In early September, the Make America Healthy Again (MAHA) Commission released a 19-page strategy to improve children’s health and reverse the epidemic of chronic diseases. The document, a follow-up to MAHA’s first report in May, paints a dire picture of American children’s health: poor diets, toxic chemical exposures, chronic stress, and overmedicalization are some of the key drivers now affecting millions of young people.
Few would dispute that children should spend less time online, exercise more, and eat fewer ultra-processed foods. But child experts say that the strategy reduces a systemic crisis to personal action and fails to confront the structural inequities that shape which children can realistically adopt healthier behaviors. After all, in 2024, the National Academies of Science, Engineering, and Medicine updated Unequal Treatment, a report that clearly highlights the major drivers of health disparities.
Debbie Gross, a child psychiatric nurse and professor at Johns Hopkins School of Nursing, welcomes the administration’s stated focus on children’s health but notes the gap between ideas and implementation. “The ideas in it are good, but it’s all about how this is going to be executed,” she said in an interview with The Fulcrum. “The devil is in the details. The change this MAHA strategy seeks is at the community level. Who are the people you are bringing to the table?”
So far, the people sitting at the table endorse the ideological views of the U.S. Health and Human Service Secretary Robert F. Kennedy Jr—notably vaccine skepticism and regulatory rollbacks——rather than a cross-section of representatives from communities with the highest disease burdens.
The MAHA commission, created by President Trump in February 2025, is dominated by officials who toe the party line, from National Institutes for Health Director Jay Bhattacharya to Agriculture Secretary Brooke Rollins, founder of the America First Policy Institute. This conservative think tank promotes a vision of America based on pronatalist, anti-immigration, and free speech policies. Gross hopes representation will broaden during implementation.
But experts warn that the administration’s rhetoric about improving children’s health often runs counter to its policy choices. In a press release that accompanied the report, Secretary Kennedy framed MAHA as a sweeping, cabinet-wide mobilization. “This strategy represents the most sweeping reform agenda in modern history,” he said. “We are ending the corporate capture of public health… and putting gold-standard science—not special interests—at the center of every decision.”
Yet the strategy largely sidesteps the social determinants of health, the conditions in which people live, work, and learn that drive health outcomes far more powerfully than personal choice. Speaking with The Fulcrum, Aviva Musicus, Science Director at the Center for Science in the Public Interest, notes that the report focuses heavily on individual responsibility while ignoring the systemic barriers that shape those daily decisions.
“Notably absent from the MAHA strategy report are strategies to address inequities and health disparities,” says Musicus. “The idea is that if we educate people, they will have the resources to take action and become healthier. The reality is that structures and systems affect our health far more than the individual decisions we make daily. Those individual decisions are a direct result of structures and systems. If you don't change the structure, you're not going to change overall health.”
Even where the MAHA strategy acknowledges environmental and behavioral harms—chemical pollutants, the role of technology—it proposes no corporate regulatory oversight. Deregulation only applies to what is perceived as government “interference.” Meanwhile, experts point out that many actions taken by the administration actively undermine the strategy’s stated goals, undermining some of the objectives laid out in the strategy. Cutting food assistance that low-income families rely on, loosening rules on pesticides linked to health risks and advancing policies that restrict access to nutritious foods.
“This administration's actions are making America hungrier and sicker,” says Musicus. “The negative impacts will be disproportionately felt by those with the lowest incomes. Stripping millions of Americans from their health insurance coverage and cutting SNAP will increase health inequities.”
The Administration’s recent decision to eliminate more than 3,800 research grants—totaling roughly $3 billion—for studies on cancer, health disparities, neuroscience, and other areas essential to children’s health further complicates MAHA’s ambitions.
In July, Gross wrote to Secretary Kennedy, urging the establishment of a dedicated agency for children within the NIH, analogous to the National Institute on Aging. She never received a response, despite the alignment with the administration’s stated priorities.
“We spend so much more money on adults than we do on children, but prevention in children costs a lot less,” says Gross. Many unhealthy behaviors, she noted, stem from corporate incentives that discourage improving food quality. “We've got a Secretary of Health who says we must prioritize healthy foods and children in schools. Meanwhile, we've got a Congress that wants to cut those programs financially. So, the question to Secretary Kennedy is how are you going to lead this in this environment?”
Gross also emphasized the essential role of nurses, often the frontline professionals, helping families build healthier lives. Yet the administration has moved to classify nursing as a non-professional degree, limiting financial support for students despite a national nursing shortage.
To meet the MAHA moment, Musicus says her organization is focusing on three priorities: holding leaders accountable for actions that undermine public health, mitigating the damage through litigation and by opposing key appointments, and articulating a proactive vision for an equitable food system. “It’s not enough to play defense,” she said. “We need to provide policymakers with an evidence-based roadmap for what true food system transformation would look like.”
The question is whether those in charge are willing to listen.
Beatrice Spadacini is a freelance journalist for the Fulcrum. Spadacini writes about social justice and public health.
