondition for ethical, evidence-based care that serves public need. Medical, dental, nursing and public health schools should say so, clearly, publicly, and now.
Author: Habib Benzian, DDS PhD MScDPH, is a former Professor of Epidemiology & Health Promotion at NYU Dental College and a fellow of the OpEd Public Voices Institute. Currently he is the Noel Martin Visiting Chair at the University of Sydney Dental School. He is also an Extraordinary Professor at the Faculty of Dentistry of the University of the Western Cape in Cape Town, South Africa. More info: LinkedIn Profile & Substack The Global Health Paradox
Competing interest: None
Handling Editor: Neha Faruqui