How Will MAHA Tackle the Root Causes of Our Kids' Health Crisis?

A Cardiologist's Perspective

Last year I wrote a Sensible Medicine post about the MAHA movement, urging physicians to approach it with an open mind and to embrace some of its guiding principles. At the time, there was little detail to discuss.

We now have the first formal MAHA Report, presented to the public last Thursday afternoon in a splashy formal White House presser, led by the President, with comments from several commission members.

As I commented on X, this document will likely form the foundation of this administration’s health agenda for the next 4 years. It is critical that every physician, biomedical scientist, and healthcare leader read and start to understand its implications.

The full report is 73 pages and consists of an introduction, an opening section outlining the state of crisis in US children’s health, sections on each of the 4 main drivers of poor health, and a concluding page with 10 major research initiatives and next steps.

The report focuses on what it calls a crisis in the health of US children, “tomorrow’s workforce, caregivers, and leaders.” Evidence for the crisis in US children’s health: 77% of US youth are unfit for military service; very high rates of obesity, T2 diabetes, prediabetes, neurodevelopment disorders, cancer, mental health disorders, and food allergies.

The report proposes a broad and “coordinated transformation of our food, health, and scientific systems” and lays our four broad areas of “root causes” and drivers of the crisis:

1. Food: “Nearly 70% of an American child’s calories today comes from ultra-processed foods (increased from zero 100 years ago), many of which are designed to override satiety mechanisms and increase caloric intake.”

2. Environmental chemical exposure: “The cumulative load of thousands of synthetic chemicals that our children are exposed to through the food they eat, the water they drink, and the air they breathe may pose risks to their long-term health, including neurodevelopmental and endocrine effects.”

3. Pervasive technology use: “Over the past four decades, American children have transitioned from an active, play-based childhood to a sedentary, technology-driven lifestyle, contributing to declines in physical and mental health. Specifically, these declines have been driven by increased screen time, reduced physical activity, and psychosocial stressors like loneliness, chronic stress, and sleep deprivation.”

4. Overmedication: “The health system has aggressively responded to these increases in childhood chronic disease with increasing rates of pharmaceutical drug prescriptions which may cause further harm to the health of American children when used inappropriately.”

The longest and probably least controversial Section 1 is on food and nutrition: “The greatest step the United States can take to reverse childhood chronic disease is to put whole foods produced by American farmers and ranchers at the center of healthcare.”This has been recognized by many in the medical field in the burgeoning “Food is Medicine” movement.

Section 2 covers environmental toxin exposure. This is likely to be more controversial and provoke more questioning and pushback from business concerns. Much of it is straight from the environmentalist movement. “Silent Spring” brought up to our time.

Section 3 covers “The Crisis of Childhood Behavior in the Digital Age.” Many others have recognized the problem of excessive screen time, inadequate physical activity, and reduced socialization in children. The movement in reducing phone use in schools has been gaining momentum. Other contributors to poor health include declining sleep, chronic stress, and loneliness.

Section 4 “The Overmedicalization of our Kids” is also likely to provoke some questioning, concern, and resistance in the medical and pharma communities. Its thesis is that “American children have, as a product of these misaligned incentives, been subject to an unprecedented period of over-prescription driven, in large part, by corporate influence, with demonstrable consequences for their health.” The report details numerous examples of allegedly overused, ineffective, or harmful treatments, directly challenging many pediatric medical and surgical practices, including psychiatric drugs, stimulants, asthma and GLP-1 drugs, some ENT procedures, antibiotics, puberty blockers, and transgender surgeries.

Most controversial in the medical/ public health community will be the “Growth of the Vaccine Schedule” discussion. Numerous concerns familiar to “vaccine skeptics,” are reviewed, including the marked rise in number of vaccine injections given since 1986, the use of fewer shots in some European countries, widespread school mandates, perceived limitations of clinical trials and safety surveillance, industry conflicts of interest and protection from liability, and perceived lack of scientific and medical freedom to question any US vaccination practices.

Section 4 closes with a hard-hitting summary of “mechanisms of corporate capture” of the US biomedical enterprise through distortion of the scientific literature and medical guidelines and exerting undue influence on legislatures, regulatory bodies, patient advocacy organizations, medical schools, CME, and media. We in the fields of medical practice and research will have to swallow hard and reflect on some of these allegations.

There are limitations of the report, of course.

The significance of some environmental toxins mentioned are disputed. In addition, we derive many benefits from living in an industrialized modern society, and economic tradeoffs associated with lowering toxin exposure must be considered. The section on vaccines will raise concerns with many people who recognize their contribution to public health. The section on research integrity and corporate influence in medical education and healthcare will seem to be overstated to many in the academic medical establishment.

I hope that the medical community can see the important generational opportunities that it presents:

1. An opportunity to refocus our society on the health and wellbeing of children. The pandemic was a disaster for US kids. School closures, activity suspensions, masking, and distancing all caused harm. Children were demonized as “vectors of disease.” Mental health problems jumped sharply, along with screen time and social isolation. The MAHA movement is an opportunity to correct some of that injury and put the focus of societal effort on enhancing the lives, health, and wellbeing of our children and our future.

2. An opportunity to advance primary and primordial prevention efforts. Many physicians and clinical investigators have been promoting the importance of prevention and treating “root causes” of disease in their practices and research for decades. MAHA is putting their work at the heart of the nation’s health agenda. The “Food is Medicine” movement has gained currency in several medical disciplines, including cardiology. MAHA will provide significant opportunities to fund more research in these disciplines and to put them into practice.

3. An opportunity put cardiovascular disease and cardiometabolic health at the center of US healthcare and public health. Covid-19 was a disease that preferentially affected people with poor metabolic health. The pandemic represented a tragic missed opportunity to put general health and wellbeing at the center of our medical and public health system. MAHA creates a new opportunity to put it at the center where it belongs. It is, in part, “pandemic preparedness,” as a healthier population will be less susceptible to future infectious disease outbreaks, whatever their source.

4. An opportunity to promote health equity. Over the past 5 years, many medical societies have recognized the importance of promoting health equity and addressing social determinants of health. The chronic diseases outlined in the MAHA Report differentially affect children and young adults within racial minorities, with lower socioeconomic status, and with higher SDOH scores. MAHA will not succeed unless these factors are addressed. The intersection of these issues and the MAHA agenda creates new opportunities for societal engagement and progress.

5. An opportunity for physicians and health care institutions to regain lost trust and credibility with the public. A JAMA study published in 2024 showed a marked and sustained loss of trust in US healthcare institutions over the past 5 years. Many of those most disaffected by the pandemic response are strong MAHA supporters. By engaging with the movement and supporting its best elements, US health professionals and institutions may regain some of this lost trust. The alternative to engagement may be a permanently lowered societal esteem, which will have serious implications for physician and patient wellbeing, payment policy, and societal influence.

6. An opportunity to bridge political divides and bring American society together around a common cause. America shows more signs of deep political division than at any point in my lifetime. MAHA has brought together constituents and supporters from across the political spectrum into a potent movement that will endure beyond this election cycle. Physicians have an opportunity to help bring the country around the common cause of our children’s health and wellbeing.

7. An opportunity to shape the biomedical research agenda. The MAHA report concludes with a one-page summary of 10 next steps to support “gold-standard research and develop a comprehensive strategy” with a pledge to deliver it in August of 2025. This “comprehensive strategy” is likely to dominate the biomedical research agenda and medical priorities of the US government through January 2029 and beyond. Our medical societies and research organization should be beating a path to the HHS Secretary’s door to ensure they are at the table for the development of this strategy.

In conclusion, the MAHA Report represents a seismic shift in US government healthcare policy. It will form the foundation for US health policy for the next four years. Now that the MAHA Commission has published its guiding principles, there are more concrete ideas for physicians to engage with.

The sensible response for physicians will be to embrace its best ideas and reflect on its criticism of our current medical and biomedical research models and practices. We should embrace the opportunity for change. We should talk more to patients about prevention and lifestyle modification and examine how we can change our own practices to align with its principles.

The sensible response for medical societies will be to engage with HHS and the health agencies to understand and advance aspects of the agenda where they intersect with their fields and missions.

This article previously appeared on Sensible Medicine.