Donald Trump and Robert F. Kennedy Jr.’s campaign to “Make America Healthy Again” gets some things right: Our country is beset by chronic disease, environmental risks, and dangerous and inappropriate corporate influence on health decisions.
But to make America healthier, we need an accurate diagnosis and an effective prescription. Although the focus on combatting chronic disease is appropriate, the MAHA combination of sound science, pseudo-science, and profiteering by so-called “wellness” companies isn’t the answer. Success will come from implementing what we know works, learning more, and avoiding simplistic solutions no more likely to make Americans healthier than get-rich-quick schemes are to make us wealthier.
The plain truth is that some things are proven to increase chronic disease, some are suspected to, and some are shown not to be the cause. The first category — proven to cause most chronic disease — includes tobacco, alcohol, junk food, and air pollution; industries that produce and sell these products undermine public policies and are the modern-day vectors of disease and death. In the second category — causes with some evidence — are “forever chemicals,” including PFAS, that may contribute to increases in some cancers and other diseases.
In the third category are vaccines, about which Kennedy has repeatedly spread falsehoods. After decades of research and billions of vaccines administered, we know vaccines save lives, do not cause chronic diseases, and can prevent cancers of the liver, cervix, and mouth. His unfounded claims don’t just prey on personal tragedies, mislead people, and undermine confidence in safe and effective vaccines; they also divert energy and attention from figuring out what really causes — and how to prevent — the chronic diseases we don’t yet understand.
Three things can make America healthier.
First, do what’s proven to prevent chronic disease
Start by implementing what we know works: Comprehensive tobacco and alcohol control policies including taxing these products, creating smoke-free places, hard-hitting ads, and restrictions on marketing, places and times of sale, and promotion.
Sugary drinks, particularly sodas, are the most harmful element in our food system and the single leading driver of the obesity epidemic; they should be taxed, removed from all educational and public institutions, and recognized — and regulated — as the tobacco equivalent in our food supply. Recent data suggest that children living in cities that tax soda are less likely to become obese. The Department of Agriculture should remove sugary drinks and other non-nutritious food from Supplemental Nutrition Assistance Program eligibility — one policy recommendation Kennedy gets right, and which I have advocated for the past 15 years. SNAP subsidizes purchase of soda and other unhealthy foods through an “unholy alliance” of agribusiness and agribusiness-funded “anti-hunger” astroturf groups.
The government should also regulate polluters and support public transportation to improve air quality. This would reduce asthma, cancer, heart disease, and more. National, state, and local governments can make it easier for people to walk, bicycle, and enjoy physical activity as part of their daily lives in their communities.
Next, improve care of people living with chronic disease
Kennedy makes it sound as if treating chronic disease is a bad thing. For instance, in a recent Wall Street Journal op-ed, he wrote, “Americans with chronic conditions are often put on medications or treatments for the rest of their lives,” which is true but misses the point: Nobody wants to have to take medicines to stay healthy, but it’s dangerous to insinuate that medications are the problem. We can walk and chew gum at the same time — prevent chronic illnesses and treat them better. Even if all effective prevention policies are implemented, millions of people will still need treatment. We need to fix our health care system so every person has a primary care team focused on keeping them healthy.
The inappropriate activities of some pharmaceutical companies play into conspiracy theories that undermine confidence in proven treatments. The reality is that the most effective medicines for our leading killer diseases are safe, effective, and inexpensive generic drugs. To prevent illness and save lives, patients need more access to effective and affordable drugs and better access to quality health care.
We also need to improve management of both pain and addiction. Opiates are a major driver of recent reductions in life expectancy.
Finally, learn about and protect us from possible harms
“Make America Healthy Again” touches on one important reason for our poor health: harmful chemicals that increase a wide range of illnesses. Nanoparticles, microplastics, and other chemicals in many consumer products may increase the risk of heart attack, stroke, and death. Other toxins, known as endocrine disruptors, may cause cancer, obesity, reproductive problems, and more. Despite their widespread use, we know and do far too little about their long-term and potentially extensive health consequences.
Bipartisan interest in making America healthier is an unexpected and encouraging development. It’s a great goal — and an achievable one — if we avoid simplistic solutions and transcend ideology to implement what’s proven to work, learn more about the causes of chronic diseases we don’t understand, and make the health of our people the only special interest that gets special treatment.
Dr. Tom Frieden, president and CEO of Resolve to Save Lives, was director of the Centers for Disease Control and Prevention from 2009-2017.