With Robert F. Kennedy Jr. now lined up to lead the Department of Health and Human Services, it appears his Make America Healthy Again movement is poised for real power.
Its central mandate: Reverse the chronic disease epidemic, which is the leading cause of death in the U.S., and drives massive health care costs.
MAHA has set its sights on big food and big pharma, arguing that these industries use lobbying power to maximize profits at the expense of the country's health.
This message served as an animating force in the final stretch of the election, as Kennedy elevated concerns about ultra-processed foods and poor nutrition, food additives, pesticides and toxic chemicals, and the harms of industrial agriculture, among other issues.
He knit together an unlikely coalition — some from the left and some MAGA supporters — eager to take on the establishment.
"Bobby Kennedy and Trump have bonded over tying the core of MAGA — which is a distrust of institutions and getting corruption out of institutions — to our health care industries," says Calley Means, an adviser to Kennedy and the Trump transition team, who spoke with NPR before Kennedy's nomination.
The ascendance of MAHA is a dizzying moment for scientists who've long pushed for more attention to lifestyle diseases — and agree reforms are desperately needed. At the same time, they're deeply worried about Kennedy's history of questioning scientific consensus on vaccines and his antagonism to mainstream medicine more broadly.
Barry Popkin, professor of nutrition at the UNC Gillings School of Global Public Health, says he'd welcome substantive policy changes that tackle diet-related illnesses like obesity and diabetes.
"If it comes, they'll have plenty of support," he says. "But I do not see that — I fear the worst."
He fears if Kennedy is confirmed as HHS head, "thousands of children may die of measles and many other infectious diseases for which children have been vaccinated for many decades." (Kennedy recently told NPR that he won't "take vaccines away from anybody.")
And yet there's no denying there are areas of substantial overlap between the goals of MAHA and scientists who have long advocated for tackling the root causes of chronic illness.
"There are some things that RFK Jr. gets right," says former CDC director Dr. Tom Frieden. "We do have a chronic disease crisis in this country, but we need to avoid simplistic solutions and stick with the science."
Public health researchers note that what Kennedy is setting out to do — even wielding the power of a major federal agency — is an immensely tall order. And many question how realistic or actionable the mission will be in a Republican-controlled, regulation-unfriendly federal government.
An ambitious to-do list
If appointed, Kennedy would have broad sway over health policy — from the Centers for Disease Control and Prevention to the Food and Drug Administration. And he has promised seismic changes, from day one, including firing hundreds of staffers and scientists.
Kennedy's influence could reach deep into health care, infectious disease prevention, drug pricing and approvals and more. But his vision for preventing chronic disease is one that he's been particularly vocal about in the lead up to this appointment.
And the MAHA to-do list is ambitious, to say the least.
Overhauling dietary guidelines, reforming federal programs that pay for ultra-processed foods, taking on crop subsidies, potentially banning pesticides and chemicals are just some of the priorities Kennedy outlined during the campaign.
"Despite the media's effort to silo this movement into fringe areas like vaccines or fluoride or things like that, the voters saw very clearly that big ideas were being talked about," says Means. "I think a spiritual connection was hit."
Means — himself a former lobbyist for the food and drug industry — has emerged as one of the leading voices in the MAHA orbit. He and his sister, Dr. Casey Means, catapulted into the political sphere after publishing a bestseller on metabolic health. Both have business ventures in the health and wellness industry.
Means helped forge the political alliance between Trump and Kennedy.
"The public health expert class has given us a public health collapse," he says. "We are on the verge of, at best, a health crisis and, at worst, a societal collapse with 20% of GDP going to health expenditures. [We're] getting sicker, fatter, more depressed, more infertile for every dollar we spend."
Means says a key to their plan is eliminating conflicts of interest.
He cites the revolving door between industry and government, the fees paid by pharmaceutical companies to the FDA, and experts who sit on advisory panels or carry out government-funded research while receiving industry dollars.
Dr. Mark Hyman, a bestselling author and longtime friend of Kennedy, says he's faced "massive" resistance over the years when he's advocated for many of these reforms on the food supply and nutrition.
"I think this is a unique opportunity," says Hyman, who is the founder of the Cleveland Clinic Center for Functional Medicine and co-founder of Function Health. "Because Trump is a burn-down-the-house kind of guy. Bobby is not looking for incremental change."
Political contradictions
The outpouring of attention on lifestyle-related diseases — and the promise to crackdown on industry influence — is a surprising twist that longtime researchers in the field are still trying to square with the broader Trump agenda.
"I'm certainly excited by this idea of addressing the root causes of chronic diseases," says Dr. Randall Stafford, a professor at Stanford School of Medicine. "But I'm not sure that those goals are consistent with other goals to deregulate the economy."
He worries that "anything that contradicts other Trump policies is going to be discarded."
Trump's first administration installed industry insiders and made decisions that run counter to some MAHA priorities, like approving dangerous pesticide products and loosening nutrition rules for school lunches.
Now Kennedy wants to do more to rein in food and pharma. He's calling for restrictions on a host of food additives and dyes. He wants to reduce the dominance of ultra-processed foods; he's called for reforming the SNAP food assistance program — formerly known as food stamps.
And he's called for an end to direct-to-consumer advertising for prescription drugs.
"A real litmus test about whether or not they're serious is whether they take on some of the economic interests that are causing our chronic disease epidemic," says former CDC director Frieden, who is now president and CEO of Resolve to Save Lives.
Popkin says the Republican Party doesn't like regulation — and pushing through reforms that go against industry interests will face enormous headwinds in Congress.
"Given the desire to cut government, they're going to want to cut regulations as a huge component. They did under Trump's first term, they're going to be more systematic about it even now," says Popkin.
Calley Means pushes back, claiming MAHA's approach is not "overregulation," but rather to rid the system of corporate influence.
"I would tell anyone skeptical about this, to look at the positives here," he says. "This MAHA agenda is one of the golden areas for true bipartisan reform."
He says Kennedy's approach will be to insist on what he terms "accurate science" and adds that "it's Congress' job to allocate money. It's Congress's job to figure out how to rectify the broken subsidy systems that led to this poisoning of the American consumer."
Edited by Jane Greenhalgh and Carmel Wroth.
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