by Alex McDonald | Special to the Courier

The “make America healthy again” movement, or MAHA, has garnered attention for its promises to address the nation’s health challenges. There is no question the U.S. health care system is failing: we have the highest health care expenditure per capita, with some of the worst health quality and outcomes. Something needs to change.

But the MAHA movement exploits fears, oversimplifies complex health issues, and manipulates public sentiment for financial gain, rather than genuinely improving health outcomes.

At face value, reducing processed foods, minimizing environmental impact, emphasizing prevention, and mitigating corporate influence on health while promoting individual autonomy all sound pretty good. However, scratch the surface of these platitudes and one quickly sees MAHA’s foundation is built on pseudoscience, conjecture, and conspiracy theories.

The movement lacks scientific rigor, medical expertise, and is outright dismissive of decades of public health institutions and people who have dedicated their careers to science and evidence-based medicine, all of which have proven to improve quality of life and have increased life expectancy by 30 years since 1900, according to the Oxford Academic’s 2023 Public Policy & Aging Report.

The MAHA movement oversimplifies complex health issues, emphasizes individual interventions and manipulates public sentiment for financial gain, rather than genuinely improving health outcomes. Most importantly MAHA fails to address the key drivers of rising chronic disease and poor health such as social determinants, access to care, evidence-based medicine, and underfunded public health efforts.

I must admit there is one aspect of the MAHA movement I do agree with: its stance against ultra-processed food consumption, which has been linked to chronic health issues. The movement advocates organic farming, healthier food production practices, shifting away from pesticide use, and reducing the consumption of artificial additives, preservatives, and oils commonly found in processed foods.

That being said, strong evidence for the health benefits of some of these initiatives is absent. Policies under MAHA include banning ultra-processed foods in schools and restricting the use of soda and sugary drinks in government assistance programs like SNAP/EBT. I agree with promoting cleaner, more nutritious food options, but we need to be aware of the lack of evidence for some of these interventions and their potential tradeoffs.

My biggest concern about MAHA is it prioritizes superficial, simple solutions and references anecdotal or highly questionable pseudoscience as “evidence” over substantive, peer reviewed science and evidenced-based approaches for very complex problems. For example, while it claims to tackle chronic diseases, its policies frequently ignore the root causes, such as socioeconomic disparities, environmental factors, and systemic barriers to health care access. Instead, it promotes measures like banning artificial food dyes, which lacks credible scientific support, or restricting evidenced-based medical care and technology. Furthermore, the movement’s reliance on fear-based messaging, manipulation and misinformation undermines trust in credible health institutions and experts.

MAHA’s financial motivations are not at all transparent, but its alignment with certain industry interests and promotion of unproven treatments and products speak volumes. There is a multi-billion dollar market for over the counter health products or treatments that have no oversight or scrutiny whatsoever. By prioritizing individual action and investment in unproven “treatments,” MAHA has placed profit over public health and doing the hard work of systemic transformation which will truly improve the health of all Americans, not just people who can afford it.

Trust me when I say that no one spends years in school, goes into public health, or focuses on preventative medicine to make money or influence people. There are much easier and faster ways to become far more wealthy. Evidence-based prevention and public health is hard, unglamorous work that is often completely ignored when it does its job well.

Among the key flaws of MAHA are:

1. Lack of scientific basis. Many of the policies and claims promoted by the movement such as the dangers of seed oils, fluoridated water, or the benefits of banning artificial food dyes, lack credibility or scientific evidence. Furthermore, the promotion of pseudoscience or highly questionable “research” only serves to confuse and muddy the waters for the public. This is by design; not all research is good quality or rises to the level or passes the scientific scrutiny needed to make good health or policy recommendations. Furthermore, much of this messaging oversimplifies complex health issues and may even contradict established research.
2. Fear-based messaging. The movement often relies on fear and misinformation to garner support. This approach can undermine trust in credible health institutions and distract from evidence-based solutions to public health challenges.

1. Focus on individual responsibility. MAHA tends to emphasize personal choices, such as dietary changes, while downplaying systemic factors like social determinants of health, access to care, and public health interventions. This narrow focus can shift blame onto individuals rather than addressing broader policy or structural issues which have far more potential to improve the health of all Americans, not just the wealthy. 

1. Financial motivations. The MAHA movement prioritizes profit over public health by promoting unproven treatments and products, the sale of which often benefits many of the key leaders of the movement. Furthermore, the financial ties are shrouded and there is little transparency regarding who or what is benefiting. This raises concerns about the true intentions behind its initiatives.
2. Contradictory policies. While advocating for health freedom, transparency, informed consent and reduced exposure to “toxins,” the movement has supported environmental deregulation that could increase environmental exposure and public health risks. MAHA has also supported policies which try to legislate the practice of medicine, impacting the physician-patient relationship and autonomy. Additionally, defunding and censoring expertise and evidence-based public health measures has intentionally created confusion and raised unfounded questions regarding health options for patients and physicians.

To mitigate the harmful effects of the MAHA movement, it is essential to promote practices and policies grounded in science and public health expertise. This is going to take all of us, and it’s going to take courage to stand up and speak out.

Counteracting the dangers of MAHA:

1. Strengthening public health. Public health systems are the backbone of a healthy society, addressing health inequities, increasing illness data tracking and communication, and promoting preventative care. We must expand funding for public health initiatives such as vaccination campaigns, community-based health programs, and community health workers, to improve access to care in underserved areas. There is clear evidence that countries with robust public health systems experience lower rates of chronic disease and better life expectancy. Expanding local health departments and increasing collaboration with community organizations can and will build trust and resilience.
2. Lifestyle medicine. Lifestyle medicine focuses on evidence-based interventions that address the root causes of chronic disease. Diet, sleep, exercise, stress reduction, social connection and avoidance of risky substances are all highly individual behavioral choices. We must create policies which encourage and promote healthy lifestyle behaviors. For example, we need to design and build walkable communities which encourage physical activity; reduce subsidies for highly processed foods; increase subsidies for healthy sustainable food and production; and strengthen policies that promote a healthy and sustainable environment.

1. Addressing social determinants of health. Social determinants, such as income, education, and housing, play an outsized role in shaping health outcomes. If we really want to improve health we need to focus here. Policies that prioritize affordable housing, accessible transportation, and equitable education systems will address the root cause of health disparities. For instance, a 2020 Kaiser Family Foundation study showed Medicaid expansion under the Affordable Care Act has proven to enhance access to health care, reduce financial barriers, and improve health.

1. Promoting preventive health care. Preventive primary care is critical for identifying and addressing health issues early. Increasing insurance coverage for screenings, vaccinations, and check-ups has shown to reduce long-term costs and improve health. Preventive services also alleviate the burden on emergency departments and hospitals and promote health equity. According to the Association of American Medical Colleges 2020 annual report, the U.S. will likely experience a shortage of 21,400 to 55,200 primary care physicians by 2033, exacerbating an existing shortfall. We must increase the number of primary care physicians as an effective and efficient way to improve the health of our nation.

1. Public education. Combating misinformation is essential to rebuilding trust in science and health care systems. Transparent and evidence-based public education initiatives can empower people to make informed decisions. Leveraging social media platforms to amplify accurate information from trusted messengers can counteract fear-mongering narratives.

The “make America healthy again” movement has a few redeemable goals, such as prevention and improved dietary efforts. But the approach is fundamentally flawed, prioritizing profit and fear over science. Addressing the true reasons behind our poor health requires systematic,  evidence-based approaches, education, and policies to increase access and address social determinants of health.

Lies and misinformation that sound good are cheap and easy to produce. But relying on science to find the truth is time consuming, expensive, and requires expertise and institutions to do the hard work to find the truth. Remember, science is not about knowing the truth, it’s about finding the truth, and having the humility and willingness to revisit assumptions and incorporate new data and information as it becomes available.

It is imperative to counteract the dangers of the MAHA movement with policies and initiatives that truly prioritize the health and well-being of all Americans, not just platitudes. It will take collective effort and systemic change to actually make America healthy.

Alex McDonald, MD, CAQSM, FAAFP, a family and sports medicine physician and member of Claremont Unified School District’s Board of Education, has lived and served in Claremont for more than a decade.