While many public health experts have criticised United States Health Secretary Robert F Kennedy Jr for undermining vaccines, several think his focus on chronic illness and big food has potential – although they are sceptical of whether he will employ proven methods to improve citizens’ health.

Obesity, and associated problems of cardiovascular disease, diabetes and hypertension, have steadily increased over the past two decades in the US (with a brief dip in 2023), and the consumption of ultra-processed food (UPF) is a major driver of this. 

“Nearly 70% of an American child’s calories today come from ultra-processed foods (67%), and over two-thirds of all calories consumed by American children are ultra-processed grains, sugars, and fats,” according to the recent Make America Health Again (MAHA) report.

Last week, Kennedy met lawmakers from Arkansas, Idaho and Utah when they announced that they would no longer allow low-income families who benefit the Supplemental Nutrition Assistance Program (SNAP) to use the food aid buy junk food and sugary drinks.

This is part of a drive by the US Department of Agriculture, which administers SNAP, and six states have adopted waivers qualifying what SNAP beneficiaries can buy. One-in-five US children were beneficiaries of SNAP in 2023, according to the MAHA report.

Kennedy’s Department of Health and Human Services announced last week that it aims to launch “a series of bold, edgy national campaigns” to make people aware of the links between ultra-processed food and diabetes and “challenge individuals to adopt disciplined, lifelong habits – centered on eating real food, physical fitness, and spiritual growth.”

Correct analysis – but no proven interventions

Global food policy expert Professor Barry Popkin told Health Policy Watch that the MAHA report “addressed ultra-processed food quite correctly and appropriately”.

“As for actions and next steps, they will come out in a month or two with a policy document, which will show us what Acts and laws they are addressing,” said Popkin, distinguished professor at the Gillings School of Global Public Health at the University of North Carolina (UNC).

Dr Tom Frieden, CEO of Resolve to Save Lives and a former director of the Centers for Disease Control and Prevention (CDC), agrees that the MAHA report “correctly identifies serious health threats from unhealthy foods, environmental toxins, and insufficient physical activity among children”. 

Frieden also notes that the report’s “emphasis on reducing industry influence is important recognition of inappropriate commercial influence in health policy”. 

But Frieden says that it “overlooks proven cost-effective interventions that reduce chronic diseases, including front-of-package warning labels, restrictions on marketing unhealthy products to children, taxes on sugar-sweetened beverages and tobacco, and comprehensive tobacco control measures. 

“Countries implementing these policies have healthier kids, yet the report dismisses such regulatory approaches,” adds Frieden, whose organisation has extensive global experience in saving lives by addressing high blood pressure and unhealthy food.

“The report makes a compelling case for government intervention to address inappropriate corporate influences, then paradoxically rejects the regulatory solutions its own data supports.”

Frieden also criticises the report for failing to address tobacco use, the US’s leading preventable cause of death; advocating for voluntary industry agreements that have “repeatedly failed”, and not mentioning how primary healthcare can detect and manage chronic diseases.

MAHA: An opportunity and risk

Popkin and UNC colleague Dr Lindsey Smith Tallie describe the MAHA movement as “arguably the largest, most energised movement to date to address the USA’s twin epidemics of obesity and type 2 diabetes” in a recent article in The Lancet.

The growing focus on nutrition and NCDs is “long overdue” as poor diet has been a leading cause of death and disability in the US “for decades”, with 20% of children and 42% of adults living with obesity, they note.

“Over half of Americans consume sugary drinks on a daily basis, whereas approximately two-thirds of daily calories come from ultra-processed foods” but there has been “virtually no progression in policy to address poor diets”, they add.

But they acknowledge that while MAHA has “tremendous potential to transform the food system”, it also “carries serious risks unless policies are based on science”.

They point to Kennedy’s “record of denying or contradicting scientific evidence” and note that he may not be free of conflict-of-interests (he has close links with Big Wellness groups that stand to benefit from his policies).

They also warn that the Trump administration’s slashing of National Institute of Health funding will cripple biomedical research. 

New York City letter

New York City, a global leader in anti-tobacco and other campaigns to address NCDs,  has also weighed in on the MAHA report via a six-page letter to the MAHA Commissioner in May.

It urged the Food and Drug Administration to finalise sodium reduction targets and establish new added sugar reduction targets.

Michelle Morse, NYC’s Acting Health Commissioner, also offered the city’s expertise in promoting healthy food.

The city has paired its 1.5 million annual SNAP beneficiaries with farmers’ markets to offer incentives to both consumers and food producers. However, Morse warned that the Trump administration’s changes to SNAP “will make it harder for families to buy the foods they need to stay healthy. It is also critical thatthe federal government doesn’t place undue administrative burdens that may lessen the efficiency orincrease the cost of this effective and economy boosting program.”

“We encourage the administration to support evidence-backed policies, to lean on the expertise that exists within state and local health departments, and to consider the potential ramifications that budget cuts may have on the goal of reducing chronic disease,” the letter concludes.

Politicization of food policy?

Popkin and Smith question whether Kennedy and the Trump administration will be able to overcome massive opposition from the food industry to regulate the food environment.

They also stress that “transparent, rigorous, and conflict-free scientific processes are used, even if the outcomes do not align with the preferred policy positions”.

Otherwise, there is the risk of a greater politicization of food and nutrition policy to the detriment of everyone,” they warn.

Kevin Hall, one of the NIH’s most senior scientists studying nutrition, metabolism and  neuroscience, announced his “early retirement” in April, saying that his research had been censored “because of agency concerns that it did not appear to fully support preconceived narratives of my agency’s leadership about ultra-processed food addiction”. His attempts to discuss his concerns with NIH leaders were ignored.

Meanwhile, Frieden warns: “Real progress demands systematic implementation of proven interventions, including through policies, regulations, and comprehensive programs like the CDC programs that Secretary Kennedy just dismantled.”

Image Credits: Thomas Kelley/ Unsplash, C-Span, Global Health Policy Incubator .

The world is within striking distance of enforcing the first legally binding treaty to protect vast areas of waters beyond national jurisdictions that cover two-thirds of the planet’s surface, a historic step that would place biodiversity in the long-lawless high seas under international law for the first time.

Nineteen countries ratified the High Seas Treaty this week at the UN Ocean Conference in Nice, France, bringing the total to 50 ratifications, just 10 short of the 60 needed for the treaty to take legal effect. The agreement was first passed by consensus at the UN and signed by 132 nations in 2023.

“The surge of ratifications of the High Seas Treaty is a tidal wave of hope,” said Rebecca Hubbard, director of the High Seas Alliance. “While many international agreements take years to enter into force, the action here in Nice today is a testament to the global momentum and urgency of action for the ocean.”

French President Emmanuel Macron confirmed that five additional countries would ratify the treaty immediately, with another 15 formally committed to joining on confirmed dates after the conference and a further 15 pledging to complete ratification by year’s end.

The rapid pace of ratifications represents lightning speed by UN standards. While the UN Convention on the Law of the Sea took 12 years to reach the ratification threshold, this agreement could enter into force just two years after signing.

“This means that this treaty will be able to enter into force on January 1 of next year, which means we would finally have an international framework to regulate and administer the high seas,” Macron said. “So that’s a win.”

Why the treaty matters and what comes next

The High Seas Treaty, or Biodiversity Beyond National Jurisdiction Treaty in official UN speak, would mark a historic moment in regulating the global commons from the overexploitation pushing the planet’s forests, oceans, weather systems, flora and wildlife to the limit.

“The ocean generates half of the oxygen we breathe. It feeds 3 billion people and sustains 600 million livelihoods,” UN Secretary-General Antonio Guterres said. “The ocean is the ultimate shared resource. But we are failing it.”

The treaty establishes binding requirements for countries to protect marine areas beyond their territorial waters, ensure sustainable use of marine resources such as fish, technology transfer, and mandate environmental impact assessments for commercial activities such as industrial fishing in international waters.

Key provisions include protecting 30% of international waters by the end of the decade, up from just 1.5%, which complements the broader 30×30 goal under the Montreal-Kunming agreement, which calls on nations to protect 30% of the world’s oceans by 2030, including their territorial waters.

The European Union, Brazil, and South Korea have championed the treaty. But vocal opposition has come from Trump’s United States—a significant setback given America’s role in crafting the agreement under the previous administration. Major players who haven’t signed include Russia, Saudi Arabia, Iran, and Japan.

Once the 60-ratification threshold is reached, a 120-day countdown begins before the treaty becomes international law. Within a year of entry into force, the first Conference of the Parties will convene—adding another “COP” to the growing list of UN climate, biodiversity, and desertification summits that has environmental diplomats joking they need new acronyms.

Undecided nations face a deadline: countries must ratify before the first Ocean COP to secure voting rights in the consensus-based decision-making process that will determine how the treaty operates.

Entry into force marks the beginning of a familiar UN process, with multiple agreements running in parallel and competing for limited diplomatic resources. Ratified members must establish enforcement and monitoring mechanisms, secure funding, and build the institutional framework to implement the treaty’s provisions.

Without protection against the mounting pressures of climate change, sea level rise, ocean acidification, record temperatures, and industrial-scale fishing by massive trawler fleets, marine ecosystems face escalating threats. Fish stocks are collapsing. Overconsumption and illegal fishing are pushing marine life to the brink.

“The deep sea cannot become the Wild West,” Guterres said. “When we protect marine areas, life returns. What was lost in a generation can return in a generation. The ocean of our ancestors – teeming with life and diversity – can be more than legend. It can be our legacy.

The absent architect

In what is becoming a familiar pattern in the international organization world, the United States and its absence cast a large shadow over the proceedings in Nice, which were shrouded in wildfire smoke crossing the Atlantic to the Mediterranean city from Canada, America’s “51st state.”

Last week, the US confirmed it would not send an official delegation to the talks, with the State Department saying the ocean preservation targets in the treaty were “at odds” with the administration’s position.

The US instead sent two observers to the negotiations, both political appointees from President Trump’s taskforce tasked with dismantling US engagement at home and abroad with efforts to fight the climate crisis. Delegations are normally made up of scientists.

The tectonic shift in the White House is a major blow for the High Seas Treaty, which the Biden administration was key to shepherding over the line. John Kerry, Biden’s special envoy for climate, wrote in the Financial Times that the treaty could “provide critical reassurance to the world that the multilateral architecture built after the Second World War is just as relevant today.”

Despite Kerry’s sentiment, it is clear—from withdrawing from the Paris climate accord, to kneecapping US efforts to monitor pollutants that cause climate change, and a complete U-turn on its support for the plastic treaty due in August—that the architect of that system has left it behind.

The Trump administration issued an executive order, “RESTORING AMERICAN SEAFOOD COMPETITIVENESS,” lauded by the fishing industry and the latest step in the withdrawal from marine protection, which includes reopening national marine monuments off New England and Pacific islands to commercial fishing.

“Federal overregulation has restricted fishermen from productively harvesting American seafood, including through restrictive catch limits, selling our fishing grounds to foreign offshore wind companies, inaccurate and outdated fisheries data, and delayed adoption of modern technology,” the administration wrote.

“The erosion of American seafood competitiveness at the hands of unfair foreign trade practices must end.”

Deep sea drama

Trump has also thrown his weight behind another key threat to the oceans: deep sea mining.

In April, the administration said it would work to “unleash” America’s offshore resource extraction in the deep sea, asserting the US’s right to mine seabeds in international waters.

The move defies the International Seabed Authority, the body in charge of such decisions under the Law of the Sea, to which the US is not party, which has placed a moratorium on mining until the full scientific picture can emerge about the threats it poses to nature.

The President of the ISA, biologist Leticia Reis de Carvalho, who defeated an industry-connected opponent in a critical election last year, called Trump’s move “a dangerous precedent that could destabilize the entire system of global ocean governance.”

“The abyss is not for sale, any more than Greenland is up for grabs,” Macron said. In another direct shot at Trump, the French president contrasted his nation’s new “Neptune Mission” for scientific exploration of the world’s oceans as the absent US charts a course to Mars.

“Rather than rushing off to Mars, let’s already get to know our final frontier and our best friend, the ocean,” Macron said.

Familiar money problems

The financial challenges facing the High Seas Treaty are daunting even by UN environmental standards.

The ocean-focused Sustainable Development Goal, known as “Life Below Water,” is by far the least funded, receiving just $10 billion over five years from 2015 to 2019—less than 0.01% of global sustainable development funding.

The UN estimates marine protection requires at least $175 billion annually. Figures from the UN High Level Panel on Ocean Economies show the funding gap comes at a considerable cost, holding back critical progress on marine conservation, fisheries reform, and the blue economy, where every $1 invested yields at least $5 in global benefits by 2050.

In March, the United States announced that it “rejects and denounces” the sustainable development goals altogether amid a projected $4 trillion total financing gap to achieve their targets, the first deadline for which was 2020.

“Agenda 2030 and the SDGs advance a program of soft global governance that is inconsistent with U.S. sovereignty and adverse to the rights and interests of Americans,” Edward Heartney of the US mission told the General Assembly.

The $175 billion in annual funding will be difficult to come by as the financial climate for international environmental treaties grows increasingly crowded as the climate crisis intensifies.

Funding gaps in the hundreds of millions already exist in UN negotiations from biodiversity to climate to desertification, competing for the same limited funds that no state or bloc appears able or willing to provide.

The UN itself, and many of its agencies, are facing existential financial crises largely as a result of the US administration’s exit from the international diplomatic world.

A high-level conference in Monaco in the days before the Nice summit attempted to galvanize funding, resulting in the launch of a public-private partnership that isn’t expected to be operational until 2028 at the earliest, when the next ocean conference is scheduled.

Subsidies strike back

Money is being spent on the ocean, just not on protection.

“These are symptoms of a system in crisis, and they are feeding off each other,” UN Secretary-General António Guterres said. “The ocean generates half of the oxygen we breathe. It feeds 3 billion people and sustains 600 million livelihoods. The ocean is the ultimate shared resource. But we are failing it.”

While funding for conservation remains functionally non-existent, subsidies that promote overfishing total $35.4 billion annually. Subsidies going directly to fuel for fishing vessels—some floating factories that rival any ship on the open water in size—alone total $7.2 billion per year, far outweighing investment in SDG 14.

The result is ships taking economically unviable voyages supported by public funds, with fishing fleets operating at 2.5 times sustainable capacity, benefiting large-scale industrial operations over small-scale fishers.

The oddity of the fishing industry’s subsidy framework is that, on paper, unsustainable management of fisheries in the long term will decimate the companies that cause their extinction.

The National Institutes of Health estimates that underperforming fisheries cost fishing companies between $51 and $83 billion every year in unrealized economic benefits from better management of fish stocks. In total, the current course charted by industrial fishing trawlers will wipe $2 trillion off the balance sheets of companies in the next three decades.

The world’s largest subsidisers are China ($7.3 billion), the EU ($3.8 billion), the US ($3.4 billion), South Korea ($2.6 billion), and Japan ($2.4 billion).

A process known as “Fish 2” is underway at the World Trade Organization seeking to limit or eliminate subsidies that contribute to overfishing.

A first-of-its-kind InfluenceMap report found that 29 of the 30 largest seafood companies oppose the very protections that would ensure their survival, actively lobbying against marine reserves and fishing restrictions.

The list includes household names like Cargill and Mitsubishi Corporation— yes, the car company, little known for being one of the world’s largest fishing conglomerates.

“Protection is not the problem—overfishing is the problem,” said marine scientist Enric Sala. “The worst enemy of the fishing industry is themselves.”