President Donald Trump issued an executive order (EO) establishing a commission to “Make America Healthy Again.”
The February 13 order identifies multiple areas for reform and directs the creation of a panel of agencies to enact research and policy plans.
The order directs the government to “aggressively combat the critical health challenges facing our citizens, including the rising rates of mental health disorders, obesity, diabetes, and other chronic diseases.”
The order was announced after Robert F. Kennedy Jr. was sworn in as Secretary of Health and Human Services. Kennedy will chair the commission, which will include other Cabinet members and heads of government agencies such as the Environmental Protection Agency, Office of Management and Budget, and National Economic Council.
Shorter Lives, More Spending
Recent decreases in average life expectancy are concerning, says John Abramson, M.D., a retired lecturer at Harvard University.
“One of the, if not the most important measures, of the function and well-being of a country is the number of years its citizens will live in good health,” said Abramson.
“‘Healthy life expectancy’ is the most nuanced comparative statistic because it is based on the total longevity, corrected for the decrease in quality of life due to chronic disease,” said Abramson. “Despite the incredible progress in medical science over the past 20 years and our rapid adoption of new medical technology, Americans’ healthy life expectancy has fallen from 38th in the world in 2000 to 67th in the world in 2021.”
As Americans’ life expectancy has decreased, health care spending has reached record highs, according to the Peterson-KFF Health System Tracker
Misplaced Priorities
The federal government has done a poor job of improving health outcomes, says Linda Gorman, director of the Health Care Policy Center at the Independence Institute.
“Interactions between genetics, individual behavior, and medical care determine health,” said Gorman. “Government needs to focus on health programs that significantly improve individual health. We know that better health is correlated with higher incomes, so it is possible that unnecessary spending may even harm health.”
The government places too much emphasis on health care delivery, and a thorough review of Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and the National School Lunch Program would be a good place to start reforming priorities, says Gorman.
“Ever since [President Barack] Obama expanded Medicaid in pursuit of coverage for all, billions of dollars have been wasted paying managed care companies to cover the largely healthy expansion population at the expense of the truly ill and disabled. The current Medicaid program is a national scandal,” said Gorman.
It is important to remember different maladies can arise while others fall, says Gorman.
“A rise in cancer cases is not, in and of itself, an indicator of poorer health,” said Gorman.
Pediatric Dietary Setbacks
“Fighting Childhood Chronic Disease” is a top priority in the EO. The president ordered the commission to provide an initial assessment of the problem within 100 days and develop an improvement strategy within 180 days.
The order calls for comparing U.S. childhood rates of chronic disease to other countries’; analysis of possible over-utilization of medication; and investigation of the effects of food ingredients, chemical exposure, use of psychotropic drugs such as selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, and stimulants, and the use of weight-loss drugs.
The commission must also evaluate “best practices” for preventing childhood health problems such as inadequate physical activity, declining mental health, and poor nutrition.
Government has exacerbated the nation’s eating problems instead of solving them, says Gorman.
“Government dietary advice has been a mess for decades,” said Gorman. “There is no particular reason to expect that government health advice will improve with a whole-of-government approach.”
Science Integrity
The order calls for restoration of the “integrity” of science, including elimination of “undue industry influence.” Policy actions should include “open-source data” and transparent research that will “empower” Americans while eliminating conflicts of interest, the order states.
“In the United States, the knowledge upon which our citizens and their doctors must rely is now largely controlled by financial goals of industry, and that is undermining not only our health but also our freedom,” said Abramson.
With 96 percent of medical research addressing new drugs and devices, only 4 percent is allocated to efficient and effective health care delivery, says Abramson.
“Our medical research agenda has been relegated to the market,” said Abramson. “The currency of the market is dollars. The currency of health care ought to be improving Americans’ health most effectively and efficiently. Allocation of research investment cannot be driven by corporate financial goals.”
Other commission directives include expansion of treatment options and greater flexibility in health insurance.
Vaccine Punt
Vaccine safety is a notable omission in the president’s order, says Jane Orient, executive director of the Association of American Physicians.
“Chronic illnesses, especially in children, are a grave concern,” said Orient. “However, we will not make much progress if we refuse to consider the potential role of 70-plus doses of vaccines. These are deliberately intended to permanently alter the immune system.
“We must know the health status of vaccinated [children] versus the small but essential control group of unvaccinated [children],” said Orient.
Orient says it is important to evaluate the long-term efficacy and safety of vaccines versus other methods of preventing disease transmission, “such as whether early treatments using repurposed medicines might be an adequate or even better approach.”
Ashley Bateman ([email protected]) writes from Virginia.
