Are We Making America Healthy Again?

HHS secretary RFK Jr. is fond of saying that America was healthier when he was a kid in the 1950s and 60s.

No doubt he was healthier. As for the entire nation, you can’t speak of any time period when we were in tip-top shape. For every example there’s a counter-example.

For instance, in 1960, only 13.4% of Americans were obese, as compared to over 40% now. But our life expectancy back then was 69.7 years. We’ve boosted that average by nearly a decade thanks to less smoking and drinking, new vaccines and medicines, bans on leaded gas, etc.

The slogan we ought to be using is not MAHA but MAH: Make America Healthier. That’s everyone’s goal, regardless of their politics, and it’s a reasonable one. Compared to other affluent OECD nations, the U.S. spends more on preventive health care, yet we rank last, or nearly so, on almost every measure of chronic disease, and we don’t live as long on average. Where’s the return on investment?

In this newsletter I want to discuss what we’re doing about this problem. Are we now, in 2025, engaged in making America healthier?

By “we” I mean all of us, but my focus is on the current administration.

We know what to do

“There’s a new milk every two weeks, you know...don’t drink cow’s milk, you should drink soy milk, then they discovered soy milk is all estrogen, and they’re like...you should drink rice milk, then they discovered that it’s like drinking carbs, and they’re like you should drink almond milk...If you don’t like that you can try this new milk, it’s called cow’s milk.” ­–Jim Gaffigan

Americans are obsessed with living healthier – arguably we should be – but, as comedians like to point out, health advice rapidly shifts and is often contradictory. It’s easy to forget that we actually know a lot about living healthier.

For instance, in the U.S., the leading risk factors for preventable chronic disease are poor nutrition, physical inactivity, tobacco use, and excessive drinking. Together these account for more than half of preventable disease deaths (heart disease, cancer, chronic respiratory diseases, type 2 diabetes, etc.).

In other words, as a nation we need better diets, more exercise, and less tobacco and alcohol. Add to that better sleep, stress management, and preventive health care, and you have a core message about living healthier.

Of course, no two scientists or medical professionals would give you exactly the same advice. Much is still debated (Can you have 1 or 2 alcoholic drinks per week without increased health risks? How much protein is ideal?), and individual needs are unique. But there is a core message.

Not everyone is fully aware of this message. Studies show that many Americans lack basic knowledge about preventive health, and their behavior often aligns with what they know.

In other words, the person who smokes or eats a lot of junk food or never gets a physical isn’t necessarily saying to themselves: I know this is risky. They may not know.

We need to get the word out. Americans need to be better informed about prevention.

Unfortunately, the current administration is undermining this goal in many ways – a sad irony, given RFK Jr.’s emphasis on prevention as the solution to our chronic disease woes.

(That sound you just heard may have been Republican readers clicking the unsubscribe button. I can go for months without losing a subscriber, but whenever I delve into politics, a few readers jump ship. All the same, healthy living is a nonpartisan concern. If Barack Obama and Bernie Sanders were to claim that vaccines cause autism, I’d pick on them too.)

So, we want to get the word out about healthier living. In what sense is the current administration making this difficult?

Now comes the “bad news” section of the newsletter. After that I’ll share good news and some suggestions.

1. You can’t spread the word if there’s nothing to say.

The Trump administration is undermining efforts to gather new health data.

Cancellations and freezes that affect funding for health research dominate the news. Less well known is that the administration is making changes that undermine public health, while at the same time ending data collection on the impact of those changes.

For instance, the One Big Beautiful Bill Act cuts $187 billion in food stamps (i.e., SNAP) over the next decade. As of last week, food banks around the country have already begun losing tens of millions of dollars of federal aid. USDA initiatives that brought farm-fresh food to schools and other organizations have been slashed. The administration’s proposed budget for 2026 includes massive cuts to the federal assistance program for women, infants and children (WIC).

While all of this was happening, the USDA quietly cancelled its annual report on food insecurity in the U.S. Next month the agency will issue a final report covering 2024 and then stop collecting data.

In short, the administration is gutting nutritional support for the poor and, simultaneously, ending data collection on how they’ll be affected. This is shameful. It’s like stopping a medical treatment at the same time you stop monitoring patient progress.

13.5% of Americans are now food insecure. That’s nearly 1 in 7 of us. Food insecurity (insufficient access to affordable, healthy food) is linked to numerous health problems, including a higher risk of chronic disease and a shorter life expectancy. Even the USDA still acknowledges this:

On its website, the USDA dismisses the soon-to-be defunct food security report as “subjective, liberal fodder”, but for three decades experts have viewed it as credible and critically informative.

(A similar phenomenon took place at the EPA this year: Regulatory changes that allow more greenhouse gas emissions – known contributors to chronic disease – have coincided with a plan to end federal emissions monitoring.)

2. You can’t spread the word if you choose not to speak.

The Trump administration is attempting to suppress health data. Not all of it. Just the inconvenient truths.

Some of these attempts have failed already. For instance, after deleting HIV- and LGBTQ+-related pages from its website, on the grounds that they promote “gender ideology”, the CDC was forced to restore them earlier this year. Most of the pages are now available, with qualifications. Here’s a screen shot from this morning:

Does cruelty make people stupid, or does stupidity make them cruel? I haven’t sorted that out yet. In the yellow box, the CDC claims that “This page does not reflect reality”, but below that they cite their own data showing that LGBTQ+ youth are at risk for a range of negative health outcomes.

These are nonpartisan facts about certain groups of people. That’s not gender ideology. It’s reality.

(The same can be said about any number of health-related inequities that disadvantage poor people and/or people of color. Hiding the data won’t benefit anyone.)

In other cases, the administration has successfully expunged information it deems unpalatable. For instance, in March, the CDC deleted from its website a 2024 advisory from then-Surgeon General Vivek Murthy declaring firearm violence to be a public health crisis.

Firearm violence is not a chronic disease, but it needs to be part of any discussion of U.S. public health. It’s the leading cause of death among Americans between the ages of 1 and 19, for instance, and no high-income nation experiences anything comparable.

The CDC website still has pages on gun violence, but they’re not well-organized, and you don’t see any of the stronger policy recommendations that Dr. Murthy proposed. In effect, the CDC now just encourages you to lock up your weapons.

(Anything deleted from the CDC website will be available on the Internet Archive and elsewhere, but the current pages are important. Legislators and policymakers rely on CDC data, and there’s an extensive trickle-down effect: Whether you know it or not, you hear about CDC data all the time. News and health organizations draw from it, and from there the information flows to bloggers and eventually pools momentarily in the latest TikTok video.)

There is a simpler way to conceal information. Instead of deleting it, you can just choose not to mention anything in the first place.

“Make our Children Healthy Again”, the report released by the MAHA Commission last month, is a good illustration of misrepresentation by omission. The report does identify many contributors to chronic illness – kudos for that – but it says nothing about nicotine products or gun violence, almost nothing about ultra-processed foods (other than to define what they are), and it fails to acknowledge scientific consensus on vaccines. This may not qualify as “suppression”, but there are certainly key omissions.

3. You can’t spread the word if you’re off topic.

The Trump administration is leading health-related discourse into irrelevancies. Not all of the time, but often enough to be dangerous. One reason is a profound lack of understanding about how science works.

For instance, back in April, RFK Jr. promised we would identify “the” cause of autism by September.

September has come and gone. HHS has made no progress, unless you call “progress“ blaming Tylenol and authorizing treatment with leucovorin. (No credible evidence supports either, although leucovorin might alleviate symptoms among a small subset of autistic children with a particular genetic variant.)

We do know more than we did in April. On October 1, Nature Genetics published an important study identifying two distinct genetic profiles of children with autism: One linked to early diagnosis and communication difficulties during infancy, the other predictive of later diagnosis and a variety of social and emotional problems in adolescence.

This study, led by University of Cambridge researchers, was supported by more than a dozen funders in the UK and Europe. HHS is not among them.

HHS did recently award $50 million in grants for credible autism research. But the agency has also cut funding to autism researchers for perceived D.E.I. issues, and it recently awarded a contract to R.P.I. to explore whether vaccines cause autism.

The latter is the stuff of cartoons. Science doesn’t work that way. Autism is a complex condition or set of conditions that reflects partially-understood interactions between genetic predispositions and environmental influences.

If that last sentence seems wordy, well, it has to be. Vaccines don’t cause autism. Nor does Tylenol. That’s just not the right way to talk about causality here. And we’re not going to fully understand the causes of autism within the next five months either.

The fuss over vaccines and Tylenol is both distracting and dangerous. One consequence is a decline in vaccination rates. Another is that funding for legitimate, sorely-needed research is being diverted to studies that are useless because they question established findings, like the absence of an MMR vaccine-autism link.

4. You can’t spread the word if people don’t trust you.

The Trump administration has hired unqualified ideologues for cabinet-level positions and other key leadership roles.

Here I’ll be brief, because “unqualified” and “ideologue” need some justification, and I’m not trying to lay out a political screed here. I just want to mention that public trust in the HHS and some of its agencies (particularly the CDC) has been declining since the early stages of the pandemic. Just this morning, KFF released poll results showing further declines, with only half of respondents now reporting a “great deal” or “fair amount” of trust in the CDC. Hopefully new leadership will inspire more trusting attitudes.

The bad news in brief

The Trump administration undermining efforts to gather health data, suppressing health data, fostering harmful discourse about health, and undermining trust in federal health agencies. None of this will help make America healthier again.

Some good news

When it comes to health advice, there will always be snake oil salesmen, ideologues, experts who fudge for profit, and individuals who are confused or just plain nuts. A guy described in JAMA Cardiology earlier this year decided to start eating 6 to 9 pounds of cheese, butter, and burgers every day. 8 months later he showed up at a doctor’s office with yellowish nodules on his palms, soles, and elbows. He was literally oozing cholesterol.

The good news is that we know what this guy did wrong. A core message about healthier living has been floating around, and in some places it has landed. Smoking is an excellent example: Every year, fewer and fewer people, including teenagers, are partaking. Among those who do, the average number of cigarettes per year has fallen from about 5,000 in 1960, down to less than 900 at present. In the decades to come, we should see meaningful impacts on chronic disease and mortality rates.

Hopefully, in spite of the Trump administration’s mendacity, growing alarm about other preventable risk factors will spur healthier living, as will advances in medical science and practice. Cancer is an interesting example: Early-onset case rates are rising, but we’re also developing new methods of screening, prevention, and treatment. (See here for an excellent discussion from earlier this week.)

So, how else can we get the word out? The September MAHA report does an adequate job of describing some of the major contributors to chronic disease, but, as observers have noted, it overlooks key contributors (e.g., tobacco and ultra-processed foods), questions evidence-based practices (e.g., fluoridation of drinking water), and it offers strategies that tend to be vague or already in place. That report is not likely to make us healthier.

Beyond MAHA, there’s no dearth of proposals for where to make improvements, whether in health literacy and behavior, prevention and treatment, community infrastructure, or the health care industry. To be fair, a lot of the proposals are about as vague as those in the MAHA report. For instance, the report states that “USDA will develop options to get whole, healthy food to SNAP participants.” This is a strategy; we need tactics. How will the USDA do this now that SNAP funding has been so deeply gutted?

Five suggestions

Here are five concrete suggestions for improving American public health, albeit in small ways:

1. Require the heads of federal agencies to have terminal degrees and experience within the agency’s purview.

This doesn’t guarantee good outcomes, but it may nurture a leadership culture in which science and medical expertise are valued more than they are at present.

For instance, under this rule, RFK Jr. would not be running HHS, and we wouldn’t see funding for meaningful research being diverted to revisit established findings (e.g., safety data on the MMR vaccine and, separately, on mifepristone).

2. Pass the Scientific Integrity Act.

The SIA, currently under consideration in the House, would require each federal agency to maintain a scientific integrity policy, and, among other things, to “ensure that scientific conclusions are not based on political considerations”. To support the bill, you can reach out your local representative directly and/or use this Union of Concerned Scientists form.

The SIA isn’t guaranteed to fix anything either, but it too might foster a more scientifically-grounded leadership culture.

3. Create guidelines for Congress on data interpretation.

Congress doesn’t have specific guidelines on how to interpret scientific evidence. It should.

For instance, on September 10, a hearing led by Senator Ron Johnson (R-WI) was devoted almost exclusively to discussion of a study claiming to show that vaccinated children become sick more often unvaccinated children do. The study is not published or even publicly available. Why not? According to Henry Ford Health, the organization that funded this study,

“This report was not published because it did not meet the rigorous scientific standards we demand as a premier medical research institution...”

(The only physician at the meeting, a Stanford professor, pointed out that in this study, vaccinated children were tracked for twice as long as unvaccinated children. No wonder more illnesses were found among the vaccinated kids).

Unpublished scientific findings do not merit congressional scrutiny. This was a waste of our tax dollars.

I’m not sure how advisory guidelines to congressional committees might look, but one of the bullet points would stress the importance of peer review.

4. Increase K-12 educational support for critical thinking, scientific literacy, and media literacy.

This is a bit of a pie in the sky, because critical thinking and the rest are already folded into the K-12 curriculum, and teachers already struggle to cover the full range of state-mandated content. Meanwhile, everyone else (including me) has their pet ideas about what ought to be added.

Still, a shift in priorities might be useful. In high school biology I dissected a cat. Frogs and fetal pigs are more commonly used nowadays. I get the educational importance of this but, arguably, the time could be better spent. Maybe it’s nice that I once knew how to identify the feline pancreas, but my classmates and I would’ve been better served by more practice evaluating the health claims that crop up every day in the news and social media.

5. Increase penalties for selling harmful products.

Smoking remains the leading cause of preventable deaths in the U.S. Thanks to the Master Settlement Agreement of 1998, tobacco companies now pay states billions of dollars per year. Why not increase their payments? Why not require states to use MSA funds for health care (since they often don’t)? Why not make smoking illegal?

Only about 20% of American adults currently use some sort of nicotine product, so a ban on smoking isn’t unimaginable, politically speaking.

Along the same lines, there’s enough bad press about ultra-processed foods that a nationwide “sin tax” on UPFs that have no nutritional value might be viable, assuming that consumers wouldn’t be forced to absorb the extra costs.

The trick would be to develop narrow definitions. Not all UPFs are harmful, and everything we eat has “nutritional value”, in the sense of providing substances that support life. We don’t need Oreos, but our bodies will put the sugars, fats, and salts they contain to use.

No offense if you like Oreos. I was raised on them. I’m still in recovery.

Thanks for reading!