What would it take to ‘Make America healthy again?’ Part 1 of 2

Thinking through the realities facing such a commitment

This piece was co-written with Dr. Nason Maani.

This week Robert F. Kennedy Jr. was confirmed as Department of Health and Human Services. The possibility of his appointment has not been without controversy, with his positions on a range of issues, notably his skepticism of some vaccines, facing justifiable scrutiny. This scrutiny reflects a reasonable response to Kennedy’s nomination, given his positions and statements. At the same time, it is worth trying to engage with the health policy goals of a new administration in good faith as it implements the policies that the president ran on, even as we call out bad policy when we see it. This reflects an acknowledgement that elections are a contest of ideas, and the American people have just unambiguously endorsed a particular vision for the country, revealing an appetite for widespread changes, including to the U.S. public health system.

Before taking office, President Trump publicly stated that his goal with respect to health and science agencies is to “restore these agencies to the traditions of Gold Standard Scientific Research, and beacons of Transparency, to end the Chronic Disease epidemic, and to Make America Great and Healthy Again!” This slogan is both welcome and somewhat perplexing, given the prior positions of both the president and his Republican party on a range of health-related issues, positions that, at first glance, do not seem to bode well for health in the U.S. This includes the efforts of the first Trump administration to repeal the Affordable Care Act, the administration’s recent actions in the area of global health, and its moves to cut NIH research funding, all of which raise concerns over the consequences of its actions around health. Early announcements and executive orders by the new administration, such as ceasing reviews and external communications at the National Institutes of Health, withdrawing the U.S. from the WHO, withdrawing the U.S. from the Paris Agreement and changing the rules governing civil servants have evoked serious concerns and merit scrutiny. Ultimately, health expertise and scientific evidence should not be partisan issues, and each policy choice involves long-tail consequences for all Americans, particularly the most vulnerable. It seems imperative, then, that the administration’s intentions be treated with the respect, caution and objectivity that administrative responsibility demands. The administration says it wants to make America healthy again. So, in this piece, we will try to take this sentiment at face value and ask:

What would it take to truly make America healthy again?

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Creating the Next Generation of Scientists

Science, as with all fields, needs the next generation in order to grow and evolve. Even more, it needs the next generation to be better than the current generation, and subsequent generations to be better still. That is how fields continue to flourish. Given the importance of science to the human enterprise, it should be of paramount importance for all of us that science continues to thrive by investing in training the next generation.

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“Not as a matter of charity”

Building a healthier world as a matter of social duty.

Recently, I have been writing some reflections that are spurred by the moment, focusing on how we need to make health a priority in our politics, and on my concerns about ensuring our politics are informed by an appreciation of their effect on people’s lives and health. Today, I want to reflect on perhaps some of the genesis of the current actions we are seeing at the federal level, actions with deep implications for national and global health. As the new US federal administration has begun making sweeping cuts to federal programs, one cannot help but feel that these programs are being cut, in part, because they are seen as being “charitable” and that charity, when times are tough, or when ideology shifts, is no longer regarded as a tenable motivation for large-scale federal expenditure. This matters for public health because much of what we do can indeed be interpretated as, at core, charitable in intent, with all the baggage this can carry in the national political debate.

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On Teaching the Foundations of Science to Populations

Biology is a core requirement of most American high school curricula. And part of the content of high school biology classes are units about genetics. Students learn about Gregor Mendel and the peas, about the double helix and how understanding DNA revolutionized science, and how specific genetic variants become readily visible phenotypes. Generations of Americans leave high school—where most will have their last formal learning about science of any kind—with at least a vague sense that genes inform aspects of who we are, and, as a corollary, that changing genes may change who we are.

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The political decision that health matters

On centering health as a value that informs politics, particularly in divided times.

The newly installed administration, like every new administration, inherits a country facing many challenges. These include challenges in our energy sector, at our border, in the emergence of natural disasters, and in the geopolitical tensions that threaten to destabilize our world. They also include, centrally, challenges in health. The U.S. faces a range of problems that have held our health back relative to peer countries, problems such as substance use, gun violence, chronic disease, mental illness, and deep inequities that have created pockets of persistent poor health among populations. For example, black Americans sicken and die at a much higher rate than white Americans from a host of health challenges, such as diabetes, heart disease, and asthma. Black maternal mortality is also higher, as is the likelihood of this population being injured or killed by gun violence. The scale of these problems echoes the scale of challenges to health we see at the global level, including under-five mortality, the threat of infectious disease, and global inequities in health that concentrate a disproportionate burden of poor health in certain regions.

These challenges raise the question: How do we create health? This question is core to the work of public health, and our efforts to answer it have yielded a great deal of data on how to go about building a healthier world. Fundamentally, we create a healthier world by creating the conditions that generate health. This is reflected in the animating metaphor of The Healthiest Goldfish — that of the goldfish who died for lack of clean water. When it comes to health, our “water” is a metaphor for the conditions in which we live. Building a healthier world takes creating healthy conditions, such as clean air and water, nutritious food, accessible education, livable wages, and an end to the misogyny and racism that deprive many of opportunities for health achievement. Ensuring these conditions are in place can play a decisive role in improving health locally, nationally, and globally.

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On cruelty, liberalism, and the moment

Finding the signal in the noise of recent days.

This is a time of change and turbulence in our national conversation. President Trump took office a week ago, and with this new administration has come a raft of changes. I have written over the past few months about the importance of those of us who work in health remaining nonpartisan, of making an effort to take a big-tent approach to health, of leaning into hope and optimism and of recognizing that there are reasons why President Trump was reelected and that we should try to understand and engage with them. We should be willing, always, to listen and learn, towards gaining back some of the trust we as a field have lost. We also owe any new administration a chance to act according to what it feels the American people have called on it to do. We have just had a free and fair election in which two competing visions for the country were defined and debated. One of those visions won, and Donald Trump, for all that is problematic about him, is a known quantity that Americans, of sound mind and body, decided they wanted to reelect. These are facts with which we should engage and which we should seek to understand, with an open heart and open mind.

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Bias

There is a bias against having biases. Our everyday use of the word bias is derogatory, suggesting a belief that is unfounded and unfair; a bias is a prejudice. In biomedical science, by the 1970s, bias had largely become a statistical, clinical trial term with a negative connotation associated with misclassification, error, a flaw in an experimental design or data collection, and lack of validity. The moral association of the term “bias” is still apparent as a disparagement, something to be avoided in our experiments. Pushing against this dominant conception of the notion, we suggest that bias, seen as a part of science that is unavoidable, may be getting a bad rap. Perhaps a more neutral understanding of what bias is could offer some insight into the process of science and a preferable approach to our thinking about scientific work.

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Challenging health in 2025, part 2 of 2

On seizing opportunities to shape a healthier world in the new year.

In last week’s essay, I suggested four trends that likely will play an outsized role in health in the coming year: the need for new ideas in health, the rise of new approaches in how we engage with health and the forces that shape it, the creation of new systems that generate health, and the work of improving public health’s relevance. In that essay, I stressed that these trends and ideas long predated this moment, representing major shifts in our engagement with health. They are structural factors in what we do, currents that already are playing a significant role in health and how we work, collectively, to support it. The essay was, in a sense, countercultural to this moment in that it did not engage with the upcoming presidential transition. Certainly, the incoming Trump administration matters for health, but had Vice President Harris won the election, I still likely would have written much the same essay, in an effort to address these longstanding trends and issues in health. This aligns with the aspiration of these essays to, at times, pull back from the daily developments of politics and culture, the current events that shape the news cycle, to engage with what is driving events at the most fundamental level.

Having identified trends in last week’s essay, I would like today to discuss how we can tackle these trends in 2025. How do we challenge ourselves to intersect with emerging trends in the pursuit of a healthier world? It can feel, at times, like large-scale trends just happen to us, with little we can do to meaningfully affect them. However, I would like to suggest that we challenge ourselves to do more, that we can engage with trends to build a healthier world in 2025 and beyond. Toward this aspiration, I would like to suggest four challenges to health in this moment, inspired by four strategies that have guided our efforts at WashU as we have begun the work of building a great school of public health in St. Louis.

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