Dr. Ashish K. Jha is dean of Brown University School of Public Health and a contributing Globe Opinion writer.
If Americans want their children to live longer, healthier lives than their parents, the country needs a strategy that is as bold as it is honest — one that confronts our biggest threats, stands firmly on the evidence, and never compromises on the truth.
The strategy report released this week by the Make America Healthy Again Commission is not that plan. The report shines a welcome light on food, fitness, and transparency, but it falls short in its honesty, its innovation, and the evidence.
Above all, it fails to mention the biggest health threats facing our nation’s children — gun violence and auto fatalities, to name two — while simultaneously undermining vaccines, which have led to the most significant improvements in children’s health the world has ever seen.
All told, the report contains a whopping 128 recommendations spanning a broad range of research and policy reforms, many of which sound good on paper but together fail to offer a comprehensive strategy for making America healthier with a clear throughline. There are large, glaring omissions and a troubling lack of detail — which, combined with Health and Human Services Secretary Robert F. Kennedy Jr.’s dismal track record on public health, should raise deep concerns, given the stakes for the health of the nation’s children.
There are places where the strategy gets important things right, especially taking aim at nutrition and food systems. For decades, US policy has supported diets dominated by ultra-processed foods. The strategy’s calls to rethink dietary guidelines, improve front-of-pack labeling, and close regulatory loopholes that let questionable additives slip through are long overdue. The report also deserves credit for elevating fitness as a national priority as well as for emphasizing transparency when it comes to science and replicability.
These are not new ideas. Scientists and policy makers have been raising alarms for decades that these issues are major problems that should be addressed, outlining ways to do so, and even taking action. For example, Michelle Obama focused heavily on campaigns based on nutrition, fitness, and children making healthier choices.
However, many of these recommendations are undermined by other actions by the Trump administration. The MAHA Commission aims to improve the quality of food and nutrition available through the Supplemental Nutrition Assistance Program, while at the same time the recent tax and spending bill looks to cut $186 billion from the program over the next 10 years. As the largest nutrition assistance program in the country, there is mounting evidence that SNAP is a powerful tool for lifting families out of poverty and reducing food insecurity.
While the contradictions are troubling, so is what is missing from the strategy. The report ignores gun violence and auto fatalities, the two leading causes of childhood mortality, and only offers partial solutions to substance abuse, another major cause of childhood mortality. It also sidesteps the impacts of extreme heat and weather caused by climate change, which can disproportionately affect children. Combining those omissions with how the report sows doubt about vaccines, the MAHA plan risks undermining its own credibility.
The number one cause of death for kids in America is gun violence, a fact that the MAHA report makes no mention of. It’s been the leading cause of death in children since 2020. In fact, a report from Johns Hopkins found that in 2022 alone, 2,526 children under 17 years old died from firearm-related injuries. The other leading cause of child mortality is motor vehicle accidents, which have killed more than 1,000 children under the age of 14 each year since 2013.
Despite these jarring figures, the MAHA strategy report is silent on these topics, offering no solutions for preventing gun deaths or making our roads safer for kids. How do we take seriously a report on children’s health that fails to acknowledge the two leading causes of death?
To tackle the opioid crisis, which spills over to children, the strategy offers some useful steps: updating OxyContin labeling, providing naloxone in schools and libraries, and warning about synthetic opioids. These are important interventions but an incomplete approach.
Handing out naloxone is life-saving, but missing from the report is a call for large-scale investments in treatment, recovery, and prevention, the backbone of any real response. These are the actions that have actually made a difference in beginning to address the opioid overdose epidemic. Naloxone distribution alone is not as effective as comprehensive community-based programs providing syringe services, linkage to medication, and hepatitis/HIV testing.
The plan also sidesteps the health consequences of climate change — driven by extreme heat, adverse weather, and air pollution — which disproportionately impacts children. Even if the MAHA Commission didn’t have the courage to mention climate change, surely acknowledging that air pollution, especially in the setting of warmer temperatures, is a major contributor to asthma, poor lung development, and a likely contributor to cardiovascular disease later in life is essential.
Perhaps the most troubling section is on vaccines, undermining a technology that has helped reduce childhood mortality by 40 percent over the past 50 years. The strategy report promises a new “framework” to ensure America has the “best childhood vaccine schedule,” to address “vaccine injuries,” and to uphold “scientific and medical freedom.” What it does not do is reaffirm the overwhelming scientific evidence that vaccines are safe, effective, and one of the greatest public health tools ever developed.
Between 1974 and May 2024, for instance, vaccines for 14 major diseases are estimated to have saved 154 million lives around the world — including 146 million children under age 5, of whom 101 million were babies younger than 1.
By emphasizing injuries and conflicts of interest without grounding its proposals in data, the plan validates skepticism instead of strengthening trust. We already have decades of “gold standard” randomized control trials, epidemiologic studies, and real-world surveillance demonstrating vaccine safety. This includes mRNA vaccines that have undergone the most rigorous clinical trials ever conducted and been administered billions of times. The report ignores all of that.
Instead, it reads as if these questions remain open, spreading a false and harmful narrative around vaccine safety. A credible vaccine policy would start by reaffirming the science and then focusing on real opportunities: modernizing vaccine platforms, accelerating next-generation vaccines for respiratory illnesses — not canceling them — and ensuring coverage for every child. That’s where innovation is needed, not in relitigating settled science.
All of this ultimately points to the same problem. The MAHA strategy report is a scattered wish list that questions our greatest scientific achievements, ignores urgent threats to children’s health, and offers no real path to a healthier America.