Make America Healthy Again Through Prevention, Says Ethicist

Medscape

27-05-2025

This transcript has been edited for clarity.
Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU Grossman School of Medicine.
There was an announcement I received February 13, establishing an order from the White House for a new commission. It's called the Make America Healthy Again Commission. I've got the order printed out in my hand.
It's something that everyone watching this video needs to be aware of and attentive to. The commission is meant to advise the federal government, chaired by the new Department of Health and Human Services leader, Robert F.Kennedy, Jr, on all matters regarding health and disease.
The executive order creating it begins with what I have to say is one of the toughest, meanest indictments of American healthcare, as it now exists, that I've read anywhere. This is not something that was cooked up by some sort of civil rights group or some kind of foundation fighting against corporate American healthcare. This is right out of the world of the president and his top health advisors.
What they're saying is that American healthcare is a grim failure because of the mess that Americans are in with respect to their health. The highest cancer rates, double the next highest rates of comparable countries. Asthma is twice as common than in most of Europe, Asia, and Africa, and the same for autoimmune diseases like inflammatory bowel disease, psoriasis, and multiple sclerosis.
It basically says the American people are on a trajectory, if we don't do something about the whole healthcare system, that is leading them to premature death and disability due to chronic illness. It also suggests that children, in particular, are at grave risk because of the way healthcare is organized and delivered now.
This is one huge indictment, and what it says is that we want fresh thinking. The charge is what can we do about better nutrition, more physical activity, change to healthy lifestyles,get off medications, try to assess new technology habits — they're talking about cell phones, I presume — and food and drug quality and safety.
It's hard to be against any of those bits of advice. I think, in many ways, what the commission is charged to do is come up with new ways to think about prevention as opposed to disease treatment. That won't come as a shock to many of you physicians watching.
Many people would like to see our healthcare system pay for more prevention, which it doesn't, and see more resources devoted to counseling and supporting people with respect to maintaining their health.
I have to say, I don't think there are any big mysteries that have to be examined here.The creation of this commission hints that somehow there are secrets out there that we don't know about. I don't believe that.
I think we know that lifestyle change is very important. We just don't know how to get it done. I think we know that better diet would be great. We just don't know how to get people to do it.
There's a huge food industry in America that stands in the way of transitioning to healthier diets. Our agriculture is built around unhealthy foods, including sugar and everything. It's going to be very tough to move what I'll call a fast-food society over to healthy lifestyles.
I don't agree with the rationale given here about the need for new thought completelybecause I think many people know that we are too oriented toward fixing, treating, and rescuing people who have diseases and not doing enough to preserve health. I don't think that's a mystery of poor or limited thinking.
There are also some concerning aspects in this order to create the committee of what they want this commission to do. For example, they say pay attention to things like cell phone towers; toxic exposures, with the suggestion being perhaps vaccines; and worrying about what's going on with children with respect to too much exposure to nasty elements of the environment.
Again, I think what's going on with children is pretty well understood: obesity. We've got a big obesity challenge, and I hope that this commission can think about ways to battle obesity. One of the things that the commission's chair, RFK Jr, wants to do is shift lifestyle. I think many of you who practice, regarding children and families, know that efforts to change lifestyle have not ended well.
It's very difficult to do it in the climate and environment in which we live when we're bombarded with ads for unhealthy food and portion sizes that are far bigger than in the rest of the world and on and on. Getting lifestyle change is so tough that we're turning more and more to the injectable weight loss drugs.I don't think that's something that RFK Jr is going to be willing to support.
I don't think we need novel thinking about how to solve it in terms of what the causes are. If we're going to make progress, my comment would be that we have to change reimbursement and what we pay for. We have to intervene earlier with people long before they're sick, with better wellness visits and better well-baby visits.We have to shift how the system delivers prevention.
I'm not quite on board with new thinking. I'm on board with new modes of thinking about how to deliver prevention to the American people.
I'm Art Caplan, at the Division of Medical Ethics at NYU Grossman School of Medicine. Thanks for watching.