Last week, the White House released a Make America Healthy Again Commission executive order that outlines a host of goals with a main purpose of addressing chronic disease in adults and children. And some medical experts are skeptical.
“Make America Healthy Again” is a Trump campaign promise and now commission that’s led by Robert F. Kennedy Jr., who was recently appointed Health and Human Services Secretary. The commission has an overarching goal of reducing the prevalence of chronic illness in Americans and looking at the “over-reliance” on certain medications, such as weight-loss drugs, mood stabilizers and ADHD medication. It also cites the rising rates of autism and ADHD, and the United States’ lower life expectancy when compared to other countries.
On the surface, there is nothing inherently wrong with the overall aim to make people healthier, happier and free of illness, two doctors told HuffPost. Physicians want to lessen chronic disease incidence. However, the approach of the Make America Healthy Again initiative worries experts.
“At the heart of the matter, you’re not gonna find a doctor in this country who doesn’t want to ‘Make America Healthy Again.’ That’s something we all strive to do,” said Dr. Eric Burnett, an internal medicine doctor at an academic medical center in New York and a health communicator on social media.
“We want to be healthy. We want to decrease chronic diseases in the general population and specifically in children,” said Dr. Sheila Young-Mercado, the president of the Association of Black Women Physicians.
And there is absolutely a chronic disease problem in this country, Burnett said. “I deal with the chronic disease epidemic every day as a hospitalist. I see the end stages of chronic illness when patients get sick enough to be in the hospital.”
What Burnett personally disagrees with is the undertones of the executive order and the overall messaging of the Make America Healthy Again Commission. Burnett said the executive order claims that no one really knows what’s causing the chronic disease epidemic in the United States.
“It suggests there’s some sort of sinister aspect to it ― that we’re hiding something, or that it’s an over-reliance upon medications, that doctors fail to address root causes of chronic illness and just give them medications just to sort of brush them off,” Burnett said.
Here’s what else concerns medical experts about the Make America Healthy Again executive order:
Experts feel the Make America Healthy Again plans could contribute to a loss of trust in doctors.
Burnett noted that in the executive order, there’s a subsection about the so-called “harms” of SSRIs, or selective serotonin reuptake inhibitors, like antidepressants and antipsychotic medications. It also mentions America having an “over-reliance” on medications for chronic diseases.
Specifically, the order calls for the commission to “assess the threat that potential over-utilization of medication” and “assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants and weight-loss drugs.
“What that does is it sort of vilifies medication and makes it seem like doctors are trying to just give you a pill to get you away when that’s not true,” Burnett said. “Most doctors will attempt to do lifestyle modifications first before relying on medications.”
“But I think what RFK Jr. fails to realize, or he’s failing to express to the public, is that chronic disease is multifactorial. It’s not just one simple fix,” Burnett continued.
“There’s socioeconomic factors, there’s social determinants of health, there’s genetics that all obviously need to be addressed in a multifactorial, multidisciplinary manner that takes time, takes effort, takes money, and I think that’s what he’s not doing. He’s simplifying it and vilifying the medical profession in the process, further eroding trust.”
The executive order doesn’t address the underlying reasons for mental health medication.
As mentioned above, the order specifically targets the prescription of mental health medications like Lexapro, Prozac and Zoloft, in addition to antipsychotics and mood stabilizers.
The order instructs the commission to look at the “prevalence and threat” of these medications. But SSRIs, antipsychotics and other mental health-focused medications are proven to be beneficial for the treatment of conditions including post-traumatic stress disorder and depression.
While taking these medications can carry some risks, that is also true for any medication out there. And for those who need these mood-stabilizing medications, the risk of not having access can be incredibly dangerous, too. Many people rely on SSRIs, for example, to manage suicidality. When people can’t get the medications they need, they also tend to self-medicate with drugs or alcohol, Young-Mercado said.
Instead of worrying about the “threat” of these medications, Young-Mercado said the root cause for the prescription of these mood-stabilizing drugs needs to be addressed, too.
“At the heart of this, it’s really looking at what’s happening in our societies — what are the levels of child abuse? What are the levels of intimate partner violence? What are the levels of community violence? What is the level of workplace trauma? What is the level of stress?” she said. “If we want to decrease reliance on these medications, what are the environmental factors that are driving them?”
Doctors are also concerned that the messaging may push people toward alternative, holistic treatments.
While the executive order does not explicitly mention alternative medicine, Burnett believes the messaging sets up distrust in traditional health care by using phrases like “over-reliance on medication and treatments” and “we must ensure our healthcare system promotes health rather than just managing disease.”
In recent years, there’s been a distrust when it comes to science and medicine, despite tons of evidence. The medical industry needs trust — not an executive order that seemingly sows doubt about prescription medications and proper disease management.
“We’re at this juncture where we need buy-in from the public … and if he vilifies us, making us seem to be just these pharma shill pill-pushers, it’s going to make the people run towards the holistic wellness industry, which obviously has their their own agenda,” Burnett said.
While there can be room for alternative or holistic wellness in your health routine, it can’t always be the only answer. For example, when a patient with diabetes stops taking medication because they’re convinced their pills are a scam and turn to holistic treatments like supplements instead, they get sicker and wind up in the hospital.
“And that’s the thing, when you have these wellness influencers and people who are trying to push this ‘MAHA’ movement of ‘get off medications and just live a healthier lifestyle’ … those holistic practitioners are never going to see the downstream consequences of their actions,” Burnett said.
This is where Burnett’s frustration lies. “I want to try to explain to people the importance of this. We’re not trying to over-rely on medication, they do serve a role, but this narrative that they’re spinning on that side is making it difficult,” Burnett noted.
Andrew Harnik via Getty Images
The executive order also doesn’t address racism, socioeconomic status and other social determinants of health.
The social determinants of health are a set of factors that can greatly impact a person’s well-being ― and they are often circumstances people are born into. They include racism and discrimination, education levels, access to nutritious foods, financial stability and pollution.
These factors play a huge part in chronic illness development and management. For example, if you live in an area with high air pollution, you’re more likely to develop asthma. Or if you’re a single parent who works multiple jobs to make ends meet, it’s likely harder to get to the doctor or pay for items that help you manage an illness properly.
Burnett noted that he hasn’t heard Kennedy or the other people in charge address the social determinants of health, and these aren’t outlined in the new executive order, either.
“I think we just don’t see the emphasis placed on that, which makes me question how serious he is about ‘making America healthy again’ when he doesn’t address the things as a physician that I see all the time that influence chronic illness,” Burnett said.
Burnett is also concerned about the gutting of diversity, equity and inclusion programs enacted by the current administration and how that could further create health care disparities, which could make these social determinants of health even more pronounced.
Looking at “health care disparities and how to address them is going to be viewed as DEI, and we’re not going to be able to ― at least on the federal level ― have funding to investigate why healthcare disparities exist,” Burnett said.
Doctors also feel there are systemic issues when it comes to health care, none of which the executive order really addresses.
There is certainly room for improvement when it comes to the health of Americans, but focusing on so-called “threats” of medications and an “over-reliance on treatments” isn’t a great starting point.
“We want to make Americans healthy, but we’re not going to provide the funding to do it,” said Young-Mercado, who is referring to health insurance access in this country. “I think … when we’re looking at who’s writing these documents, we have to assume that having access to health care isn’t actually an issue for them, so it may not be something that they’re really thinking about.”
Access to health care includes having health insurance at all, but also being able to afford an expensive bill that isn’t covered by insurance and being able to access government health care programs for those who are eligible.
For instance, more than 70 million Americans get their physical health care and behavioral health care through Medicaid, but currently, Republicans have their eye on the state-federal health care program and want to cut billions of dollars in funding to Medicaid.
“If we want to be able to address chronic diseases and increase life years in the U.S., then we have to maintain and improve Medicaid for our population. That’s not something that we can get rid of,” said Young-Mercado.
The executive order also compares America’s negative health outcomes to Europe’s positive health outcomes, which is not a fair assessment.
When someone says that Europeans are so much healthier than Americans, Burnett points to two things — “A, they have walkable cities, right? They have cities where their infrastructure is such that people can walk around. They don’t have to drive a half an hour to get to the supermarket. And B, they may have access to universal health care. They don’t have to worry that if they go to their doctor for, you know, for something, that they’re going to be in six figures’ worth of medical debt.”
“I think that there’s also a disconnect in the realities of how we want to create this program, how we want to envision making America healthy without the underlying funding to make it happen. That’s our major problem,” said Young-Mercado.