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MAKE AMERICA HEALTHY AGAIN?  
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Katelyn Jetelina, Jess Steier and Kristen Panthagani
October 16, 2024
Your Local Epdemiologist
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_ RFK, Jr.'s plan sounds catchy, but won’t move the national
needle. To build a healthier, freer America for all, focus on what
truly works, not what merely sounds catchy. _

What Is Public Health?,
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_YLE is taking our own advice
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being upfront: This post is based on data AND our personal values
system that highly prioritizes public health. Our goal here is to lay
out, to the best of our ability, what a policy would mean based on
objective data and personal experiences watching how public health
works in real life._

A catchy slogan from RFK, Jr. has been unearthed in anticipation of
the elections: Make America Healthy Again
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dedicated their careers to protecting and improving the health of
populations, we absolutely agree that we need to work towards making
America healthier! 

After all, America has room for improvement: We live the shortest
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have the most
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deaths, have worse
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access, and have worse
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compared to other developed countries. 

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Health Care System Performance Rankings. Source
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Commonwealth Fund, 2024. Annotated by YLE

The first step is to ACCURATELY IDENTIFY WHAT IS CAUSING US TO BE
UNHEALTHY AND FIX THAT. We won’t make substantial progress if we
chase after falsehoods. 

But the big MAHA talking points—organic food and pesticides,
alternative medicine, and removing pharmaceutical hold—often lack
specificity, are riddled with falsehoods, and widen the risk
perception gap
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on relatively minor issues while overlooking more significant threats
that shape our health. 

In addition, the key players behind the proposal have a horrible
record on evidence-based policies: consistently discouraging routine
vaccines, touting the health benefits of unproven and potentially
dangerous remedies such as raw milk, and promoting supplements for
profit instead of evidence-based treatments. 

To achieve a healthier tomorrow, core values of public health can help
with: 

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The pursuit of accurate information

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The pursuit of reducing preventable diseases and hazards,

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The protection of everyone’s health

THE PURSUIT OF SCIENTIFIC REALITY

Creating a better world means first clearly seeing the world as it
is. 

One of the most dangerous aspects of the MAHA campaign
is MIXING REASONABLE STATEMENTS WITH OUTRIGHT FALSEHOODS. This
combination makes it extremely difficult for the general public to
distinguish fact from fiction and determine where we can get the most
bang for our buck.

Some examples include: 

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_“Medicaid should pay for 3 organic meals daily for every
American._” Access to nutritional food is a huge problem in the
U.S.—this part is true. However, there is no strong evidence 
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date that organic food is nutritionally superior. And organic food can
be unhealthy — you can make ice cream organic, but that doesn’t
make it good for you. We should prioritize increasing access to
nutrient-dense foods—whether fresh, frozen, or canned—regardless
of whether they’re organically or conventionally grown. 

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_“Embrace alternative medicine.” _Many alternative medical
therapies simply do not work
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more dangerously, may discourage people from seeking tested therapies.
Instead, addressing our primary care crisis would have a much bigger
impact on our nation’s health. Primary care matters
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associated with decreased mortality and chronic diseases, like
cardiovascular disease.

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_“Get toxic residues and pesticide residues out of our
foods.” _Residues on fruits and vegetables are extremely limited.
Simple actions, like washing with running water
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residues. A push towards the European model is less
about _actual_ exposure levels and more about _theoretical_ harm.
Organic farming also uses pesticides, just different ones that
aren’t necessarily safer for humans
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the environment
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And they usually need more to be as effective. 

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_“Prohibit members of the U.S. Department of Agriculture Advisory
Committee from making money from food or drug companies.” _While
avoiding conflicts of interest is important, this proposal creates a
false dichotomy between expertise and industry and excludes valuable
knowledge and expertise. For instance, despite industry connections
through his research, Dr. Walter Willett, a professor at Harvard, has
shaped public health guidance on the role of healthy fats and
plant-based diets. A more balanced approach involves transparent
disclosure and management of potential conflict, similar to models
used by the NIH
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CONFLICTS OF INTEREST THAT ARE HANDLED APPROPRIATELY VERSUS GENUINE
CORRUPTION.

THE PURSUIT OF REDUCING PREVENTABLE DISEASES AND HAZARD

Freedom can mean very different things to different people. On the one
hand, it can mean “do what we wish,” but on the other, it’s a
“pursuit of living free from preventable hazard and disease.” In
the United States, our culture balances the two. 

ACCESS TO MEDICAL CARE HELPS AMERICANS LIVE FREE, HEALTHY LIVES—to
live, prosper, and contribute to society. However, Americans
face _MORE BARRIERS_ to accessing and affording healthcare than
their counterparts. One in four
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has trouble paying their medical bills, which leads to delayed care
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many conditions become emergencies, increasing costs and resulting in
poorer health. 

MAHA suggests using Medicaid to pay for organic food and gym
memberships. It’s unclear if they intend to cut insurance coverage,
but given budgetary constraints and the high cost of organic food,
this may be a consequence. This would be a big problem: Diet and
exercise are very important but cannot solve all medical problems. A
delivery of organic produce is no replacement for access to
healthcare.

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Source: Commonwealth Fund, 2024
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Moreover, MAHA calls for “cleaning up the public health agencies.”
This is like trimming the fire department even though more houses are
catching fire, as public health’s DNA is prevention. While we agree
that federal agencies need to be more nimble, flexible, and responsive
to the needs on the ground, proposals like MAHA overlook the existing
challenges in public health infrastructure: 

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_MAHA CALLS [[link removed]] FOR
DECENTRALIZING PUBLIC HEALTH._ But public health is already
decentralized. The power of public health is already given to the
States, which makes sense since public health is local. However, under
this proposal state funding diminishes; only a skeleton remains until
the next emergency. How can we focus on prevention—including through
efforts like access to mental health, addressing food deserts, and
preventing teen pregnancy—when we have barely enough resources to
put out fires?

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_MAHA CALLS FOR WEAKENING CDC THROUGH RESTRUCTURING_. CDC, our
national public health entity, holds the State public health ligaments
together through data and guidance. If this weakens even further, the
whole system breaks. Adding more institutions (like proposals to split
up the CDC) _adds_ to bureaucracy. Institutions need to be cohesive
with sufficient, stable, and efficient funding if we want institutions
to be more nimble. 

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_“REPLACE INDUSTRY-CAPPED OFFICIALS WITH HONEST PUBLIC HEALTH
SERVANTS.” _This implies that public health agencies are completely
controlled by pharma, which is simply false. It also implies that
public health employees are not honest servants. Public health
professionals don’t get into this profession for the money
(there’s not much); we are here for the mission. 

PROTECT THE HEALTH OF EVERYONE 

Public health’s core mission is to improve population health. Part
of this strategy involves addressing the needs of the most vulnerable.

For example, consider routine vaccination mandates. Children <1 year
are the most vulnerable to measles, and pregnant women are the most
vulnerable to rubella but are not eligible for vaccinations.
So, _everyone else_ gets MMR to protect high-risk people through
herd immunity (and everyone else.). (Note: RFK, Jr. has spent the past
two decades eroding vaccine trust that has done irrevocable damage.) 

Large-scale, evidence-based interventions help reduce chronic
conditions, too. For example:   

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Instead of advocating for meditation alone, coordination between
mental health and primary health care improves
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health. Parental leave also helps families that can barely make ends
meet, reducing
[[link removed](22)00311-5/fulltext] stress.

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Instead of focusing on pesticides’ small impact, policies to reduce
environmental pollution
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protect vulnerable communities from industrial exposures. For example,
low-income groups continue to be exposed to higher levels
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dangerous fine particulate air pollution than higher-income groups.

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Rather than vilifying non-organic items, we should promote policies
that improve access to nutrient-dense, affordable options
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food deserts. 

BOTTOM LINE 

Everyone agrees we need to build a healthier America. Many of MAHA’s
vague proposals won’t substantially improve it; in some cases, it
will move us backward. National progress comes from policies
that LEAD WITH EVIDENCE, IMPROVE ACCESS TO QUALITY HEALTHCARE, AND
INVEST IN PREVENTION AND INFRASTRUCTURE. 

Let's focus on what truly works, not what merely sounds catchy.
That’s how we'll build a healthier, freer America for all.

_“Your Local Epidemiologist (YLE)” is founded and operated by Dr.
Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two
little girls. The main goal of this newsletter is to “translate”
the ever-evolving public health science so that people will be
well-equipped to make evidence-based decisions. This newsletter is
free to everyone, thanks to the generous support of fellow YLE
community members. To support this effort, subscribe here
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_Dr. Jess Steier @theunbiasedscipod
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health scientist, founded Unbiased Science
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and dispel misinformation._

_Kristen Panthagani, MD, PhD @kmpanthagani
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Medicine physician at Yale and creator of the medical blog You Can
Know Things [[link removed]]. _

 

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* RFK jr.
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