23-05-2025
RFK Jr.'s MAHA Commission Just Published Its First Report. Here Are 5 Crucial Things It's Missing.
ROBERT F. KENNEDY, Jr.'s Make America Healthy Again Commission's first report came out today, focusing on the causes of chronic disease in children in the US. Of course, America should be focusing on chronic diseases, which are the leading causes of death and disability, costing $4.5 trillion in annual health care expenditures. We lag far behind peer countries in life expectancy. More than 40% of adults and 20% of children are classified as obese.
We don't need a Commission to study the causes of chronic disease—because we already know them. Largely preventable, nonmedical risk factors such as poor nutrition, physical inactivity, and alcohol and tobacco use drive chronic diseases, which are unequally distributed, and strongly related to race, income, and geographic location.
The MAHA commission should focus on the primary drivers of chronic diseases, but its priorities mirror the pet peeves and anti-science views of RFK, Jr. The Commission's charge doesn't even mention foods that are high in added sugars and sodium, or even alcohol and tobacco. Instead, the charge includes issues that contribute to chronic diseases in limited ways (food additives), rest on shaky evidence (causes of autism), or represent the Secretary's long-held views (opposition to weight-loss medications).
These issues distract from policies already proven to work but have struggled to gain political support. Moreover, the focus on chronic disease should not come at the expense of ongoing investments in infectious diseases, particularly given the current avian H5N1 influenza and measles outbreaks.
There are clear policies that could help prevent chronic diseases, such as:
Reducing sodium and added sugars in food.
Front-of-package nutritional labeling.
Dietary guidelines encouraging fruits, vegetables, plant-based proteins, and whole grains, while limiting red or processed meat, refined grains, and foods high in saturated fat, sodium, and added sugar.
Tobacco control including reduced nicotine levels in cigarettes.
Protecting federal entitlement programs like Medicaid and the Supplemental Nutrition Assistance Program (SNAP).
For more on these topics, see my recent article in JAMA Health Forum. Even though the MAHA commission is off to an inauspicious start, it could still become a catalyst for evidence-based investments and policies to reduce the burden of chronic diseases. That requires policies based on science and doing the hard political work.
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