Since Robert F. Kennedy Jr suspended an independent presidential run to back Donald Trump’s bid for the White House, his laser-focus has been on one mission: “Make America Healthy Again” by attacking the threat of chronic disease.

Now sitting atop the United States health system, the anti-vaccine scion of the Kennedy dynasty released a major policy paper to advance that agenda last month, known as the “MAHA commission” report. Its centrepiece: the childhood chronic disease epidemic.

The 73-page document, pledging a return to “gold-standard” science and reversal of the childhood chronic disease crisis by “confronting its root causes—not just its symptoms,” was quickly found to be riddled with factual inaccuracies, mischaracterisation of research presented as evidence, and citations of at least seven studies that did not exist at all.

The report’s technical errors, bad science and blatant use of artificial intelligence dominated media coverage following its release.

Lost in the controversy over its scientific flaws was what the report left out: several of the deadliest causes of chronic disease in the United States – the very “epidemic” Kennedy’s MAHA manifesto claims to tackle.

Tobacco, the largest preventable cause of chronic disease in the US, causing lung cancer, heart disease and stroke, claims around 450,000 lives annually per CDC figures. It is never mentioned, despite most smokers starting as children.

Alcohol deaths, which rose 29% from 2016 to 2021, and drug overdoses claiming over 80,000 lives yearly – both risks that often begin in adolescence – are entirely absent, despite fentanyl being central to Trump’s ‘war on cartels’ and the deportation raids that sparked the largest protests in US history last week.

Air pollution, responsible for 50,000 to 200,000 preventable deaths in the US every year from chronic diseases such as heart disease, stroke, lung cancer and respiratory illness, is omitted entirely from the report.

“Pollution” writ-large – from vehicles, industrial emissions and other sources that cause chronic disease – is mentioned five times: four times in footnotes, with its sole appearance in the main text a reference to “light pollution” from smartphones, tablets and laptops disrupting sleep patterns.

Trump administration policies have banned the terms ‘pollution’ and ‘air pollution’ from federal documents, according to leaked memos and free speech groups.

Taken together, the report ignores the first, fifth, sixth and seventh leading causes of preventable death in the United States from chronic diseases – which the report, and Kennedy’s HHS, claim as their north star.

The chronic disease risk factors left out of the report are responsible for an estimated 2.2 million deaths annually – roughly 30% of all deaths in America and 70% from the top eight preventable causes each year as identified by the CDC.

“Those are big causes of death,” said Michael Brauer, an expert in chronic disease at the University of British Columbia and lead author on the global burden of disease report, a landmark international study compiling the causes of death around the world. “These are huge omissions.”

The MAHA commission’s four silos – children’s exposure to technology, ultra-processed foods, chemicals and overmedicalisation – fail to understand how chronic diseases work, Brauer added. Chronic diseases result from multiple risk factors – including but not limited to diet, sleep habits, smoking, environmental exposures, age and preexisting conditions – that pile up together, not single identifiable causes, he explained.

“It’s trying to pinpoint ‘this is the cause of this, this is the cause of that,” Brauer said. “For chronic diseases, that’s just not the way things work.”

Global food policy experts have also expressed doubts about Kennedy’s approach to ultra-processed foods – one of the four pillars he does address. They question whether he will follow necessary science and use proven interventions to tackle this threat.

A Secretary Undermining His Own Mission

Kennedy’s actions since taking office contradict his stated mission of making chronic disease his department’s top priority.

Despite insisting throughout confirmation hearings in Congress he would not stand in the way of access to vaccines, the HHS secretary – who rose to political prominence as the leader of the world’s largest anti-vaccine group during the pandemic – moved last month to remove the COVID-19 vaccine from the CDC immunisation schedule.

This would eliminate federal funding for COVID vaccines for uninsured children and pregnant women, effectively ending access for millions of Americans.

This comes as new estimates from the American Academy of Paediatrics find long COVID, a chronic neuroimmune disorder affecting the brain, spinal cord and nervous system with no known cure, may have overtaken asthma as the most prevalent chronic condition in US children.

Kennedy’s HHS argues children rarely die from COVID-19 – ignoring that long COVID has become a leading chronic condition among children, potentially placing millions at risk of an as-yet incurable disease.

Kennedy’s policy decisions also run counter to the emphasis placed on chemicals and environmental exposures for children in the MAHA report. While the policy paper dedicates one of its four chapters to this threat, he axed the division at the Center for Disease Control and Prevention (CDC) that investigates environmental hazards like heavy metals and air pollution – the very data required to craft policy protecting children from dangers highlighted by his own commission.

With the CDC’s environmental health division eliminated, protecting Americans from toxic exposures would fall even more heavily on the Environmental Protection Agency. Yet that agency faces a proposed 55% budget cut – from $9 billion to $4 billion – in the White House’s 2025 budget, the largest reduction in EPA history.

Administrative Assault

HHS is not alone in undermining the MAHA agenda – the Trump administration strikes new blows against the health objectives it claims to champion seemingly every week.

A wave of policies has targeted the agencies, programs, scientific research and laws that protect children and the wider public from chronic disease risk factors since the new administration took office – and members of the MAHA commission are leading the charge.

Commission members include Lee Zeldin, the EPA chief, and Russell Vought, the architect of Project 2025 and head of the Office of Management and Budget, who has spearheaded mass firings across the federal government’s scientific and health agencies.

Kennedy touts the firing of a quarter of the federal health workforce overseen by Vought — 10,000 total staff across the CDC, National Institutes of Health, and Food and Drug Administration — as necessary to rein in the “pandemonium” of “sprawling bureaucracy” and reverse the “chronic disease epidemic.”

Meanwhile, Zeldin’s EPA issued a legal filing on Tuesday “reconsidering” a ban on chrysotile asbestos, known as “white asbestos,” the last type of the deadly carcinogen still in use in the US. Asbestos exposure causes mesothelioma, lung cancer, and other fatal diseases that kill 40,000 Americans annually.

That filing included a statement of support from EPA administrator Lynn Ann Dekleva, who joined the agency from her post as a lobbyist for the American Chemistry Council – the petrochemical industry’s largest trade group representing Chevron, ExxonMobil, Shell, and other major corporations – which brought the lawsuit to reverse the ban the EPA now supports.

Labeling efforts to fight climate change a “cult” at a press conference in Washington last week, Zeldin announced his agency would remove greenhouse gas emissions limits from power plants.

The EPA stated in a press release that pollution from coal, gas and oil plants were “not significant contributors to dangerous air pollution,” deciding the agency should review pollutants individually before reconsidering emissions limits.

Asked if there is any uncertainty on the science of fossil fuel pollution’s health effects, Brauer was short: “No.”

“Anything burning is going to create air pollution and air pollution is harmful,” Brauer said. “That’s not something we need to reinvestigate or do more science on – it’s very clear.”

The same regulatory rollback removes limits on dangerous chemical discharges of mercury, arsenic and lead from power plants – chemicals that cause cancer, brain damage and developmental disabilities even at low exposure levels.

In an apparent contradiction, the EPA described the rule it is repealing – known as MATS – as “highly effective in protecting public health and the environment.”

The agency’s own press release cited the rule’s success: a 90% drop in mercury emissions from coal plants, 96% reduction in acid gas emissions, and 81% cuts in nickel, arsenic and lead discharges since 2012. The self-defeating argument suggests possible AI authorship of the release.

The EPA has already eliminated requirements for most power plants and heavy industry to monitor greenhouse gas emissions, citing financial burden to industry. It also pushed back a tax on methane emissions – the potent greenhouse gas up to 80 times more powerful than CO2 over 20 years – by a decade to 2035.

Beyond air emissions, the EPA postponed requirements for chemical manufacturers to disclose internal safety studies on 16 toxic substances – including known carcinogens like benzene and chemicals linked to developmental harm such as BPA – extending the deadline by more than a year to May 2026.

The delay keeps critical health data hidden from communities facing exposure to chemicals that cause cancer, brain damage in children, and reproductive disorders through everyday products like plastics, gasoline, and rubber tires – the very exposures the MAHA commission claims to prevent.

“We know industries will pollute to the levels they are allowed to,” Brauer said. “If we’re blind they’ll pollute more. That’s why we monitor – so we can enforce the laws that we have.”

Chemical Counter Currents

The MAHA report makes special mention of the threats of “Superfund sites,” described in the commission paper as “areas contaminated with industrial toxic waste which, depending on their level of contamination and cleanup status, could further compound their risk for chemical exposure and associated adverse outcomes.”

Nearly 25% of US children live in close proximity to one of the 1,341 Superfund sites nationwide, according to the report. These sites include abandoned chemical plants, former mining operations, ecological disasters, closed military bases with toxic waste, and industrial dumps where hazardous materials like lead, asbestos, and radioactive waste have contaminated soil and groundwater.

Yet the administration is systematically dismantling the agencies that protect communities from these very chemical hazards.

The Chemical Safety Board (CSB), an independent federal oversight committee that analyzes industrial chemical accidents and develops safety recommendations, is slated for elimination in Trump’s budget proposal. White House pressure led the CSB — a strictly advisory body with no power to legislate, fine or pursue legal action — to submit a budget request of zero dollars for the first time in its history.

The Clean Air Scientific Advisory Committee (CASAC) – an independent body of scientists created by Congress to ensure air quality policies protect public health from toxic pollutants including lead, mercury, and fine particulate matter – was similarly dismantled in January. Federal filings show the board remains empty at the time of writing.

Bodies like the CSB and CASAC serve as critical watchdogs for communities exposed to chemical risks and environmental pollution, investigating everything from refinery explosions and pipeline ruptures to toxic releases at Superfund sites, chemical plant fires, and industrial accidents that threaten nearby schools and neighborhoods.

Without these oversight bodies, residents near industrial facilities and contaminated sites lose their primary source of independent accident investigation, safety recommendations, and public health data. Communities would have no federal entity to determine why a chemical plant exploded, what toxins were released, or how to prevent future disasters.

The disconnect between the MAHA report’s concern for Superfund sites and the administration’s actions grows starker. The Trump administration has sued New York and Vermont to block laws requiring oil companies to pay for cleanup costs at the very Superfund sites the MAHA commission identifies as threats to children’s health.

The Department of Justice called these state efforts to hold polluters accountable “climate extremism” and “unconstitutional overreach,” despite the laws targeting the same contaminated sites Kennedy’s report warns endanger millions of American children.

“The last Administration wasted billions on ‘research’ and fake science in Green New Scam and culturally Marxist programs,” Rachel Cauley, a spokesperson for OMB, told E&E news of the administration’s rollbacks. “Under President Trump, our science agencies are actually doing science again.”

The Cost in Lives

As the administration dismisses climate science as “fake,” researchers at the University of Maryland published a first-of-its-kind analysis last week calculating the real-world costs of these rollbacks in lives and dollars.

Under what researchers describe as a “full rollback scenario” – reversing major legislation including the Inflation Reduction Act, infrastructure bills, and Clean Air Act protections totaling over $1 trillion, plus major EPA policy reversals – an estimated 22,800 Americans would die from increased air pollution over the next decade, with a $1.1 trillion loss to US GDP by 2035.

Fine particulate matter, known as PM2.5 – microscopic particles that penetrate deep into lungs and bloodstream, causing heart disease, stroke, and lung cancer – would increase by 10% under the rollbacks, killing approximately 3,100 additional Americans annually.

States with weaker air quality regulations would bear the heaviest burden in the absence of federal standards, with West Virginia, North Dakota, and Texas among the hardest hit, the report found.

The researchers note that 77% of IRA funding has flowed to Republican-majority districts – suggesting these lawmakers may face pressure from constituents benefiting from clean energy jobs and investments to preserve the programs, despite party opposition to the legislation.

“Basically this can be thought of as an underestimate,” said Alicia Zhao, the study’s lead author. “Like a lower bound of what repealing these clean energy policies could result in.”

The analysis excludes other toxic pollutants and climate impacts like intensifying wildfires – a growing threat as smoke laden with toxic particles increasingly blankets American cities, triggering asthma, heart attacks, early onset dementia, and premature death.

The administration’s proposed cuts would eliminate NASA and NOAA satellites that track this smoke, leaving communities without critical air quality warnings.

“Wildfire smoke is not something we’re going to be able to control,” Brauer said. “We can’t put a law and say: forests, stop burning! That’s exactly why we need to maintain progress on controllable pollution sources – not take our foot off the gas.”

Taking Aim at Air Pollution

These projected deaths would only increase under the administration’s legislative agenda. Buried within the 1,116 pages of Trump’s “Big Beautiful Bill” – the behemoth budget reconciliation measure currently before the Senate – lies a direct assault on America’s air pollution infrastructure.

An analysis by Health Policy Watch of the budget measure found nearly $37 billion in federal funding cuts to air quality and pollution programs running between 2021 and 2031 – the largest cut to air pollution funding in US history.

The eliminated programs, spread across the Inflation Reduction Act and Clean Air Act, include laws addressing air pollution at ports, schools, and cities; tailpipe emission restrictions for standard and diesel vehicles; air quality monitoring stations in low-income communities; reduction, reporting and enforcement of greenhouse gas limits nationwide; and EPA funding for timely scientific reviews.

While it remains unclear at the time of writing how much funding has been distributed from programs slated for termination, the Greenhouse Gas Reduction Fund – the largest single item at $27 billion – saw $20 billion frozen by the EPA in March.

If funds were distributed evenly over program lifespans, an estimated $5.88 billion would remain unspent through January 2025, or $25.88 billion including the frozen GGRF funds.

“This marks a stark turn from the waste and self-dealing of the Biden-Harris Administration intentionally tossing ‘gold bars off the Titanic,'” Zeldin said of freezing the GGRF funds, which he alleges were distributed through “crony capitalism” to partisan organizations.

Air pollution policies enacted by the EPA undergo rigorous cost-benefit analysis before approval. Despite their price tags, these regulations consistently deliver some of the highest returns on investment in government, ranging from 3-to-1 to 30-to-1 per dollar invested.

“We want to provide the public with the best information, full stop,” Brauer said. “We’re not doing this for any other reason. It’s to provide policymakers the information they need to prioritize how federal dollars are spent.”

“This is information that actually helps the government spend money more effectively,” Brauer concluded. “As a citizen, if the government is not doing that, then I don’t think the government’s doing its work well.”