The MAHA Report is a missed opportunity

Less than six months into the new administration, the Department of Health and Human Services (HHS) has produced its Make Our Children Healthy Again Assessment, as ordered in Section 4 of President Trump’s executive order. This assessment was completed so quickly mainly because it is simply a grab bag of independent and unconnected children’s health trends barely tied to an assortment of pet projects from 1990s environmentalists and health advocates.

While it appears to be loaded with scientific research—it has 522 citations in its 68 pages even after fixing the handful that were found to have errors—the references read more like a catalog of every scientific article that purports a link between any given substance and children’s health, rather than a thorough examination of the issues the report focuses on. The studies cited reflect a wide variety of themes and quality.

The report’s most compelling section is when it lists several genuinely problematic health trends facing America’s youth, including diabetes prevalence and mental health issues. Unfortunately, most of the report doesn’t focus on these issues or specifically analyze the research on these trends to uncover root causes or potential solutions.

Instead, it merely moves on to trend after trend, then names an assortment of potentially villainous actors and behavioral trends that HHS Secretary Robert F. Kennedy Jr. and others in the activist health movement have been criticizing for decades. The report is full of threads but doesn’t tie any of them together.

It is also not a comprehensive report on children’s health. If it were, it would note areas in which children’s health has improved as well. For instance, mortality from childhood leukemia has plummeted over the past 50 years. Across the board, survival rates for childhood cancers have improved dramatically over the decades.

Thanks to medications and management, many conditions are no longer the burdens on people’s lives that they once were. In addition to childhood leukemia, fewer children are living with cystic fibrosis and congenital heart disease, just to name a few.

Any comprehensive review of the increasing prevalence rates of diseases should consider the possibility that these are themselves a consequence of improving health care. While that may seem counterintuitive, a higher survival rate will translate to a higher prevalence rate.

To illustrate using an extreme example, if everyone with lung cancer dies within three months then only a small percentage of people would test positive for it, but if 99 percent of people with lung cancer live fifty more years, then the number of people living with it would be very high, and a trend on a graph would suggest lung cancer is getting worse.

HHS surely has a difficult job as these are complex issues, and past administrations have damaged their credibility with misguided suggestions.

The report concludes with a single page containing its ten recommendations, and they are minor when compared to the issues and criticisms the report lays out. The first on the list is to address the long-standing concern over the fact that many research studies cannot be replicated by independent scientists. While that is a noble endeavor, it is an unusual lead recommendation for a report that purports to be based on that very research. The rest of the recommendations are broadly conceived modifications of research agenda, information generation, or information dissemination. None of them will have a significant effect on the issues described.

MAHA proponents should be disappointed by this. There are some genuine problems with children’s health and multiple concerning trends that deserve closer inspection. There are also many ideas for how to improve things. HHS is well positioned to inform the public, but that potential has been wasted with this report.