On Feb 13 2025, President Trump issued an Executive Order to create the Make America Healthy Again Commission, and directed them report on the “childhood chronic disease crisis”. The Commission was given 100 days and on May 22, their MAHA Report was released to the public.

At 73 pages long, most people won’t read the whole report. And even if they do, it’s not easy to parse. Many claims are misrepresentations of real studies, and others are backed up only by fake citations to studies that never existed. But this is exactly what E is for Epi is here for! To help you make sense of public health claims.

Which is why I read the MAHA Report; so you don’t have to. Here is Part I of my reactions. Enjoy!

P.S. Don’t forget to Subscribe so you don’t miss out on Part II.

Before we dive in, it’s worth mentioning that I downloaded the MAHA Report from the government’s website on June 1 at 10:49am. The reason this is worth mentioning is because they keep revising and reposting the report whenever anyone finds a totally made-up fake citation. So, there’s a possibility that things I discuss here will have been changed or removed from any version of the Report you go download later.

With that caveat out of the way, let’s start at the beginning.

Purpose of This Assessment

The Executive Order tells the Commission to:

[S]tudy the scope of the childhood chronic disease crisis and any potential contributing causes, including the American diet, absorption of toxic material, medical treatments, lifestyle, environmental factors, Government policies, food production techniques, electromagnetic radiation, and corporate influence or cronyism

That’s a very broad set of things to look at but it’s also quite clear: the Commission is directed to study everything that might be affecting the long-term health of American children.

Which is why I find it a bit surprising that on the very first page of the report they say that purpose of the report is to examine four potential children’s health issues:

• Poor diet;

• Environmental chemicals;

• Lack of physical activity and chronic stress; and

• Over-medicalization.

But they do also state on this first page that they believe these four factors “present the clearest opportunity for progress”. So, perhaps, they have decided to focus on areas where they thought change could happen? Despite what they were told to do by the President!

Introduction

Until very recently (March 2025) I taught epidemiology and public health to graduate-level students. If I had assigned my students to write a report on the drivers of poor health among American children, the Introduction is where I would expect to see an overview of the problem: what are kids getting sick from, what are kids dying from, and how have these changed over time.

And so, given the framing of this Report as addressing a chronic health crisis, I’d expect to see at least one graph with data up until the end of 2024 showing that in the last handful of years not only have chronic diseases increased in frequency but that the speed of increase is also increased. Otherwise, is it really a crisis?

What does the Report Introduction say?

The health of American children is in crisis.1 Despite outspending peer nations by more than double per capita on health care, the United States ranks last in life expectancy among high-income countries — and suffers higher rates of obesity, heart disease, and diabetes.

That second sentence ends with a citation “12” which, judging by the fact that this is the first time anything has been cited in the report, is probably supposed to say “1, 2”. What are these sources? The first is a post on the Petersen-KFF Health Tracker website which discusses life expectancy and health care spending globally, for people over the age of 15. I don’t know about you, but IMO that’s not a very strong start to a report about children’s chronic disease.

The Report goes on to say (and don’t worry, I’m not going to block quote the whole thing!):

Today’s children are the sickest generation in American history in terms of chronic disease and these preventable trends continue to worsen each year

Yikes, that sounds bad doesn’t it! And this “factoid” is accompanied by a citation: A paper in Academic Pediatrics from 2025. That’s a real paper, analyzing data from a government-conducted survey called the National Health Interview Survey. Unfortunately, the authors only had access to data up to 2018. Which seems like a limitation if we are trying to establish a chronic health crisis in 2025.

But while the Report cites this study, it doesn’t tell us specifically what the study says. Does this study support the Report authors’ claim?

The graph below shows the main finding from the cited study. Remember, the Report interprets this as “today’s children are the sickest generation in American history”. The blue line is the prevalence of chronic conditions and functional limitations among US children ages 5-17 from 1999 to 2018. The orange line is chronic conditions alone. And it’s true. These rates do appear to be rising over time. But not astronomically so.

The Report authors use this graph to justify their claim that today’s children are the sickest ever. But this graph shows children ages 5-17 from 1999 to 2018. The very youngest of those children are at least 12 years old now. So how can this graph tells us anything at all about children ages 5-11 in 2025?

It’s too bad no one from this government Committee on Children’s Health could figure out how to get more recent data from the government’s own National Health Information Survey. And, before you ask, yes, this is an annual survey.

Moving on.

Right about now you might be asking yourself: “Why should we care about children’s health?” Now, personally, I am not asking myself this but the Report’s authors clearly thought some people would, because they make sure to tell us in that very same sentence that worsening children's health is “posing a threat to our nation’s health, economy, and military readiness.” So, I guess we are supposed to care about children’s health because of military readiness?

Anyway. The report then segues back to talking about health expenditures and provides us with a graph. This is the first graph in the report, which presumably means it is the one the authors’ feel is the most compelling for establishing the case for a chronic disease crisis in children. At least, that’s what I would expect to find in a report I was grading.

Here’s what they chose to show: Life Expectancy and Health Expenditure Per Capita By Country (1970-2023).

As an aside: somewhat inexplicably, this graph is sourced from Our World in Data, despite the authors having previously used the Peterson-KFF Health System Tracker. Now, there’s nothing wrong with that per se, but it does mean that this graph is insufficiently cited. My students would lose points on that for sure.

But more than that, what even is going on in this graphic? Look at the x-axis. Now, look at the title. Now look at the x-axis again. Finally, ask yourself this question: do the red dots represent US health care spending over time?

The answer is yes, but it’s also not that simple. Because while the red dots each represent the health expenditures for the US for one year, the order of the dots is based on the amount of spending. Not on the year. Which means you cannot read this graph as if it shows a trend over time. In fact, if you go to Our World in Data you will see that US health care spending goes up and down at least a little bit all the time. So these dots are absolutely not ordered by time.

What the Report authors have done here is simply overlay a series of graphs from 1970 to 2023 on top of each other, with no way for the reader to reconstruct the time-ordering of those points, despite the graph title suggesting that this shows the pattern of spending over time. The 2023 dot could be anywhere at all on that x-axis. It’s really not clear to me as a reader what they hoped to convey to the audience beyond “hey look, we have a graph!”.

Having apparently made their case for a chronic disease crisis in children (at least for now), the Report authors then proceed to describe the reasons for this crisis. They blame the “forces of modernization and industrialization”.2

Furthermore, they accuse federal and state governments of having “sometimes been guided more by corporate profit than public interest”, and claim that “leading scientific and medical institutions have grown complacent, defaulting to symptom management”.

And while I agree that many of our best biomedical and scientific advances in the past several decades have been focused on treating disease, I’m not sure I would describe that as “complacency”.

The Introduction closes out with two promises. First, that this Report will give “radical transparency” about the current situation of children’s health in America. And second, that “America will begin reversing the childhood chronic disease crisis during this administration”.3

And those promises sound great. But if you read carefully, there are some concerning ideas hidden in there.

The authors suggest that farmers should be “the center of how we think about health”. I find this troubling given how many causes of disease have nothing to do with farms, and I suspect many farmers would find this troubling too!

They also suggest that the goal of the health care system should be to prevent and reverse diseases, not "manage” them. Which is all well and good in theory, but… can you tell me even one chronic disease that we as a human species have ever learned to cure? I’ve been wracking my brains, but I just can’t think of one.

But to “manage” a disease means to control the symptoms and progression and help people live happy, fulfilling lives. That we can do this for so many diseases is a success, not a failure, of modern medicine!

And, as a final troubling note, the Introduction ends by making the claims that the solution to the chronic disease crisis will require the use of AI, and these solutions will thus only begin to happen over the next 10 years. Which, correct me if I’m wrong, is long after the Trump administration should be over.

I’m going to stop here for today’s read-through because, even though we’ve only read the first two (short) sections, there’s a lot to digest. These first 8 pages of the report paint a picture of a Report that was put together in a haphazard way, without a clear agenda, and without making use of any of the myriad of resources the government already has for thinking about and studying these problems.

I sure hope the remaining 65 pages aren’t this bad. But I’m not holding my breath.

Come back tomorrow for Part II: A Generation at Risk!

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